Role Of Leptin/Adiponectin Ratio In Iraqi Type 2 Diabetic Patients Treated With Different Antidiabetic Agents

Abstract

Background: Leptin/adiponectin ratio has a potential additional value as a marker of central role of excess adipose tissue in insulin resistance, thus it contributes in the modulation of diabetes mellitus risk. Adipose tissue is involved in the regulation of energy balance and insulin action in type 2 diabetes mellitus patients.Aim of this study: Study of the role of leptin/adiponectin ratio and its association with insulin resistance in type 2 diabetic patients treated with different oral antidiabetic agents.Materials and Methods: Ninety patients with type 2 diabetes mellitus (45 males and 45 females) age between (35-60 years) and body mass index (<25) were enrolled in this study in addition to 40 healthy subjects matched with the patients for age, gender and body mass index. This study was conducted between March to December 2016 in the National Diabetes Center for Treatment and Research and Al-Yarmook teaching hospital/ Baghdad/ Iraq. We divided the patients into three groups according to medication option: Group I-include 30 type 2 diabetic patients treated with metformin alone, Group II-include 30 type 2 diabetic patients treated with glibenclamide alone, Group III-include 30 type 2 diabetic patients treated with metformin and glibenclamide. Blood samples were analyzed for fasting serum glucose, glycosylated heamoglobin, fasting serum insulin, total cholesterol, triglyceride, high density lipoprotein cholesterol, serum leptin, serum adiponectin, homeostasis model assessment of insulin resistance and leptin/adiponectin ratio.Result: Fasting serum glucose, glycosylated heamoglobin, fasting serum insulin, insulin resistance, total cholesterol, triglyceride and serum leptin levels showed significant increase in diabetic patients when compared with control group (p<0.05). High density lipoprotein cholesterol and serum adiponectin levels showed significant decrease in diabetic patients (p<0.05), while leptin/adiponectin ratio was significantly higher for diabetics as compared with controls (p<0.01). Leptin concentration was significantly low as well as adiponectin concentration was significantly higher in type 2 diabetic patients treated with metformin alone (group I) when compared to those treated with glibenclamide alone (group II) or those treated with metformin plus glibenclamide (group III), while non-significant difference was noticed between (group II) and (group III). Homeostasis model assessment of insulin resistance in group I and III (patients treated with metformin as monotherapy or combination) showed a significant positive correlation with leptin and negative correlation with adiponectin (p<0.01), but non-significant correlation was recorded in group II (patients treated with glibenclamide alone). Correlation of homeostasis model assessment of insulin resistance with leptin/adiponectin ratio found to be significant in metformin treated groups (p<0.05) while non-significant with glibenclamide group. Conclusion: Leptin/adiponectin ratio in type 2 diabetes mellitus can serve as an index of insulin resistance independent of body mass index. Leptin/adiponectin ratio can measure the usefulness of antidiabetic therapy based on insulin level and insulin sensitivity.