engleski

Diabetic patients with fetty liver are under increased risk for development of nephropathy

Objective. Increased albumine/creatinine (A/C) ratio is a marker of endothelial dysfunction in patients with diabetes mellitus. The aim of the study was to determine the correlation of A/C ratio with parameters of metabolic syndrome (MS). Design. Observational, cross-sectional study. Patients. Three hundred and nineteen patients with type 2 diabetes mellitus (DM2), glucose intolerance (GI) and control group (CG) underwent the study. Methods. Clinical and laboratory parameters important for the definition of diabetes and metabolic syndrome: C-reactive protein (CRP), adiponectin (ApN), fibrinogen, homocystein, A/C ration, liver function tests, lipid values, uric acid (UA), glycated haemoglobin (HbA1c), fasting (fPG) and postprandial plasma glucose (ppPG), blood pressure, body mass index (BMI) and waist circumference (WC) have been determined. GI was diagnosed based on oral glucose tolerance test (OGTT). Insulin resistance (IR) was assessed using homeostatic model assessment (HOMA2) from fasting insulin (FI) and fPG. Fatty liver index (FLI) was calculated using BMI, WC, triglycerides (Tg) and gamma-glutamyl transpeptidase (GGT) to estimate the presence of fatty liver. Patients were divided according to the A/C ratio (≤2.5 and >2.5) and the FLI (60 and >60). Results. ANOVA revealed significant difference in A/C ratio between the three groups of patients ( DM2, GI and CG) (p=0.002). Significant difference was found in A/C between DM2 and GI (4.47  15.57 vs. 2.84  12.44) (p=0.002) and DM2 and CG (4.47  15.57 vs. 2.55  7.1) (p=0.032), but not between GI and CG. In patients with DM2 significant difference was found in IR (p=0.001), FLI (p=0.012), HbA1c (p=0.012) and GGT (p=0.034) between groups of patients according to A/C, and in ApN (p<0.001), IR (p<0.001), CRP (p<0.001), A/C ratio (p=0.003), ALT (p<0.001), HDL (p<0.001), Tg (p<0.001) and GGT (p=0.034) according to FLI. In patients with DM2 A/C ratio correlated significantly (p<0.01) with fPG (r=0.25), ppPG (r=0.25) and HbA1c (r=0.24). FLI correlated significantly (p<0.01) with ApN (r=-0.35), WHR (r=0.58), A/C ratio (r=0.38), CRP (r=0.35), ALT (r=0.43) and IR (r=0.39). Only 3 patients with GI and 3 patients with CG had values of A/C ratio >2.5mg/mmol. Conclusions. Patients with DM2 and A/C ratio >2.5 mg/mmol have significantly higher values of IR, FLI, HbA1c and GGT. FLI alongside glycaemia regulation and MS parameters has an influence on A/C ratio level in patients with DM2.

fetty liver; nephropathy; diabetes mellitus

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