University of Monastir, College of Pharmacy, Tunisia.
Department of Clinical Pharmacy, University of Kerbala, College of Medicine, Kerbala, Iraq.
Medicine (Baltimore). 2024 Nov 1;103(44):e40330. doi: 10.1097/MD.0000000000040330.
Type 2 diabetes mellitus (T2DM) is a major global health issue associated with chronic inflammation, which contributes to both disease progression and its complications, including cardiovascular and microvascular disorders. Key inflammatory markers such as tumor necrosis factor-alpha, interleukin-6 (IL-6), E-selectin, and P-selectin are elevated in T2DM patients and are implicated in the development of these complications. Understanding how treatments such as insulin and metformin affect these markers is crucial for improving therapeutic strategies in T2DM. This study investigated the effects of insulin and metformin on these inflammatory markers in T2DM patients. This was a cross-sectional study involving patients with diabetes on insulin (group A), metformin only (group B), and healthy controls (group C). Participants were enrolled from the Diabetic Center in Karbala, Iraq and underwent clinical assessments including ophthalmologic examinations. Fasting blood glucose, HbA1c and lipids levels were assessed. The levels of inflammatory markers (IL-6 and TNF-α), and adhesion molecules (sE-selectin and sP-selectin) were measured using Enzyme-Linked Immunosorbent Assay (ELISA). The study included 522 patients with diabetes: 356 receiving insulin (group A), 70 receiving metformin (group B) and 96 healthy controls (group C). T2DM patients treated with insulin exhibited significantly more microvascular complications than those treated with metformin. Higher rates of retinopathy (64.3% vs 11.4%) and neuropathy (69.9% vs 11.4%) were observed in the insulin group, whereas the incidence of nephropathy did not differ significantly (14.6% vs 11.4%). Inflammatory markers were lower in the insulin group: TNF-α levels were 3-fold lower and IL-6 levels were 8-fold lower. Conversely, sE-selectin levels were 1.5-fold higher in the insulin group, and sP-selectin levels were 1.4-fold higher in the metformin group. This study highlights distinct differences in inflammatory markers and systemic complications between T2DM patients treated with insulin and those treated with metformin alone. Further research is needed to explore the mechanisms underlying these observations and optimize treatment strategies for T2DM patients.
2 型糖尿病（T2DM）是一个全球性的主要健康问题，与慢性炎症有关，炎症既促进疾病进展，也导致其并发症，包括心血管和微血管疾病。肿瘤坏死因子-α、白细胞介素-6（IL-6）、E-选择素和 P-选择素等关键炎症标志物在 T2DM 患者中升高，并与这些并发症的发生有关。了解胰岛素和二甲双胍等治疗方法如何影响这些标志物对于改善 T2DM 的治疗策略至关重要。本研究调查了胰岛素和二甲双胍对 T2DM 患者这些炎症标志物的影响。这是一项横断面研究，涉及使用胰岛素的糖尿病患者（A 组）、仅使用二甲双胍的患者（B 组）和健康对照组（C 组）。参与者从伊拉克卡尔巴拉的糖尿病中心招募，并进行了包括眼科检查在内的临床评估。检测空腹血糖、HbA1c 和血脂水平。使用酶联免疫吸附试验（ELISA）测量炎症标志物（IL-6 和 TNF-α）和黏附分子（sE-选择素和 sP-选择素）的水平。该研究纳入了 522 名糖尿病患者：356 名接受胰岛素治疗（A 组）、70 名接受二甲双胍治疗（B 组）和 96 名健康对照组（C 组）。与接受二甲双胍治疗的患者相比，接受胰岛素治疗的 T2DM 患者表现出更多的微血管并发症。胰岛素组的视网膜病变发生率（64.3%比 11.4%）和神经病变发生率（69.9%比 11.4%）更高，而肾病发生率无显著差异（14.6%比 11.4%）。胰岛素组的炎症标志物水平较低：TNF-α 水平低 3 倍，IL-6 水平低 8 倍。相反，胰岛素组的 sE-选择素水平高 1.5 倍，而二甲双胍组的 sP-选择素水平高 1.4 倍。本研究强调了接受胰岛素和单独接受二甲双胍治疗的 T2DM 患者之间在炎症标志物和全身并发症方面的显著差异。需要进一步研究探索这些观察结果的机制，并优化 T2DM 患者的治疗策略。
