Type 2 diabetes mellitus and its renal complications in relation to apolipoprotein E gene polymorphism

The apolipoprotein E (APOE) epsilon 2 allele is reported to be associated with greater risk of renal impairment in type 2 diabetes. Relationships among APOE polymorphisms, renal impairment, and biochemical parameters were explored. A prospective study of 405 consenting Chinese type 2 diabetic patients (mean age standard deviation (SD): 59.2 +/- 10.3 years) without advanced complications at entry was conducted. APOE genotyping and measurement of plasma biomarkers of oxidative stress and antioxidants were performed at entry. HbAIC, plasma glucose, lipids, creatinine, urine albumin/creatinine, and blood pressure were measured at entry and at up to 4 years of follow-up. APOE allelic frequencies were in Hardy-Weinberg equilibrium. Odds ratios of albuminuria at entry and/or during follow-up for different APOE groups were not significantly different. The non-epsilon 2 (epsilon 3/3, epsilon 3/4, epsilon 4/4) group had significantly greater plasma ascorbate (51.6 +/- 20.1 mu mol/L) than the epsilon 2 (epsilon 2/2, epsilon 2/3) group (44.5 +/- 16.2 mu mol/l., P = 0.021), but higher plasma ascorbate levels did not seem to decrease the risk of renal impairment in the non-epsilon 2 group. Baseline plasma lipid-standardized alpha-tocopherol levels were least in epsilon 2 subjects with persistent albuminuria (3.6 +/- 1.1 mu mol/mmol of total cholesterol plus triglycerides, P = 0.008) compared with epsilon 2 subjects who had no albuminuria at entry or during follow-up (4.5 +/- 0.8 mu mol/mmol of total cholesterol plus triglycerides). The APOE epsilon 2 allele does not seem to be associated with increased risk of renal impairment in Chinese type 2 diabetic patients. Plasma lipid-standardized alpha-tocopherol may play a role in determining risk of renal dysfunction in type 2 diabetes.