Cardiometabolic characteristics of type 2 diabetes patients depending on obesity phenotypes

Abstract

Background. The problem of studying the causes and mechanisms of metabolic disorders in metabolic syndrome and type 2 diabetes mellitus (T2DM) is one of the most important questions in modern medicine. It is due to the growing prevalence of dysmeta­bolic conditions and their serious consequences for the population health in the modern world. The initial hypothesis was that the differences in hormonal and metabolic conditions in patients with T2DM can be explained by the peculiarities of the anabolic-catabo­lic balance in different metabolic phenotypes. The aim of the work was to study the features of anthropometric and compositional parameters, indicators of carbohydrate, lipid and purine metabolism, anabolic-catabolic balance as predictors of cardiovascular diseases in patients with T2DM, depending on the phenotype. Materials and methods. One hundred and sixty-five patients with T2DM were included in the study, 71 women and 94 men aged from 32 to 82 years (59.0 ± 8.3 years). They had a level of glycated hemoglobin higher than 6.7 % (8.3 ± 1.8 %) against the background of taking oral hypoglycemic agents. Results. During the examination, it was found that the metabolism of patients without general obesity has a predominantly catabolic orientation, which, compared to those with general obesity, is manifested in a lower absolute accumulation of total and visceral fat, a reduced level of uricemia (due to a lower reabsorption of urate in the renal tubules, a lower activity of the anabolic pathway of reutilization), which is accompanied by a lower level of anabolic hormones, insulin and dehydroepiandrosterone sulfate (DHEA-S), and a higher level of the catabolic stress hormone cortisol. General obesity in patients with body mass index ≥ 30 kg/m2 is caused by the predominant influence of anabolic hormones (insulin, DHEA-S), which contribute to the de novo synthesis of fatty acids and purine bases, the reutilization of purines and the reabsorption of uric acid. This leads to the accumulation of fat in the subcutaneous and visceral adipose tissue and an increase in the level of uricemia under the conditions of a lower content of the catabolic hormone cortisol. Conclusions. The application of a set of anthropometric, composition biochemical and hormonal indicators allows for a differential diagnosis of alimentary hypokinetic (anabolic) and stress (catabolic) phenotypes in patients with T2DM. An additional characteristic of the metabolic status in T2DM may be the assessment of uric acid production and excretion in patients with varying degrees of obesity. The listed signs indicate an anabolic type of metabolism in obesity.