Tip 2 diabetes mellituslu hastalarda mikroalbuminüri, insülin direnci ve kardiyovasküler risk
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Date
2006-08-03
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Uludağ Üniversitesi
Abstract
Son çalışmalar tip 2 diyabette mikroalbuminüri (MAU) varlığı ile hedef organ hasarları ve kardiyovasküler hastalık riski arasındaki ilişkilere yönelmişlerdir. Bu çalışmada, Tip 2 diabetes mellituslu (DM) hastalarda MAU ile glisemik kontrol, insülin direnci (İR) ve diğer kardiyovasküler risk faktörleri arasındaki ilişki değerlendirilmiştir. İnsülin gereksinimi olmayan, normal renal fonksiyonlu 29 mikroalbuminürik ve 68 normoalbuminürik tip 2 DM’lu hasta çalışmaya dahil edildi. Tüm hastalarda antropometrik ölçümler ve kan basıncı kaydedildi. Serum açlık ve tokluk kan şekerleri, insülin, CRP, transferrin, fibrinojen düzeyleri, lipid profili ve renal fonksiyonlar ölçüldü. İR, Homeostasis Model Assessment (HOMA) metodu ile hesaplandı. HDL-kolesterol düzeyleri MAU’li hastalarda daha düşük (45.3 ± 7.8 mg/dl’ye karşılık 49.8 ± 7.5 mg/dl) iken, kan basınçları, serum insülin ve HOMA-İR (8.64 ± 6.9 karşılık 5.42 ± 5.4) değerleri MAU’li hastalarda normoalbuminüriklerden daha yüksekti. HbA1C değerleri dikkate alındığında MAU gurubunda 18 (%62), normoalbuminüri gurubunda 26 (%38.8) hastanın glisemik kontrolü kötü idi. Kilolu, obez, hipertansif, dislipidemik hasta, retinopati veya nöropati sıklığı oranları her iki gurupta benzerdi. MAU bel çevresi, bel kalça oranı, VLDL-kolesterol ve trigliserid düzeyleri ile koreleydi. Lojistik regresyon analizi MAU için kadın cinsiyet, sigara kullanımı ve HOMA-IR değerinin >5.51 olmasının bir risk faktörü olduğunu gösterdi. Sonuçta İR MAU’li tip 2 diyabetli hastalarda artmıştır. İR’ni azaltan tedavi yaklaşımları bu hastalarda yararlı olacaktır
Recent studies focus on the relationship between target organ damage and cardiovascular disease risk with microalbuminuria (MAU) in type 2 diabetes. In this study, the relation between MAU and glycemic control with insulin resistance (IR) and other cardiovascular risk factors in patients with type 2 diabetes mellitus (DM) was evaluated. 29 microalbuminuric and 68 normoalbuminuric type 2 DM patients with normal renal function and no insulin requirement were included in the study. In all patients, anthropometric measurements and blood pressures were recorded. Serum fasting and postprandial glucose, insulin, CRP, transferrin, fibrinogen levels, lipid profiles and renal functions were measured. IR was calculated with Homeostasis Model Assessment (HOMA) method. Blood pressures, serum insulin and HOMA-IR (8.64 ± 6.9 vs. 5.42 ± 5.4) values in patients with MAU were higher than those of normoalbuminuric ones, while HDLcholesterol levels of patients with MAU were lower (45.3 ± 7.8 mg/dl vs. 49.8 ± 7.5 mg/dl). When HbA1C values were taken into account, glycemic controls of 18 patients (62%) in MAU group and 26 (38.8%) in normoalbuminuria group were poor. The ratios of overweight, obese, hypertensive and dyslipidemic patients and frequencies of retinopathy or neuropathy were similar in both groups. MAU was correlated with waist circumference, waist-to-hip ratio, VLDL-cholesterol and triglyceride levels. Logistic regression analysis showed that female gender, smoking and HOMA-IR value >5.51 were risk factors for MAU. Finally, IR increased in type 2 diabetic patients with MAU. Treatment approaches reducing IR will be useful in these patients.
Recent studies focus on the relationship between target organ damage and cardiovascular disease risk with microalbuminuria (MAU) in type 2 diabetes. In this study, the relation between MAU and glycemic control with insulin resistance (IR) and other cardiovascular risk factors in patients with type 2 diabetes mellitus (DM) was evaluated. 29 microalbuminuric and 68 normoalbuminuric type 2 DM patients with normal renal function and no insulin requirement were included in the study. In all patients, anthropometric measurements and blood pressures were recorded. Serum fasting and postprandial glucose, insulin, CRP, transferrin, fibrinogen levels, lipid profiles and renal functions were measured. IR was calculated with Homeostasis Model Assessment (HOMA) method. Blood pressures, serum insulin and HOMA-IR (8.64 ± 6.9 vs. 5.42 ± 5.4) values in patients with MAU were higher than those of normoalbuminuric ones, while HDLcholesterol levels of patients with MAU were lower (45.3 ± 7.8 mg/dl vs. 49.8 ± 7.5 mg/dl). When HbA1C values were taken into account, glycemic controls of 18 patients (62%) in MAU group and 26 (38.8%) in normoalbuminuria group were poor. The ratios of overweight, obese, hypertensive and dyslipidemic patients and frequencies of retinopathy or neuropathy were similar in both groups. MAU was correlated with waist circumference, waist-to-hip ratio, VLDL-cholesterol and triglyceride levels. Logistic regression analysis showed that female gender, smoking and HOMA-IR value >5.51 were risk factors for MAU. Finally, IR increased in type 2 diabetic patients with MAU. Treatment approaches reducing IR will be useful in these patients.
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Keywords
Tip 2 diabetes mellitus, Metabolik kontrol, Mikroalbuminüri, İnsülin direnci, Type 2 diabetes mellitus, Insulin resistance, Microalbuminuria, Metabolic control
Citation
Ersoy, C. vd. (2006). "Tip 2 diabetes mellituslu hastalarda mikroalbuminüri, insülin direnci ve kardiyovasküler risk". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 32(2), 35-41.