The contributions of fasting and postprandial blood glucose increments to oxidative stress and inflammation in dyslipidemic type 2 diabetic patients with stable ischemic heart disease.
OBJECTIVE
Contributions of fasting and postprandial blood glucose increments on level of inflammation and oxidative stress biomarkers in patients with stable ischemic heart disease (IHD) and diabetes mellitus type 2 (T2DM) was evaluated.


METHODS
Ninety T2DM patients (60 with IHD and 30 without IHD) treated with metformin and/or sulphonylurea were enrolled in cross-sectional nested case-control clinical study. The areas under the six-point daily glucose curve above the fasting glucose concentrations (AUCpp) and over 5.5mmol/L (AUCbg) were calculated to determine postprandial (AUCpp) and fasting (AUCbg-AUCpp) glucose increments. Malondialdehyde (MDA), protein carbonyl group (PCO), fibrinogen, C-reactive protein (hsCRP), leukocyte count and adhesion molecules ICAM-1 and VCAM-1 were determined.


RESULTS
AUCbg-AUCpp 58.2 (95%CI 40.6-75.8) was higher in IHD group compared to non-IHD 36.9 (95%CI 23.5-50.2) mmol*h/L. They had significantly higher ICAM-1 (mean±SD) 72.70±30.6 vs. 60.22±22.6ng/mL and MDA 16.47±4.5 vs. 13.42±4.01μmol/g plasma proteins, but similar PCO, VCAM-1, fibrinogen, hsCRP concentration and leukocyte count. AUCpp positively correlated with MDA (r=0.45) and ICAM-1 (r=0.32) in the presence of IHD, and VCAM-1 (r=0.44) in the absence of IHD. AUCbg-AUCpp positively correlated with PCO (r=0.45) in the absence of IHD. The analysis revealed that AUCpp over turning point of 0mmol*h/L was associated with high MDA and ICAM-1 expression in diabetics with IHD. AUCbg-AUCpp over 30mmol*h/L leads to high oxidative protein modification in diabetics without IHD.


CONCLUSIONS
In T2DM patients with stable IHD, AUCpp at any point, significantly contributes to increasing of MDA and ICAM-1 expression. Fasting blood glucose increment showed significant correlation with carbonyl content in diabetics without IHD.
Institute of Pathophysiology, Faculty of Medicine, University of Niš, Serbia; Clinic of Cardiology, Clinical Center Nis, Serbia. Electronic address: boris_dj@medfak.ni.ac.rs.
Boris
B
Djindjic
Clinic of Cardiology, Clinical Center Nis, Serbia.
Tomislav
T
Kostic
Institute of Radiology, Clinical Center Nis, Serbia.
Zoran
Z
Radovanovic
Institute of Biomedical Research, Faculty of Medicine, University of Niš, Serbia.
Natasa
N
Djindjic
Clinic of Cardiology, Clinical Center Nis, Serbia.
Marko
M
Lazovic
Institute of Biomedical Research, Faculty of Medicine, University of Niš, Serbia.
Misko
M
Zivic
Clinic of Cardiology, Clinical Center Nis, Serbia.
Zoran
Z
Perisic
Clinic of Cardiology, Clinical Center Nis, Serbia.
Nebojsa
N
Krstic
D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D050171:Dyslipidemias / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005215:Fasting / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D018384:Oxidative Stress / Q000502:physiology*; D019518:Postprandial Period / Q000502:physiology
D001786:Blood Glucose; D018836:Inflammation Mediators
Adhesive molecules; Diabetes mellitus; Fasting hyperglycemia; Inflammation; Ischemic heart disease; Oxidative stress; Postprandial hyperglycemia