title: Insulin resistance and inflammation - A further systemic complication of COPD.
abstract: Chronic obstructive pulmonary disease (COPD) is associated with a continuous systemic inflammatory response. Furthermore, COPD is associated with an excess risk for cardiovascular disease and type II diabetes. Systemic inflammation in other populations is a factor in atherogenesis and has been associated with insulin resistance. We assessed the association between systemic inflammation and insulin resistance in non-hypoxaemic patients with COPD. Fasting plasma glucose, insulin and inflammatory mediators were measured in 56 patients and 29 healthy subjects. Body mass index (BMI) and height squared fat- and fat-free-mass index were similar between subject groups. Using homeostatic modelling techniques, mean (SD) insulin resistance was greater in the patients, 1.68 (2.58) and 1.13 (2.02) in healthy subjects, p=0.032. Fasting plasma insulin was increased in patients while glucose was similar to that in healthy subjects. Patients had increased circulating inflammatory mediators. Insulin resistance was related to interleukin-6 (IL-6), r=0.276, p=0.039, and tumour necrosis factor alpha soluble receptor I, r=0.351, p=0.008. Both IL-6 and BMI were predictive variables of insulin resistance r(2)=0.288, p<0.05. We demonstrated greater insulin resistance in non-hypoxaemic patients with COPD compared with healthy subjects, which was related to systemic inflammation. This relationship may indicate a contributory factor in the excess risk of cardiovascular disease and type II diabetes in COPD.
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Cardiff University, Llandough Hospital, Vale of Glamorgan, UK. boltonce@cf.ac.uk
authors.forename: C E
authors.initials: CE
authors.lastname: Bolton
authors.forename: M
authors.initials: M
authors.lastname: Evans
authors.forename: A A
authors.initials: AA
authors.lastname: Ionescu
authors.forename: S M
authors.initials: SM
authors.lastname: Edwards
authors.forename: R H K
authors.initials: RH
authors.lastname: Morris
authors.forename: G
authors.initials: G
authors.lastname: Dunseath
authors.forename: S D
authors.initials: SD
authors.lastname: Luzio
authors.forename: D R
authors.initials: DR
authors.lastname: Owens
authors.forename: D J
authors.initials: DJ
authors.lastname: Shale
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications*; D018121:Receptors, Cytokine / Q000097:blood; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D016207:Cytokines; D018121:Receptors, Cytokine; D002097:C-Reactive Protein