Is the insulin necessary for the struggle against oxidative stress in diabetes mellitus type 2 - a pilot study.

Da li je insulin neophodan za borbu protiv oksidativnog stresa u dijabetesu melitusu tip 2 - pilot studija.

Background/Aim. Hyperglycaemia has a detrimental effect on the progress of micro/macrovascular complications in patients with diabetes mellitus type 2 (T2DM). Additionally, all known complications in T2DM are coupled with oxidative stress developed from different metabolic pathways. The aim of this study was to estimate the quality of glucoregulation and the degree of oxidative stress in T2DM patients depending on the applied therapeutic protocol and assess their correlation with clinical data and crucial biochemical parameters important for the development of diabetes complications. Methods. All included patients were divided into two groups: those treated with oral antidiabetic drugs (OAD) and those treated with oral antidiabetic drugs and insulin (OADINS). Thiobarbituric acid reactive substances (TBARS), total sulfhydryl groups (TSH), the activity of superoxide dismutase (SOD), total nitrites (NOx), vascular endothelial growth factor (VEGF), and activities of matrix metalloproteinase 9 (MMP9) were measured, together with lipid profile and routine biochemical parameters. All subjects were analyzed for demographic characteristics and detailed medical history as well as smoking habits and calculated for body mass index (BMI). Results. All patients were uniformly poor glucoregulated and dyslipidemic. SOD activity was decreased, and lipid peroxidation was increased in the OAD group compared to OADINS. Deficient glucoregulation in both the OAD and the OADINS groups did not associate with an oxidative state outcome. In both of these groups, the concentrations of VEGF and MMP9 were significantly higher than in controls. Conclusion. The better antioxidative outcome, expressed with a normalized concentration of TBARS, preserved TSH, and normalized SOD activity in T2DM patients treated with OADINS compared to those treated exclusively with OAD, suggests the need for more careful consideration of earlier insulin introduction into T2DM therapy in order to prevent the development of complications. [ABSTRACT FROM AUTHOR]

Uvod/Cilj. Kod bolesnika sa dijabetesom melitusom tipa 2 (T2DM), hipergikemija podstiče progresiju mikro/makrovaskularnih komplikacija. Dodatno, sve poznate komplikacije u T2DM povezane su sa oksidativnim stresom koji nastaje različitim metaboličkim procesima. Cilj rada bio je da se proceni kvalitet glikoregulacije i stepen oksidativnog stresa kod bolesnika sa T2DM u zavisnosti od primenjenog terapijskog protokola i njihova povezanost sa kliničkim podacima i ključnim biohemijskim parametrima važnim za razvoj dijabetesnih komplikacija. Metode. Svi ispitivani bolesnici bili su podeljeni u dve grupe: grupa bolesnika lečenih samo oralnim antidijabetičnim lekovima (OAD) i grupa lečenih OAD i insulinom (OADINS). Praćeni su tiobarbiturna kiselina-reagujuće supstance (TBARS), totalni sulfhidrili (TSH), aktivnost superoksid dizmutaze (SOD), ukupni nitriti (NOx), vaskularni endotelni faktor rasta (VEGF), aktivnost matriksne metaloproteinaze 9 (MMP9), lipidni profil i rutinski biohemijski parametri. Svim ispitanicima su analizirane demografske karakteristike, detaljna medicinska istorija, pušačke navike, a izračunat im je i indeks telesne mase (BMI). Rezultati. Svi bolesnici su imali loše regulisanu glikoregulaciju i bili su dislipemični. Pokazana je smanjena aktivnost SOD i povećana lipidna peroksidacija u OAD grupi u poređenju sa OADINS grupom. Loša glikoregulacija u grupama OAD i OADINS nije bila povezana sa rezultatima oksidativnog stanja. I u OAD i u OADINS g rupi, k oncentracije V EGF i M MP9 b ile s u značajno više u odnosu na kontrole. Zaključak. Bolji antioksidativni odgovor registrovan kroz normalizovanu koncentraciju TBARS, očuvan TSH i SOD u granicama normalnih vrednosti kod T2DM bolesnika lečenih OADINS u odnosu na bolesnike lečene samo OAD, upućuju na potrebu za pažljivijim razmatranjem ranijeg uvođenja insulina u terapiju obolelih od T2DM, kako bi se sprečio razvoj komplikacija. [ABSTRACT FROM AUTHOR]

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