Insulin Resistance and Contrainsular Response in Type 2 Diabetes Mellitus Patients with Acute Coronary Syndrome

Abstract

BACKGROUND: The number of patients with diabetes mellitus (DM) is progressively increasing all over the world. Over the past three decades, the global burden of diabetes has increased from 30 million in 1985 to 382 million in 2015, and current trends indicate that the prevalence of diabetes grows progressively. The phenomenon of insulin resistance established in the majority of type 2 DM (T2DM) patients. T2DM is associated with β-cell deficiency, α-cell resistance to insulin, and reduced effects of incretin. However, the role of insulin and glucagon in the process of cardiovascular complications in diabetic patients is a matter of debate.
 AIM: Our study aims to estimate insulin resistance and the contrainsular response in patients with T2DM and acute coronary syndrome (ACS).
 METHODS: The 104 T2DM patients aged 18–70 years participated in the observational study carried out in the Karaganda regional cardiosurgery hospital and ambulatory. The first group included 37 patients hospitalized for ACS in the first 24 h of admission. The second group included 67 patients without ACS. Determination of insulin resistance and contrainsular response was provided using a multiplex immunological assay with XMap technology on Bioplex 3D.
 RESULTS: During the research, we have discovered a decreased level of glucagon and increased homeostasis model assessment of insulin resistance (HOMA-IR) in patients with T2DM diabetes and ACS. Evaluation of traditional correlation interactions of HOMA-IR and indicators of carbohydrate metabolism showed a positive correlation with fasting plasma glucose in both study groups (Group 1: R = 0.47, p = 0.003; Group 2: R = 0.41, p = 0.024). Glucagon-like peptide (GLP)-1 has a weak positive correlation with HOMA-IR only in the first group (R = 0.32, p = 0.006). Increased insulin resistance was associated with high GLP-1 levels and low glucagon. The logistic regression model established that an increased HOMA-IR index rises the chance of ACS by 10.6% (OR = 1.106 [95% CI 1.105–1.206], p = 0,021). The logistic regression model, reflecting the relation between glucagon and ACS, shows that increased glucagon reduces the ACS odds (OR = 0.989 [95% CI 0.979–0.999], p = 0.026). The adjusted regression model showed no significant influence of early presented factors on the probability of ACS.
 CONCLUSION: There is a trend toward elevated HOMA-IR insulin resistance index and decreased level of glucagon in diabetic patients with ACS.