The Relationship Between Lipid Metabolism and The Level of Albuminuria with Single Nucleotide Polymorphism -204A>C [rs 3808607] CYP7A1 Gene in Patients with Type 2 Diabetes Mellitus and Diabetic Nephropathy

Comorbid overweight/obesity and chronic pancreatitis exacerbate the dyslipidemia progression in type 2 diabetic patients

Objective. The aim of present study was to analyze the serum lipid profile parameters in patients with type 2 diabetes mellitus (T2DM) and comorbidities [overweight/obesity and/or chronic pancreatitis (CP)] to determine the contribution of these pathologic factors to lipid metabolism disorders in T2DM.

Methods. The study involved 579 type 2 diabetic (T2D) patients with comorbid overweight/ obesity and/or CP. The serum lipid panel parameters [total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C)] were determined by commercially available kits on a Cobas 6000 analyzer (Roche Hitachi, Germany). Low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and remnant cholesterol (RC) levels were calculated using formulas. The data were statistically analyzed using STATISTICA 7.0.

Results. It was shown that dyslipidemia in T2D patients is characterized by unidirectional changes regardless the presence/absence of comorbid overweight/obesity or CP. At the same time, the most severe dyslipidemia was detected in T2D patients with a combination of comorbid over-weight/obesity and CP. Both the elevated body mass index (BMI) and CP can aggravate lipid metabolism disorders in T2DM. In our study, however, the BMI increase positively correlated with the number of dyslipidemia patients characterized by exceeding all target lipid levels for diabetic patients. This is in contrast to T2D patients with normal body weight and comorbid CP, in whom only LDL-C and TG exceeded the target lipid levels.

Conclusions. A combination of comorbidities, such as obesity and CP in T2D patients, produced a mutually aggravating course defined particularly by common pathogenic links, insulin resistance, chronic generalized low-intensity inflammation, endothelial dysfunction, and dyslipidemia caused primarily by triglyceridemia.

Insulin receptor substrate 1 gene variations and lipid profile characteristics in the type 2 diabetic patients with comorbid obesity and chronic pancreatitis

Objective. Type 2 diabetes mellitus (T2DM) is one of diseases that develops in a setting of polymorbid processes or more often promotes their development, forming in this spectrum the phenomenon of comorbidity. The aim of this study was to evaluate changes in the lipid panel data in T2DM patients with comorbid obesity and chronic pancreatitis (CP) taking into account the C/A polymorphism of the insulin receptor substrate 1 (IRS1) gene (rs2943640). Methods. The study involved 34 T2DM patients and 10 healthy individuals. The rs2943640 IRS1 gene polymorphism was genotyped using the TaqMan real-time polymerase chain reaction (PCR) method. Blood serum lipid panel data were determined with commercially available kits on a Cobas 6000 analyzer. Results. In patients with only T2DM and T2DM + comorbid obesity, an association between IRS1 gene polymorphism (rs2943640) and lipid profile abnormalities with maximum changes of the lipid characteristics recorded in C/C genotype carriers was found. Within the C/C genotype of the IRS1 gene (rs2943640) in type 2 diabetic patients with comorbid obesity and CP, significantly lower high-density lipoprotein cholesterol (HDL-C) levels and significantly higher levels of triglycerides (TG), non-HDL-C and remnant cholesterol (RC) in relation to type 2 diabetic patients with comorbid obesity were found. At the same time, within the C/A genotype of the IRS1 gene (rs2943640), significant changes of lipid panel data were found in type 2 diabetic patients with comorbid obesity relative to the control group (p<0.001). Conclusions. Our data indicate that the presence of the C allele of IRS1 gene (rs2943640) in both homozygous and heterozygous states may indicate increased risk of dyslipidemia in type 2 diabetic patients with comorbidities.

High-density lipoproteins and clinical outcomes of COVID-19 in hemodialysis patients: A multicenter, propensity-score matched case-control study

Abstract. A decline in high-density lipoprotein (HDL) has been observed in the general population of COVID-19 infected patients. However, little research has been devoted to this topic in hemodialysis (HD) patients and there is a general lack of data on the association between the baseline HDL level and COVID-19 outcomes in HD patients. The present study aimed to assess the association between baseline HDL levels and the risk of developing severe outcomes of COVID-19 infection in HD patients. Methods. A total of 428 HD patients aged 55 (44-64) years and a dialysis vintage of 44 (21-76.6) months were enrolled in this multicenter propensity-score matched case-control study. After propensity-score matching (1 :1), 142 COVID-19 infected HD patients were compared with 142 HD patients who had never been infected with COVID-19. Propensity scores were estimated with MedCalc software based on potential confounding variables (age, diabetes, dialysis vintage and cardiovascular events). Baseline HDL levels were obtained from electronic health records of the patients (the last measurements were carried out before the COVID-19 onset). The endpoints of the study were COVID-19-related hospitalization, oxygen maintenance, and death. The data were presented as the median and the interquartile ranges [Me (Q25-Q75)] and compared using the Mann-Whitney or Kruskal-Wallis tests, as appropriate. The Spearmen correlation test was used to assess the association between HDL and other markers. The multivariate logistic regression and the receiver operating characteristic (ROC) analyses were performed to evaluate the ability of HDL for predicting the severity of COVID-19 infection. The Cox regression analysis was used to determine the association between HDL and COVID-19-associated mortality. Results. Among 142 patients infected with COVID-19, 40 patients (28%) patients were hospitalized, 34 patients (24%) needed oxygen supplements and 16 patients (11.3%) died. The baseline HDL level was significantly lower in the COVID-19 patients compared with the non-infected patients (1.22 (0.97-1.59) vs 1.52 (1.08-1.85) mmol/L, p = 0.011). Moreover, the baseline HDL level was significantly negatively associated with CT findings of pulmonary involvement (r = -0.76, p < 0.0001) and had a strong inverse correlation with serum C-reactive protein (r = -0.42, p = 0,0002) and D-dimer (r = -0.65, p < 0.0001). The multivariate logistic regression analysis demonstrated that HD patients with HDL concentration <1.22 mmol/l have 3 times higher risk of COVID-19 infection (OR 2.8; 95% CI 1.2; 6.5, p = 0.003).  In the Cox regression analysis adjusted for the patients’ age, diabetic status, dialysis vintage and cardiovascular events, low HDL level (<1.22 mmol/L) was found to be associated with COVID-19-related mortality in the HD patients (χ2 = 9.2, p = 0.002). Conclusions. Baseline low HDL-C level was independently associated with COVID-19 morbidity, severity and mortality in HD patients.