J Korean Diabetes.  2021 Sep;22(3):207-219. 10.4093/jkd.2021.22.3.207.

Combined Effects of Insulin Resistance and Inflammation on Comorbidities of Type 2 Diabetes

• Kim EJ
• Lee EY
• Lee YH
• Choi YJ
• Park SW
• Lee EJ
• Lee HC
• Huh KB

• KMID: 2526203
• DOI: http://doi.org/10.4093/jkd.2021.22.3.207

Abstract

Background
Insulin resistance (IR) and inflammation are closely related to each other and share common pathophysiological and metabolic mechanisms. We aimed to investigate the combined effect of IR and inflammation on comorbidities of type 2 diabetes mellitus (T2DM).
Methods
A total 3,758 patients with T2DM were recruited through Huh’s Diabetes Center from January 2003 to June 2009. Insulin sensitivity was measured by a rate constant for plasma glucose disappearance (Kitt , %/min) using short insulin tolerance test. High sensitivity C-reactive protein (hs-CRP) was used as a surrogate for inflammation.
Results
Patients with the lowest tertile of Kitt (IR group) showed worse cardio-metabolic parameters while those with the highest tertile of hs-CRP levels had worse cardio-metabolic parameters. The prevalence of metabolic syndrome, fatty liver, albuminuria, and carotid atherosclerosis decreased with Kitt tertile, but increased with hs-CRP tertile. In multiple regression analysis, both Kitt and hs-CRP were independent risk factors for comorbidities of T2DM. In addition, they showed synergistic effects on these comorbidities.
Conclusion
Both IR and inflammation were significantly associated with comorbidities of T2DM in a dose dependent manner. In addition, the coexistence of IR and inflammation may synergistically contribute to increased comorbidities of T2DM.

Keyword

Albuminuria; Atherosclerosis; Diabetes mellitus; type 2; Fatty liver; Inflammation; Insulin resistance; Metabolic syndrome

Figure

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  Fig. 1. Prevalence of various comorbidities according to the tertile ofKitt (A) and hs-CRP (B). P for trend was indicated in each graph. Kitt, rate constant for plasma glucose disappearance; hs-CRP, high sensitivity C-reactive protein; T, tertile.

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  Fig. 2. Multiplicative effect ofKitt and hs-CRP on the odds of metabolic syndrome (A), fatty liver (B), albuminuria (C), and carotid atherosclerosis (D). Adjusted for age, sex, duration of diabetes, body mass index, systolic blood pressure, smoking, HbA1c, creatinine, low-density lipoprotein cholesterol, diabetes medication, antihypertensive medication, and lipid-lowering agents. Kitt, rate constant for plasma glucose disappearance; hs-CRP, high sensitivity C-reactive protein; T, tertile.

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