Abstract
AimsIntraperitoneal (IP) insulin administration is a last‐resort treatment option for selected patients with type 1 diabetes mellitus (T1DM). As the IP route of insulin administration mimics the physiology more closely than the subcutaneous (SC) route, we hypothesized that IP insulin would result in less oxidative stress (expressed as systemic level of free sulphydryl (R‐SH) content) compared to SC insulin in subjects with T1DM.Materials and methodsProspective, observational case‐control study. Serum thiol measurements were performed at baseline and at 26 weeks in age‐ and gender‐matched patients with T1DM. Serum‐free thiols, compounds with a R‐SH group that are readily oxidized by reactive oxygen species, are considered to be a marker of systemic redox status.ResultsA total of 176 patients, 39 of which used IP and 141 SC insulin therapy were analysed. Mean baseline R‐SH concentration was 248 (31) μmol/L. In multivariable analysis, the route of insulin therapy had no impact on baseline R‐SH levels. The estimated geometric mean concentrations of R‐SH did not differ significantly between both groups: 264 (95% CI 257, 270) for the IP group and 258 (95% CI 254, 261) for the SC group with a difference of 6 (95% CI −2, 14) μmol/L.ConclusionsBased on R‐SH as a marker of systemic oxidative stress, these findings demonstrate that the route of insulin administration, IP or SC, does not influence systemic redox status in patients with T1DM.
Highlights
The findings in this 26‐week study suggest that the route of insulin administration, IP or SC, does not influence the systemic redox sta‐ tus in patients with type 1 diabetes mellitus (T1DM)
free sulphydryl (R‐SH) concentrations at base‐ line and at the end of the study were higher among T1DM patients treated with IP insulin, this was not significantly different as com‐ pared to the group of patients treated with SC insulin
In the only previous study that investigated the in‐ fluence of the route of insulin administration on the redox status, an identical dose of insulin was administered for 4 weeks via the IP and SC route to STZ‐induced diabetic rodents.[20]
Summary
This multicentre study was investigator‐initiated and had a prospec‐ tive, observational matched case‐control design. Gender (male = 1) Age (years) Current smokers (yes = 1) Current alcohol use (%) BMI (kg/m2) Systolic blood pressure (mm Hg) Diabetes duration (years) Retinopathy present (yes = 1) Neuropathy present (yes = 1) Nephropathy present (yes = 1) Macrovascular complication present (yes) Total insulin dose (IU/d/kg) HbA1c (mmol/mol) Fasting glucose (mmol/L) C‐peptide C‐reactive protein Creatinine (μmol/L) Albumin (U/L) Alkaline phosphatase (U/L) Gamma‐GT (U/L) AST (U/L) ALT (U/L) HDL‐cholesterol LDL‐cholesterol Triglycerides Urine microalbumin:creatinine ratio MAGE MODD CV Route of insulin administration (SC = 1).
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