Adipose tissue dysfunction and metabolic disorders: Is it possible to predict who will develop type 2 diabetes mellitus? Role of markErs in the progreSsion of dIabeteS in obese paTIeNts (The RESISTIN trial)

The aim of this study was to valuate if there are some differences in metabolic parameters among obese which will develop diabetes and those that will not develop diabetes. We enrolled 959 obese, normal glucose tolerant, of either sex, outpatients and evaluated them for 8 years. We evaluated: body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), fasting plasma insulin (FPI), homeostasis model assessment (HOMA) index, blood pressure, lipid profile, lipoprotein(a), adiponectin (ADN), resistin, leptin, high sensitivity reactive protein (Hs-CRP), tumor necrosis factor-alpha (TNF-alpha), retinol binding protein-4 (RBP-4), adipsin, vaspin, visfatin, omentin-1, chemerin. After 8 years of observation, 429 patients maintained euglycemia, while 133 patients developed dysglycemia, and 90 developed diabetes. In dysglycemic patients, ADN was lower, and resistin was higher compared to baseline, while in diabetic patients ADN was lower, and resistin was higher both compared to baseline, and compared to euglycemic and dysglycemic patients. High sensitivity C-reactive protein, TNF-alpha were higher in both dysglycemic and diabetic patients compared to baseline, but the values recorded in diabetics were higher both compared to euglycemic and dysglycemic. Visfatin was higher and omentin-1 was lower compared to baseline, and compared to euglycemic patients in diabetics. Odds ratio showed that lower levels of adiponectin and higher levels of resistin, but not of other cytokines, increased the risk of developing type 2 diabetes mellitus. Data seem to suggest that lower levels of adiponectin, and higher levels of resistin can be predictive of a future diabetes in obese people, even years before the disease onset.