ODP214 INSULIN REQUIRING DIABETES MELLITUS(IRDM) and CAD

Abstract

Abstract Background Several studies have shown a higher risk of coronary artery disease(CAD) in insulin-requiring T2 diabetes mellitus(IRDM) patients which could be linked with DNA methylation(proinflammatory cytokines),histone deacetylase activity(mitochondrial function-oxidant stress) and micro RNAs impacting insulin secretion and action, endothelial function and atherosclerotic process. [1,2,3,4,5]. Insulin therapy has been shown to be associated with atherosclerosis. [3]Clinical Study: A retrospective study of twenty T2 DM patients was done to observe the association of IRDM and CAD. There was equal sex distribution with mean age of 55 years in males and 50 years in females. Ten (50%)patients were insulin requiring(IRDM),having a mean insulin requirement of 0.57 units/kg in males and 0.98 units/kg in females. Seven(35%) patients had CAD;five(50%)of IRDM and two(20%)of non-insulin requiring patients. The mean insulin dose of IRDM patients with CAD was 0.74 units/kg in males and 1.3 units/kg in females and those without CAD was 0.30 units/kg in males and 0.73 units/kg in females. There was no significant difference in the prevalence of hypertension, dyslipidemia and nephropathy between the patients with or without CAD. All the three IRDM males with CAD had BMI less than 25 kg/m 2 where as both the IRDM females with CAD had BMI greater than 25 kg/m 2 . Both the IRDM females with CAD had CAD before institution of insulin therapy, though they ultimately required higher insulin dose denoting higher degree of insulin resistance(IR) and suggesting non-contribution of insulin therapy in the pathogenesis of CAD. Conclusion This study highlights a)higher incidence of CAD in IRDM patients, b)higher insulin requirement in CAD patients,c)higher insulin dose in females as compared to males and d)females(all obese)having CAD earlier than males,having CAD before insulin therapy but requiring higher dose than non-CAD females. These could be due to a) insulin deficiency and predominantly IR impacting IRDM[3];b)IR enhancing atherosclerosis((through proinflammatory cytokines, oxidant stress and procoagulant activity (not measured)promoting CAD[2,3,4,]);c)higher BMI[6] and associated greater IR[3] contributing to higher insulin dose in females, though,they required insulin much later;some studies have shown female gender having a protective effect on insulin initiation[5];d)the overlap of traditional CV risk factors viz. dyslipidemia,hypertension, nephropathy in IRDM and non-IRDM patients with or without CAD points towards the predominant contribution of proinflammatory cytokines viz CRP and procoagulants viz . PAI in the aetiopathogenesis of CAD[4]. Further studies on larger patient population are required to substantiate these observations.