The contributions of fasting and postprandial blood glucose increments to oxidative stress and inflammation in dyslipidemic type 2 diabetic patients with stable ischemic heart disease

Background/objectives: Contributions of fasting and postprandial blood glucose increments on level of inflammation and oxidative stress biomarkers in patients with stable ischemic heart disease (IHD) and diabetes mellitus type 2 (T2DM) was evaluated. Methodology: Ninety T2DM patients (60 with IHD and 30 without IHD) treated with metformin and/or sulphonylurea were enrolled in cross-sectional nested case-control clinical study. The areas under the six point daily glucose curve above the fasting glucose concentrations (AUCpp) and over 5.5 mmol/L (AUCbg) were calculated to determine postprandial (AUCpp) and fasting (AUCbg-AUCpp) glucose increments. Malondialdehyde (MDA), protein carbonyl group (PCO), fibrinogen, C-reactive protein (hsCRP), leukocyte count and adhesion molecules ICAM-1 and VCAM-1 were determined. Results: AUCbg-AUCpp 58.2 (95%Cl 40.6-75.8) was higher in IHD group compared to non-IHD 36.9 (95%Cl 23.5-50.2) mmol*h/L. They had significantly higher ICAM-1 (mean +/- SD) 72.70 +/- 30.6 vs. 60.22 +/- 22.6 ng/mL and MDA 1647 +/- 4.5 vs. 1342 +/- 4.01 mu mol/g plasma proteins, but similar PCO, VCAM-1, fibrinogen, hsCRP concentration and leukocyte count. AUCpp positively correlated with MDA (r = 045) and ICAM-1 (r = 032) in the presence of IHD, and VCAM-1 (r = 044) in the absence of IHD.AUCbg-AUCpp positively correlated with PCO (r = 045) in the absence of IHD. The analysis revealed that AUCpp over turning point of 0 mmol*h/L was associated with high MDA and ICAM-1 expression in diabetics with IHD.AUCbg-AUCpp over 30 mmol*h/L leads to high oxidative protein modification in diabetics without IHD. Conclusion: In T2DM patients with stable IHD,AUCpp at any point, significantly contributes to increasing of MDA and ICAM-1 expression. Fasting blood glucose increment showed significant correlation with carbonyl content in diabetics without IHD. (C) 2016 Elsevier Ireland Ltd. All rights reserved.