Indexed indicators of insulin resistance and insulin sensitivity in cardiorenal metabolic syndrome

Abstract

Introduction. Impaired insulin secretion and insulin resistance (IR) play a leading role in the pathogenesis of diabetes mellitus and in the development and progression of metabolic syndrome also. However, the characteristics of IR in the setting of cardiorenal metabolic syndrome (CRMs) are poorly described. The aim is to characterize indexes of IR and insulin sensitivity (IS) in patients with CRMs. Materials and methods. In accordance with the Helsinki’ Declaration, 100 patients with acute forms of coronary heart disease were examined. They were divided into groups: G0, G1, G2, G3 depending on the stage of CRMs. Glomerular filtration rate was calculated according to MDRD (GFRM) and Cockcroft-Gault (GFRc). Carbohydrate metabolism was assessed by oral glucose tolerance test with parallel determination of insulin and C-protein. A number of indices were calculated: HOMA-IR; %Bcalc; %S; IR; QUICKI; McAuley; Gutt; Cederholm; Matsuda; Avignon; Shuster; DI DeFronzo; Drivsholm; Stumvoll early; Stumvoll late; Philips; Wareham. The results were statistically processed and presented as M±m. Correlation analysis was performed using the Spearman-Pearson tests, with a significance level of p<0.05. Results. IR can be diagnosed in different stages of CRMs due to the values of the HOMA-IR and QUICKI insulin resistance indices. The decrease of liver sensitivity to insulin and insulin resistance (%S and McAuley) with low insulin secretion in both the early and late stages were observed in patients with 1 stage of CRMs. The 2d stage of CRMs was characterized by insulin resistance according to HOMA-IR and IR with a decrease in the number of functioning beta-cells (%Bcalc). These cells are overactivated with a predominance of the early phase of secretion (Stumvoll early). The 3d stage of CRMs was characterized by sufficient hepatic sensitivity to insulin and reduced peripheral tissues sensitivity (Cederholm <65). Conclusions. Insulin resistance and insulin sensitivity indices in cardiorenal metabolic syndrome have shown that IR can be diagnosed in all stages of CMRs. Insulin resistance increases and peripheral tissue sensitivity to insulin decreases according cardiorenal metabolic syndrome progression.