SOME ASPECTS OF INSULIN RESISTANCE FORMATION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Keywords:chronic obstructive pulmonary disease, metabolic syndrome, insulin resistance
Background: Chronic obstructive pulmonary disease (COPD) is characterized by a combination of progressive lesions of the broncho-pulmonary system with systemic effects and formation of comorbid pathology. The aim of the research was to investigate probable aspects of insulin resistance (IR) formation in patients with chronic obstructive pulmonary disease by comprehensive assessment of the dependence of carbohydrate metabolism on the pulmonary function tests (PFT), intensity of clinical manifestations (based on СОPD Assessment Test — CAT), inflammation activity and cardiovascular risk (CVR).
Materials and Methods. Data of 73 patients with COPD of stage II-III at remission period were analyzed. The presence of IR was diagnosed by glucose, insulin, HOMA index and C-peptide levels.
Results: In COPD patients, normal fasting glucose levels were provided by a significant increase, compared to control, of insulin production, which is evidenced by an increase of HOMA-IR index (2,8-fold) and C-peptide (2,1-fold). In most the patients with COPD IR was present even at the moderate disorders of PFT. The analysis of carbohydrate metabolism in relation to the CAT value and inflammation activity revealed that even in patients with stable course of disease (CAT < 10 points) there is a significant increase in C-peptide, without changes of glucose, insulin and HOMA-IR index. At CAT ≥ 10 points, all studied indices significantly increased. Also, it was found that even at low CVR, despite normal fasting glucose levels, there is a significant increase in insulin, HOMA-IR index, and C-peptide. At high CVR, these changes were amplified.
Conclusions. In patients with chronic obstructive pulmonary disease the development of insulin resistance is observed even at moderate bronchial obstruction and low cardiovascular risk with an increase in these manifestations according to the elevation of COPD Assessment Test. These changes are one of the leading factors of secondary vascular damage with the development of comorbid pathology of the cardiovascular system, which significantly complicates the course of the disease.
Global Initiative for Chronic Obstructive Lung Disease. GOLD 2020. URL: https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf
Lemko OI, Haysak MO, Reshetar DV. Ukr Therapeutical J 2021;1: 85-92. http://doi.org/10.30978/UTJ2021-1-85.
Naseem S, Baneen U. J Family Med Prim Care 2019;8(10): 3393-3398. http://doi.org/10.4103/jfmpc.jfmpc_482_19.
Zhou W, Li CL, Cao J, Feng J. Clin Respir J 2020;14(12): 1159-1165. http://doi.org/10.1111/crj.13253.
Ghatas T. Egypt J Bronchol 2017;11(1): 11-15. http://doi.org/10.4103/1687-8426.198983.
Lemko O I, Haysak M O, Reshetar DV. Ukr. Therapeutical J 2021;2: 57-65. http://doi.org/10.30978/UTJ2021-2-57.
Piazzolla G, Castrovilli A, Liotino V, et al. PloS ONE 2017;12(10): e0186708. https://doi.org/10.1371/journal.pone.0186708.
Leighton E, Sainsbury CA, Jones GC. Diabetes Ther 2017;8(3): 475-487. http://doi.org/10.1007/s13300-017-0265-4.
Kiran Z, Majeed N, Zuberi BF. Pak J Med Sci 2015;31(6): 1505-1510. http://doi.org/10.12669/pjms.316.7983.
Ishii M, Yamaguchi Ya, Hamaya H, et al. Sci Rep 2019;9: 20206. https://doi.org/10.1038/s41598-019-56759-3.
Liotino V, Vulpi MR, Castrovilli A, et al. Eur Respiratory J 2018;52(62): PA3620. http://doi.org/10.1183/13993003.congress-2018.PA3620.