EFFECT OF FORCED RESETTLEMENT ON CHRONIC INFLAMMATION AND INSULIN RESISTANCE IN DIABETIC CARDIAC AUTONOMIC NEUROPATHY
DOI:
https://doi.org/10.21856/j-PEP.2025.1.04Keywords:
internally displaced persons, type 2 diabetes mellitus, cardiac autonomic neuropathy, chronic low-grade inflammation, insulin resistanceAbstract
Emotional reactions to psychosocial stress in internally displaced persons (IDPs) are accompanied by a disturbance of the autonomic nervous system (ANS). ANS dysfunction plays an important role in the modulation of chronic low-grade inflammation (CLGI), is associated with the development of insulin resistance (IR), type 2 diabetes mellitus (T2DM) and cardiac autonomic neuropathy (CAN).
Objective. To evaluate the features of some indicators of CLGI and IR in internally displaced persons with subclinical diabetic CAN.
Materials and methods. We examined 15 practically healthy individuals (group 1, control), patients with T2DM with subclinical CAN residents of Lviv and the region (group 2, n = 15) and patients with T2DM with subclinical CAN who received IDP status (group 3, n = 15). Age, sex, duration of T2DM, BMI and HbA1c did not differ in the groups (P > 0.05). Subclinical CAN was determined by verification of impaired cardiovascular reflex tests and results of short-term heart rate variability. The content of high-sensitivity C-reactive protein (hsCRP), immunoreactive insulin (IRI), tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 in the blood was determined using enzyme-linked immunosorbent assay systems. The index of IR (HOMA-IR) and TNF-α/IL-10 were calculated. The obtained data were compared using the nonparametric Mann-Whitney test, and the median (Me) and interquartile range (Q25-Q75) were used to describe them. Statistical significance at the level of P < 0.05. TIBCO Software Inc. (v. 14.0.0.15).
Results. Comparative analysis of HOMA-IR revealed that the most pronounced IR was observed in patients with T2DM with subclinical CAN who received IDP status (5.2 ± 1.7 [2.8; 8.1]) compared with patients in group 2 (P2 < 0.05). An increase in hsCRP was detected in patients with subclinical CAN, which is especially characteristic of patients in group 3 (9.9 ± 4.9 [2.1; 18.7] mg/L, P2 < 0.05). At the same time, the content of TNF-α, IL-6, IL-10, as well as the indices of TNF-α/IL-10 were increased. The most pronounced increase in TNF- α and TNF-α/IL-10 was observed in IDPs with subclinical CAN (17 ± 4.9 pg/mL [2.8; 21.6], P2 < 0.001) and 3.0 ± 2.9 [0.2; 9.9] (P2 < 0.05).
Conclusions. Comparative analysis of HOMA-IR indices suggests that the most pronounced IR is observed in patients with T2DM with subclinical CAN who received IDP status. Subclinical CAN in patients with T2DM who received IDP status is characterized by a more significant increase in the concentration of hsCRP, TNF-α, and TNF-α/IL-10.
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