Risk factors for microvascular atherosclerotic changes in patients with type 2 diabetes mellitus [Čimbenici rizika za mikrovaskularne ateroskelrotske promjene u bolesnika sa šećernom bolesti tipa 2]

Šimić, Iveta and Pećin, Ivan and Tedeschi-Reiner, Eugenia and Zrinšćak, Ozren and Šućur, Nediljko and Reiner, Željko (2013) Risk factors for microvascular atherosclerotic changes in patients with type 2 diabetes mellitus [Čimbenici rizika za mikrovaskularne ateroskelrotske promjene u bolesnika sa šećernom bolesti tipa 2]. Collegium Antropologicum, 37 (3). pp. 783-787. ISSN 0350-6134

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Abstract

Diabetes mellitus is a metabolic disorder primarily characterized by elevated blood glucose levels and by microvascular and macrovascular complications which increase the morbidity and mortality. The aim of this study was to assess whether in high risk patients with type 2 diabetes mellitus whose blood pressure and lipid levels are well controlled still exist risk factors for microvascular changes and target organ damage (nephropathy and retinopathy). In this case control retrospective study 326 patients (111 with nephropathy and/or retinopathy and 215 controls) were enrolled. Nephropathy or retinopathy was present in 10.1% and 26.9% cases, respectively. Only 71% of patients (no significant difference between cases and controls) were treated with antidiabetic drugs. Therefore their diabetes was not properly controlled (hemoglobin A1c was 7.96% in cases and 7.58% in controls). Patients with microvascular changes had significantly longer diabetes than the controls (p < 0.05) but there were no significant differences between these two groups concerning lipids concentrations. Statins and fibrates were used by significantly less (p < 0.05) patients with microvascular complications than by those without them (21.6% vs. 36.3% and 1.8% vs. 17.2% respectively). The results of this study suggest that the duration of the disease and adequate control of glycaemia in patients with type 2 diabetes mellitus are more important for microvascular complications than the serum lipoproteins levels. Lipid-lowering treatment might have an impact on microvascular complications in patients with type 2 diabetes, irrespectively of their serum lipid levels.

Abstract in Croatian

Šećerna bolest obilježena je povišenim razinama glukoze u krvi te razvitkom mikrovaskularnih i makrovaskularnih komplikacija koje su uzrok povećanom morbiditetu i mortalitetu. Cilj je ovog istraživanja bio istražiti da li u visoko rizičnih bolesnika sa tipom 2 šećerne bolesti i dobro kontroliranim arterijskim tlakom i lipidima u serumu postoje rizični čimbenici koji mogu biti uzrokom mikrovaskularnih promjena i posljedičnog oštećenja ciljnih organa, posebno nefropatije i retinopatije. U ovo “case-control” retrospektivno ispitivanje uključili smo sveukupno 326 ispitanika (111 sa nefropatilom i/ili retinopatijom i 215 bolesnika bez tih komplikacija – kontrolna skupina). 10,1% ispitanika imalo je nefropatiju, a 26.9% imalo je retinopatiju. Samo 71% ispitanika (bez značajne razlike među skupinama) bilo je liječeno antidijabeticima. Stoga ne čudi da im je regulacija glukoze u krvi bila nedostatna (hemoglobin A1c bio je 7.96% u bolesnika sa nefro/retinopatijom, a 7.58% u onih kontrolne skupine). Bolesnici s mikrovaskularnim komplikacijama u usporedbi s onima iz kontrolne skupine rjeđe su koristili statine (21.6% vs. 36.3%) i fibrate (1.8% vs. 17.2%). Bolesnici sa mikrovaskularnim promjenama bolovali su od dijabetesa značajno dulje nego oni iz kontrolne skupine (p < 0.05) ali nije bilo razlike u koncentracijama lipida između te dvije skupine. Rezultati našeg istraživanja ukazuju da su u bolesnika sa tipom 2 šećerne bolesti za razvitak mikrovaskularnih komplikacija važniji trajanje bolesti i odgovarajuća kontrola glikemije nego li koncentracije lipoproteina u serumu. Primjena lijekova za snižavanje lipida u krvi može imati učinak na mikrovaskularne komplikacije u bolesnika sa šećernom bolešću tipa 2 neovisno o koncentracijama lipida u serumu.

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