Inflammatory markers as risk factors for microangiopathy in type 1 diabetic patients on functional intensive insulin therapy from the onset of the disease

Our aim was to assess the incidence and predictors of nephropathy and retinopathy in type 1 diabetic patients treated with intensive functional insulin therapy (IFIT) from the onset of disease. We recruited 100 patients aged under 30 years with newly diagnosed type 1 diabetes, educated in IFIT at baseline. We assessed at baseline and every year: diabetic knowledge, hypoglycaemic episodes, quality of life, metabolic control, serum concentration of C-peptide, hsCRP, intracellular adhesion molecule-1 (sICAM-1), vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNFα).At follow-up (6.1 ± 1.6 years), 17 patients with background retinopathy had higher: FPG (13.5 ± 4.1 mmol/l versus 10.1 ± 3.6 mmol/l, p = 0.0018), HbA1c (8.8 ± 1.3% versus 8.1 ± 1.4%, p = 0.04), systolic blood pressure (128.1 ± 16.6 mmHg versus 119.8 ± 14.0 mmHg, p = 0.04) and sICAM-1 (290.9 ± 100.0 ng/ml versus 237.12 ± 53.44 ng/ml, p = 0.03). The risk of retinopathy was associated with the level of diabetic knowledge (OR = 7.84; 95%CI: 1.07–57.42, p = 0.02), low HDL cholesterol level (OR = 4.86; 95%CI: 1.41–16.87, p = 0.01), high SBP (OR = 3.75; 95%CI: 1.16–12.19, p = 0.03) and DBP (OR = 7.43; 95%CI: 2.11–26.15, p = 0.002). Eighteen subjects with positive microalbuminuria had higher values of: HbA1c (9.0 ± 1.8% versus 8.0 ± 1.3%, p = 0.04), triglycerides (1.5 ± 1.0 mmol/l versus 1.0 ± 0.4 mmol/l, p = 0.01), LDL cholesterol (3.6 ± 1.1 mmol/l versus 3.0 ± 0.9 mmol/l, p = 0.01), hsCRP (4.9 ± 4.9 mg/l versus 1.8 ± 1.9 mg/l, p = 0.02) and VEGF (376.62 ± 216.26 pg/ml versus 250.68 ± 130.67 pg/ml, p = 0.02). We observed relationship between microalbuminuria and BMI (OR = 4.50; 95%CI: 1.42–14.22, p = 0.013), low HDL cholesterol (OR = 7.28; 95%CI: 2.06–25.66, p = 0.002), high LDL cholesterol (OR = 4.61; 95%CI: 1.33–15.97, p = 0.01) and triglycerides (OR = 8.33; 95%CI: 1.73–40.12, p = 0.009), diastolic blood pressure (OR = 11.43; 95%CI: 3.16–41.36, p = 0.0002) and hsCRP (OR = 4.40; 95%CI: 1.15–16.86, p = 0.047). The results indicate the influence of low-grade inflammatory process and insulin resistance on the development of diabetic microangiopathy.