Effect of Optimization of Glycaemic Control on Mannan-Binding Lectin in Type 1 Diabetes.

Gry Høst Dørflinger,Jakob Appel Østergaard,Steffen Thiel,Charlotte Brink Holt,Troels Krarup Hansen

doi:10.1155/2017/1249729

Gry Høst Dørflinger, Jakob Appel Østergaard + Show 3 more

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https://doi.org/10.1155/2017/1249729

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Abstract

Objective Mannan-binding lectin (MBL) concentration in plasma is increased in subjects with type 1 diabetes and associated with increased mortality and risk of diabetic nephropathy. Recent findings show that pancreas transplantation reduces MBL concentration. Whether the increased MBL concentration is reversed by improved glycaemic control remains unknown. We investigated the effects of improved glycaemic control on MBL concentration in patients with type 1 diabetes. Methods We measured MBL, fructosamine, and HbA1cat baseline and after 6 weeks in 52 type 1 diabetic patients following the change from conventional insulin therapy to insulin pump therapy. Results After initiation of insulin pump therapy, the total daily insulin dose was significantly reduced (from 51 ± 18 IE/day to 39 ± 13 IE/day, P < 0.0001). There was a significant decrease in HbA1c from 8.6% to 7.7% (from 70 mmol/mol to 61 mmol/mol, P < 0.0001) and in fructosamine levels (from 356 μmol/L to 311 μmol/L, P < 0.0001). MBL levels decreased by 10% from 2165 μg/L (IQR 919–3389 μg/L) at baseline to 1928 μ/L (IQR 811–2758 μg/L) at follow-up (P = 0.005), but MBL change was not significantly correlated with changes in insulin dose, HbA1c, or fructosamine. Conclusions MBL concentration decreased following the initiation of insulin pump therapy in patients with type 1 diabetes and did not correlate with changes in glycaemic control.

Highlights

Diabetic vascular complications progress in part as a consequence of hyperglycaemia
In patients with mannan-binding lectin (MBL) above the median, MBL concentration changed from 3379 μg/L (IQR 2535–4061 μg/L) to 2711 μg/L (IQR 2199–3910 μg/L) (P = 0 07) whereas in patients with MBL below the median, MBL concentration changed from 955 μg/L (IQR 399–1429) to 877.5 (252–1149) (P = 0 01)
Our main goal was to examine the impact of improved glycaemic regulation on MBL levels in patients with type 1 diabetes

Summary

Introduction

Diabetic vascular complications progress in part as a consequence of hyperglycaemia. A growing body of evidence links the complement system, in particular mannan-binding lectin (MBL) and the lectin partway, to this pathophysiological process.MBL is a soluble pattern recognition molecule of the innate immune system that may activate the complement system via the lectin pathway. Concentration of circulating MBL is predominantly determined by the genotype, where polymorphisms give rise to large interindividual differences [1]. Intraindividual differences in MBL concentrations are far smaller [2] and fluctuate as an acute-phase response [3] and from hormonal influence [4, 5]. MBL levels are increased in patients with type 1 diabetes, and high levels of MBL have been associated with increased mortality [6] and development of nephropathy [7,8,9]. Deficiency of MBL protects mice against diabetic nephropathy [13]. Low MBL levels have been associated with enhanced risk of myocardial infarction [14] and more pronounced plaque formation [15]. MBL seems to have a beneficial role in the clearance of atherogenic lipoproteins by monocytes and macrophages [16]

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