The metabolic syndrome is associated with high-normal urinary albumin excretion and retinopathy in normoalbuminuric type 1 diabetic patients [Metabolički sindrom je povezan s visoko normalnim izlučivanjem albumina u mokraći te retinopatijom u normoalbuminuričnih bolesnika sa šećernom bolešću tipa 1]

Duvnjak, Lea and Kokić, Višnja and Bulum, Tomislav and Kokić, Slaven and Krnić, Mladen and Hozo, Izet Salih (2012) The metabolic syndrome is associated with high-normal urinary albumin excretion and retinopathy in normoalbuminuric type 1 diabetic patients [Metabolički sindrom je povezan s visoko normalnim izlučivanjem albumina u mokraći te retinopatijom u normoalbuminuričnih bolesnika sa šećernom bolešću tipa 1]. Collegium Antropologicum, 36 (4). pp. 1373-1378. ISSN 0350-6134

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Abstract

Although metabolic syndrome was not extensively studied in type 1 diabetes, higher insulin resistance, the core feature of the syndrome was found to be associated with increased risk of developing microvascular complications. As diabetic nephropathy may progress to advanced lesion before microalbuminuria appears, we investigated the association of the metabolic syndrome and estimated glucose disposal rate (eGDR) with urinary albumin excretion (UAE), retinopathy and neuropathy in normoalbuminuric type 1 diabetic patients. Two hundred and 98 patients (UAE < 30 mg / 24 h at three occasions) were divided according to the IDF metabolic syndrome; eGDR (mg kg(-1) min(-1)) was calculated: 24.31-(12.22 x WHR) - (3.29 x HT) - (0.57 x HbA1c), (WHR = waist-to-hip ratio, HT = hypertension). Patients with (n = 99) compared to those without metabolic syndrome (N = 199) showed higher UAE (15.96 +/- 9.10; 13.48 +/- 8.36 mg /24 h), C-reactive protein (2.39 +/- 4.09;1.12 +/- 2.03 mg/L), prevalence of retinopathy (70.7; 55.27%) and polyneuropathy (80.8; 68.3%), and lower eGDR (5.75 +/- 1.74; 8.96 +/- 1.9), (p > 0.05). In patients with high-normal UAE, retinopathy and polyneuropathy eGDR was significantly lower compared with patients with low-normal UAE, and without retinopathy and polyneuropathy. In multiple regression analysis UAE and retinopathy were associated with diabetes duration (beta = -0.20, beta = -0.62), eGDR (beta = - 0.106; beta = -0.041), metabolic syndrome (beta = 0.49, beta = 0.28), (p > 0.05). In type 1 diabetic patients insulin resistance and IDF defined metabolic syndrome are associated with high-normal UAE, retinopathy and polyneuropathy. The predictive value of the metabolic syndrome for development of microalbuminuria and retinopathy needs to be assessed in further follow-up studies.

Abstract in Croatian

Iako metabolički sindrom nije široko proučavan u šećernoj bolesti tipa 1, utvrđena je povezanost povećane inzulinske rezistencije, glavne odrednice sindroma, s povišenim rizikom razvijanja mikrovaskularnih komplikacija. Kako se dijabetička nefropatija može razviti do uznapredovalog oštećenja prije nego se pojavi mikroalbuminurija, istražili smo povezanost metaboličkog sindroma i procijenjene stope razdiobe glukoze (eGDR) s urinarnim izlučivanjem albumina (UAE), retinopatijom i neuropatijom u normalbuminuričnih bolesnika sa šećernom bolešću tipa 1. 298 bolesnika (UAE <30 mg / 24 h u tri mjerenja) podijeljeni su prema IDF (International Diabetes Federation) kriteriju na one s i one bez metaboličkog sindroma; eGDR (mg kg–1 min–1) je izračunata: 24,31 – (12,22 x WHR) – (3,29 x HT) – (0,57 x HbA1c), (WHR=waist-to-hip ratio – omjer struk:bok, HT=hipertenzija). Bolesnici s (N=99) u usporedbi s onima bez metaboličkog sindroma (n=199) pokazali su povišene UAE (15,96±9.10; 13,48±8.36 mg / 24 h), C-reaktivni protein (2,39±4,09; 1,12±2,03 mg/L), prevalenciju retinopatije (70,7; 55,27%) i polineuropatiju (80,8; 68,3%), a nižu eGDR (5,75±1,74; 8,96±1,9), (p>0,05). Kod bolesnika s visoko-normalnim UAE, retinopatijjom i polineuropatijom, eGDR je bila značajno niža u usporedbi s bolesnicima s nisko-normalnom UAE te bez retinopatije i polineuropatije. UAE i retinopatija su u multiploj regresijskoj analizi bili povezani s trajanjem dijabetesa (beta = –0,20, beta = –0,62), eGDR (beta = –0,106; beta = –0,041), metaboličkim sindromom (beta = 0,49, beta = 0,28), (p>0,05). U bolesnika sa šećernom bolešću tipa 1 inzulinska rezistencija i metabolički sindrom definiran po IDF-u bili su povezani s visoko-normalnom UAE, retinopatijom i polineuropatijom. Prediktivnu vrijednost metaboličkog sindroma za razvoj mikroalbuminurije i retinopatije treba procijeniti daljnjim istraživanjima.

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