Association of serum adiponectin with diabetic microvascular complications among south Indian type 2 diabetic subjects — (CURES-133)

https://doi.org/10.1016/j.clinbiochem.2014.10.009Get rights and content

Highlights

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    Subjects with any microvascular complications had higher levels of adiponectin.

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    Adiponectin was increased in subjects with retinopathy compared to those without.

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    Adiponectin was increased in subjects with neuropathy compared to those without.

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    Adiponectin levels were not different in subjects with and without nephropathy.

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    Serum adiponectin levels increased with the severity of diabetic retinopathy.

Abstract

Objectives

To assess the association of serum adiponectin and microvascular complications of diabetes in an urban south Indian type 2 diabetic population.

Design and methods

Diabetic subjects [n = 487] were included from Chennai Urban Rural Epidemiology Study (CURES). Four-field stereo retinal color photography was done and diabetic retinopathy (DR) was classified as non-proliferative DR (NPDR) or proliferative DR (PDR) according to the Early Treatment Diabetic Retinopathy Study grading system. Sight threatening DR (STDR) was defined as the presence of NPDR with diabetic macular edema, and/or PDR. Neuropathy was diagnosed if vibratory perception threshold of the great toe using biothesiometry exceeded ≥ 20 V. Nephropathy was diagnosed if urinary albumin excretion (UAE) was ≥ 30 μg/mg creatinine. Serum total adiponectin levels were measured by radioimmunoassay.

Results

Subjects with any microvascular complications had significantly higher levels of adiponectin levels compared to those without the complications (geometric mean: 6.1 vs. 5.3 μg/mL, p = 0.004). The adiponectin level was significantly higher in subjects with DR (6.8 vs. 5.5 μg/mL, p = 0.004) and neuropathy (5.6 vs. 6.5 μg/mL, p = 0.024) compared to those without. Adiponectin levels were not significantly different in subjects with and without nephropathy. Serum adiponectin levels increased with the severity of DR [No DR — 5.5 μg/mL; NPDR without DME — 6.5 μg/mL; STDR — 8.3 μg/mL, p = 0.001]. Regression analysis revealed adiponectin to be associated with microvascular disease (presence of neuropathy and/or retinopathy and/or nephropathy) (OR: 1.44, 95% CI: 1.01–2.06, p = 0.049) even after adjusting for age, gender, BMI, HbA1c, diabetes of duration, serum cholesterol and triglycerides, hypertension and medication status.

Conclusion

In Asian Indians with type 2 diabetes, serum adiponectin levels are associated with microvascular complications and also with the severity of retinopathy.

Introduction

Diabetic complications represent a significant cause of morbidity and mortality in diabetic patients [1] and some of the characteristic complications include retinopathy, nephropathy and neuropathy. Adiponectin is the most abundant adipocytokine secreted in the adipose tissue and has been shown to be decreased in conditions such as obesity [2], insulin resistance [3], and type 2 diabetes mellitus (T2DM) [4]. It also has anti-atherogenic [5], anti-inflammatory [6], and insulin sensitizing [7] functions and hence by improving hyperglycemia, it could affect the development and progression of diabetic microangiopathy. It also helps to modulate vascular function and various inflammatory processes [8]. However, the association between serum total adiponectin and diabetic microangiopathy is controversial and the results from existing reports are inconsistent [9], [10].

Overexpression of adiponectin has been shown to attenuate pathological retinal and choroidal neovascularization [11], [12] suggesting that it may be a potential alternative therapy for the treatment of retinal vascular diseases. However, the association of adiponectin with diabetic retinopathy is still largely unknown. Conflicting results regarding the levels of adiponectin in patients with retinopathy have been reported [9], [10].

Recent reports suggest that serum and urinary adiponectin levels are increased in T2DM patients with overt nephropathy [13]. It is also known that plasma adiponectin levels increased in primary nephrotic syndrome [14]. The literature on the levels of adiponectin in diabetic neuropathy is scanty and one study has shown that higher serum adiponectin levels were associated with an increased probability of cardiac autonomic neuropathy [15].

The aims of the present study were to look at the levels of adiponectin in patients with and without diabetic retinopathy, nephropathy and neuropathy and to assess the association of adiponectin with the severity of diabetic retinopathy in an Asian Indian population.

Section snippets

Subjects and methods

Study subjects were recruited from the Chennai Urban Rural Epidemiology Study (CURES), conducted on a representative population of Chennai (formerly Madras), in southern India using systematic random sampling technique. The details of the sampling and methods of the study are published elsewhere [16]. Details of the sampling are described on our website (http://www.mdrf.in/misc/CURES.pdf). Briefly, in Phase 1, a detailed questionnaire was used to obtain basic demographic data and fasting

Results

Of the 487 diabetic subjects studied, DR was present in 81 (16.6%) [NPDR — 68 (14.0%); STDR — 13 (2.6%)], nephropathy in 143 (29.4%) [microalbuminuria — 140 (28.8%); macroalbuminuria — 3 (0.6%)] and neuropathy 138 (28.3%) of the subjects. 266 (54.6%) had either one or more microvascular complications. Among this group, 16 subjects (6.0%) had all three microvascular complications of diabetes, while 64 subjects (24.1%) had two microvascular complications and 186 subjects (69.9%) had only one

Discussion

The major findings of the study are: 1) With increasing number of microvascular complications the levels of adiponectin increased in the study subjects and an increased adiponectin levels were associated with a significantly increasing odds of microvascular complications even after adjusting for several confounders; 2) adiponectin levels were significantly higher in subjects with diabetic retinopathy and diabetic neuropathy compared to their respective controls, whereas adiponectin levels did

Conflict of interest

The author(s) declare(s) that there is no conflict of interests regarding the publication of this paper.

Acknowledgment

We acknowledge gratefully the help of the epidemiological team for the fieldwork, eye technicians for performing preliminary eye testing and retinal photography, technicians for performing biothesiometry and most importantly the subjects who participated in the study. This is the 133 study from the CURES. JS and KI acknowledge the fellowship from CSIR-SRF.

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