Endocrine Abstracts

Background: Chronic pyelonephritis (CP) is a common kidney infection complication in patients with diabetes mellitus and one of the main reasons of chronic kidney disease in diabetic patients.

The objective: Of the study was to determine the features of the carbohydrate metabolism and insulin resistance in patients with CP depending on the phenotype of latent autoimmune diabetes in adults (LADA).

Methods: 28 patients with LADA and CP were examined, as well as 25 representatives of the control group. The patients were divided into two groups by the phenotype of LADA: 19 patients with LADA1 and 9 with LADA2. We studied fasting plasma glucose levels, glycated hemoglobin (HbA1c), HOMA-IR index and anthropometric indicators: body mass index (BMI), waist circumference (WC) and waist circumference to hip circumference ratio (WC/HC).

Results: Fasting plasma glucose level was 40.3% higher in patients with LADA1 than in the control group (P<0.001), in LADA2 it was 2 times higher (P<0.01). The HbA1c indicator was 83.6% higher in LADA1 and 55% higher in LADA2 compared to the control (P<0.001), respectively. HOMA-IR index was registered 1.6 times lower in LADA1 group compared to the control (P<0.05), but 2.2 times and 3.4 times higher in LADA2 compared to the control and LADA1 (P<0.001). BMI in LADA1 was lower than in the control group by 11% (P=0.001); in LADA2 it was higher by 17.8% (P<0.01) than in the control group and by 32.5% in relation to LADA1 (P<0.001). The WC was lower by 1.3% when comparing the LADA1 and control group (P<0.05), in LADA2 – by 34.6% and by 36.4% higher than in the control and LADA1 group respectively (P<0.001). The WC/HC was found to be higher by 20.5% in individuals with LADA2 compared to control and by 25% compared to LADA1 (P<0.001). In patients with LADA1 positive relationships were recorded between the HbA1c and the age of manifestation of diabetes (r=0.489; P<0.05). In the LADA2 group negative correlations were found between the fasting plasma glucose and the duration of diabetes (r=-0.725; P<0.05); HbA1c level and the age of manifestation of diabetes (r=-0.788; P<0.05); HbA1c and the duration of diabetes (r=0.690; P<0.05).

Conclusion: Insufficient compensation of diabetes is noted in patients with LADA1 and LADA2 without differences in intergroup comparison, however the degree of insulin resistance and abdominal obesity as main components of metabolic syndrome prevalence in patients with LADA2 which indicates the higher cardiovascular risk in this category of patients.