ABSTRACT
Diabetic nephropathy (DN) is one of the significant causes of chronic kidney disease (CKD) and end stage renal disease (ESRD) globally. Cytokines play a vital role in the pathogenesis and progression of CKD. DN is considered as an inflammatory disease. Vitamin D is a reno-protective fat soluble agent, whose deficiency is associated with the levels of inflammatory molecules and progression of DN. Thus, the objective of this study was to analyse the expression of cytokines in diabetic patients with and without nephropathy and correlate with vitamin D levels. MATERIAL: Clinical details and serum samples from 84 diabetic patients without nephropathy and 84 diabetics with nephropathy were collected. The separated serum was used to measure Vitamin D and Cytokines; IL-1, IL-6, TNF-α. Fasting insulin levels were measured and HOMA-IR was calculated. OBSERVATION: Diabetics with & without nephropathy had hypovitaminosis D. Severe hypovitaminosis D (< 10 ng/ml) was observed in 36.9% nephropathy subjects when compared to diabetics without nephropathy (19%). The serum IL-6 levels were high (p<0.001) and IL-1 (p<0.001) and TNF- α (p<0.001) were low in diabetic patients with nephropathy. CONCLUSION: Diabetics with and without nephropathy have low vitamin D. Severe hypovitaminosis D was observed in diabetic nephropathy subjects, when compared to diabetics. IL-6 is significantly increased in diabetic nephropathy. A weak negative correlation of IL-1 and TNF-α was seen with vitamin D in diabetics without nephropathy, whereas IL-6 had a weak negative correlation with vitamin D in diabetics with nephropathy.
Subject(s)
Diabetes Mellitus , Diabetic Nephropathies , Renal Insufficiency, Chronic , Vitamin D Deficiency , Cytokines/metabolism , Diabetic Nephropathies/etiology , Female , Humans , Interleukin-1 , Interleukin-6/metabolism , Male , Renal Insufficiency, Chronic/complications , Tumor Necrosis Factor-alpha , Vitamin D , Vitamin D Deficiency/complications , VitaminsABSTRACT
BACKGROUND: The effect of thyroid status on insulin sensitivity is of great interest but despite various studies there is conflicting data on this subject. Hypothyroidism has been associated with disorders of glucose and insulin metabolism involving defective insulin secretion in response to glucose, hyperinsulinemia, altered peripheral glucose disposal and insulin resistance. Thyroid dysfunction leads to alterations in glucose and lipid metabolism which is an important risk factor for cardiovascular diseases. The dyslipidemia and insulin resistance should be managed aggressively to reduce the impending risk. OBJECTIVES: The prime objectives of the study were as follows: 1. To compare and correlate insulin resistance levels with T3, T4, and TSH in hypothyroidism patients. 2. To compare and correlate lipid profile with T3, T4, and TSH in hypothyroidism patients with healthy controls. MATERIALS AND METHODS: Forty hypothyroidism patients and Forty healthy age and sex matched controls in the age group of 18 to 45 years were taken for the study. The venous blood samples collected were used for estimation of thyroid hormones, insulin, glucose and lipid profile. RESULTS AND DISCUSSION: There is significant increase in insulin, Homa-IR and glucose levels in hypothyroidism cases when compared to controls. Cholesterol, LDL, VLDL and triglycerides were significantly increased, whereas HDL was significantly decreased in hypothyroidism cases when compared with controls. Insulin was moderately correlated with cholesterol but there was no correlation with other lipid profile parameters in hypothyroidism patients. Homa-IR was significantly correlated with TSH in hypothyroidism cases when compared with controls. TSH was significantly correlated with cholesterol and LDL in hypothyroidism cases (both clinical and subclinical) when compared with controls. The present study helps to evaluate changes in insulin resistance and lipid risk factors. These factors should be managed aggressively to reduce the impending risk of cardiovascular diseases.
