Inflammatory markers as risk factors for microangiopathy in type 1 diabetic patients on functional intensive insulin therapy from the onset of the disease

Abstract 

Our aim was to assess the incidence and predictors of nephropathy and retinopathy in type 1 diabetic patients treated with intensive functional insulin therapy (IFIT) from the onset of disease. We recruited 100 patients aged under 30 years with newly diagnosed type 1 diabetes, educated in IFIT at baseline. We assessed at baseline and every year: diabetic knowledge, hypoglycaemic episodes, quality of life, metabolic control, serum concentration of C-peptide, hsCRP, intracellular adhesion molecule-1 (sICAM-1), vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNFα).

At follow-up (6.1±1.6 years), 17 patients with background retinopathy had higher: FPG (13.5±4.1mmol/l versus 10.1±3.6mmol/l, p=0.0018), HbA1c (8.8±1.3% versus 8.1±1.4%, p=0.04), systolic blood pressure (128.1±16.6mmHg versus 119.8±14.0mmHg, p=0.04) and sICAM-1 (290.9±100.0ng/ml versus 237.12±53.44ng/ml, p=0.03). The risk of retinopathy was associated with the level of diabetic knowledge (OR=7.84; 95%CI: 1.07–57.42, p=0.02), low HDL cholesterol level (OR=4.86; 95%CI: 1.41–16.87, p=0.01), high SBP (OR=3.75; 95%CI: 1.16–12.19, p=0.03) and DBP (OR=7.43; 95%CI: 2.11–26.15, p=0.002). Eighteen subjects with positive microalbuminuria had higher values of: HbA1c (9.0±1.8% versus 8.0±1.3%, p=0.04), triglycerides (1.5±1.0mmol/l versus 1.0±0.4mmol/l, p=0.01), LDL cholesterol (3.6±1.1mmol/l versus 3.0±0.9mmol/l, p=0.01), hsCRP (4.9±4.9mg/l versus 1.8±1.9mg/l, p=0.02) and VEGF (376.62±216.26pg/ml versus 250.68±130.67pg/ml, p=0.02). We observed relationship between microalbuminuria and BMI (OR=4.50; 95%CI: 1.42–14.22, p=0.013), low HDL cholesterol (OR=7.28; 95%CI: 2.06–25.66, p=0.002), high LDL cholesterol (OR=4.61; 95%CI: 1.33–15.97, p=0.01) and triglycerides (OR=8.33; 95%CI: 1.73–40.12, p=0.009), diastolic blood pressure (OR=11.43; 95%CI: 3.16–41.36, p=0.0002) and hsCRP (OR=4.40; 95%CI: 1.15–16.86, p=0.047). The results indicate the influence of low-grade inflammatory process and insulin resistance on the development of diabetic microangiopathy.

Keywords: Type 1 diabetes, Inflammatory markers, Microangiopathy, Intensive insulin therapy