medigraphic.com
Colegio de Medicina Interna de México.

2005, Number 6

<< Back Next >>

Med Int Mex 2005; 21 (6)

Metabolic syndrome and inflammation in patients with diabetes mellitus type 2. A preliminary report

Juárez RMS, Mendoza NVM, Sánchez RM, Rosado JJ, Díaz RMC, Ortega SMA, Serrano LA, Rosas BJV

Language: Spanish
References: 34
Page: 409-416
PDF size: 64.95 Kb.


ABSTRACT

Background: the insulin resistance is the main element in the development of type 2 diabetes mellitus and is associated with central obesity, hypertension, dislipidemia, atherosclerosis and coagulation, and fibrinolysis impaired. Recently it has been suggested that the inflammatory process and the natural immune system are associated with the pathogenesis of the disease, related with the elevation of some cytokines and elevated levels of inflammatory markers of the acute phase response.
Objective: To demonstrate the relationship of the elevated levels of the C reactive protein with the metabolic syndrome in type 2 diabetic patient.
Patients and methods: This was a descriptive and cross sectional study in 58 ambulatory patients with type 2 diabetes mellitus. There were excluded patients with autoimmune, oncologyc or clinical coronary artery disease, those who were receiving immunosupressors or antinflammatory drugs for any reason, infection disease, end stage of nephropathy and neuropathy. In all patients the body mass index, waist-circumference index, systolic blood pressure and intravenous glucose, serum insulin, glucosilated hemoglobin, lipids and C reactive protein were determined. There was a descriptive analysis and linear regression model for quantitative variable.
Results: We included 30 males (54.5%) and 25 females (45.5%) with median age 53.11 ± 7.33 years. The metabolic control, using the glucosilated hemoglobine as marker, were good in only 15 patients (27.27%), middle in 10 patients (18.18%) and poor control in 30 patients (54.55%). The metabolic syndrome was found in 48 patients, 29 males and 19 females. C reactive protein was found elevated in 15 patients associated with poor metabolic control (p‹0.045).
Conclusions: The present data suggest that a low grade of inflammatory response is associated with type 2 diabetes mellitus and metabolic syndrome, determined by the C reactive protein and a poor metabolic control.


REFERENCES

  1. Lerman I. Atención integral del paciente diabético. 2ª ed. México: McGraw-Hill Interamericana, 1998.

  2. Secretaría de Salud. Encuesta Nacional de Enfermedades Crónicas. 1996.

  3. Secretaría de Salud. Programa Nacional de Salud 2001-2006. La democratización de la salud en México. Hacia un sistema universal de salud. 3ª ed. México: Secretaría de Salud, 2001;p:44.

  4. Estadísticas sociodemográficas. México: estructura de las defunciones por países seleccionados según principales causas de mortalidad general. http://inegi.gob.mx.

  5. Buden G. Pathogenesis of type 2 diabetes insulin resistance. Endocrinol Metab Clin North Am 2001;30(4):801-15.

  6. Cusi K. Rol de la resistencia a la insulina en la patogenia de la diabetes tipo 2 y la enfermedad cardiovascular. Diabetes Care 1999. (Sup en español).

  7. Pearson T, Mensah G, Alexander W, et al. Markers of inflammation and cardiovascular disease. Circulation 2003;107:499-551.

  8. Legrand W, Visser C, Hermens W, et al. C-reactive protein as a cardiovascular risk factor. Circulation 1999;100:96-102.

  9. Hoffmeister A, Rothenbacher D, Bäzner U, et al. Role of novel markers of inflammation in patients with stable coronary heart disease. Am J Cardiol 2001;87(3):1-11.

  10. Epstein F. Atherosclerosis an inflammatory disease. N Engl J Med 1999;430(2):115-24.

  11. Pelliniemi T, Irjala K, Mattila K, et al. Immunorreactive interleukin-6 and acute phase proteins as prognostic factors in multiple mieloma. Blood 1995;85(3):765-71.

  12. Ramzi S, Cotran R, Kumar V, Collins T. Patología estructural y funcional. 6ª ed. México: McGraw-Hill Interamericana, 2000.

  13. Ward P, Lentsch AB. The acute inflammatory response and its regulation. Arch Surg 1999;134:666-9.

  14. Abbas A, Lichtman A, Pober J. Inmunología celular y molecular. 4ª ed. México: McGraw-Hill Interamericana, 2002.

  15. Gabay C, Kusnner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448-54.

  16. Flier J, Underhill L. Protective and damaging effects of stress mediators. N Engl J Med 1998;338(3):171-7.

  17. Pickup J, Mattock M, Chusney G, Burt D. NIDDM as a disease of the innate immune system: association of the acute-phase reactants and interleukin 6 with metabolic syndrome X. Diabetologia 1997;40:1286-92.

  18. Festa A, D’Agostino R, Howard G, et al. Chronic subclinical inflammation, as part of insulin resistance syndrome. Circulation 2000;4:42-7.

  19. Telmelkova-Kurktschiev T, Siegert G, Bergman S, et al. Subclinical inflammation is strongly related to insulin resistance but no to impaired insulin secretion in a high risk population for diabetes. Metabolism 2002;51:743-9.

  20. Hak A, Pois H, Stehouwer C, et al. Markers of inflammation and cellular adhesion molecules in relation to insulin resistance in non diabetic elderly. The Rotterdam Study. J Clin Endocrinol Metab 2001;86(9):4398-405.

  21. Leinonen E, Hurt-Camejo E, Wiklund O, et al. Insulin resistance and adiposity correlate with acute-phase reaction and soluble cell adhesion molecules in type 2 diabetes. Atherosclerosis 2003;166:387-94.

  22. Han T, Sattar N, Williams K, et al. Prospective study of C-reactive protein in relation to the development of diabetes and metabolic syndrome in the México City Diabetes Study. Diabetes Care 2002;25(11):2016-21.

  23. Schimid M, Duncan B, Sharrett A, et al. Markers of inflammation and prediction of diabetes mellitus in adults (atherosclerosis risk in communities study): a cohort study. Lancet 1999;353:1649-2.

  24. Pradhan A, Manson J, Rifai N, et al. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001;286(3):327-34.

  25. Thorand B, Lowel H, Schneider A, Kolb H, Meisinger C, Frohlich M. C-reactive protein as a predictor for incident diabetes mellitus among middle-aged men. Arch Inter Med 2003;163(1):93-9.

  26. Festa A, Agostino R, Tracy R, Haffner S. Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes. The insulin resistance atherosclerosis study. Diabetes 2002;51:1131-7.

  27. Barzilay JI, Abraham L, Heckbert SR, et al. The relation of markers of inflammation to the development of glucose disorders in the elderly. Diabetes 2001;50(10):2384-9.

  28. Norma Oficial Mexicana: NOM-174-SSAI-1998 “para el manejo integral de la obesidad”.

  29. Norma Oficial Mexicana: NOM-030-SSA2-1999 “para la prevención, tratamiento y control de la hipertensión arterial”.

  30. Consenso Mexicano sobre el Tratamiento Integral del Síndrome Metabólico. Med Int Mex 2002;18(1):12-41.

  31. Mendoza-Nuñez VM, García-Sánchez A, Sánchez-Rodriguez M, Galván-Duarte RE, Fonseca-Yerena ME. Overweight, waist circumference, age, gender, and insulin resistance as risk factors for hyperleptinemia. Obes Res 2002;10(4):253-9.

  32. Snidjer MB, Dekker JM, Visser M, Stehouwer CD. C-reactive protein and diabetes mellitus type 2. Diabetologia 2001;44(Suppl 1):115A.

  33. Frohlich M, Imhof A, Berg G, et al. Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care 2000(23);1835-9.

  34. Visser M, Bouter LM, McQuillan GM, Wener M, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999;282:2131-5.




2020     |     www.medigraphic.com