Metabolic endotoxemia and diabetes mellitus: A systematic review.
In this systematic review we analyzed studies that assessed serum concentrations of lipopolysaccharide (LPS) and/or lipopolysacharide-binding protein (LBP) in diabetic patients compared with healthy people. Articles were selected using PubMed and Scopus. Search terms used were endotoxemia, endotoxins, LPS, LBP, diabetes mellitus (DM), type 1 (T1DM), type 2 (T2DM), insulin resistance, humans, epidemiologic studies, population-based, survey, representative, cross-sectional, case-control studies, observational, and clinical trials. Two authors independently extracted articles using predefined data fields, including study quality indicators. There was a great variability in the estimates of metabolic endotoxemia among the studies. Most of the studies observed higher LPS or LBP concentrations in diabetic subjects than in healthy controls. T1DM and T2DM subjects presented higher mean fasting LPS of 235.7% and 66.4% compared with non-diabetic subjects, respectively. Advanced complications (e.g. macroalbuminuria) and disease onset exacerbate endotoxemia. Antidiabetic medications decrease fasting LPS concentrations. Among these medications, rosiglitazone and insulin present higher and lower effects, respectively, compared with other treatments. T1DM and T2DM seem to increase metabolic endotoxemia. However, some confounders such as diet, age, medication, smoking and obesity influence both diabetes and endotoxemia manifestation. A better understanding of the interaction of these factors is still needed.
Instituto Federal do Sudeste de Minas Gerais, Campus Barbacena, Rua Monsenhor José Augusto, 204, Bairro São José, Barbacena, Minas Gerais, Brazil. CEP 36205-018. Electronic address: junianut@yahoo.com.br.
Júnia Maria Geraldo
JMG
Gomes
Nutrition and Health Department, Federal University of Viçosa (Universidade Federal de Viçosa), Avenida PH Rolfs, s/n, Viçosa, Minas Gerais, Brazil. CEP 36570-000.
Jorge de Assis
JA
Costa
Nutrition and Health Department, Federal University of Viçosa (Universidade Federal de Viçosa), Avenida PH Rolfs, s/n, Viçosa, Minas Gerais, Brazil. CEP 36570-000.
Rita de Cássia Gonçalves
RCG
Alfenas
D000209:Acute-Phase Proteins; D002352:Carrier Proteins / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D019446:Endotoxemia / Q000097:blood*; D006801:Humans; D007333:Insulin Resistance; D008070:Lipopolysaccharides / Q000097:blood; D008562:Membrane Glycoproteins / Q000097:blood; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D002352:Carrier Proteins; D008070:Lipopolysaccharides; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein
Diabetes mellitus; Endotoxin; Insulin resistance; Lipopolysaccharide; Lipopolysaccharide-binding protein