A Critical Appraisal of the Diagnostic and Prognostic Utility of the Anti-Inflammatory Marker IL-37 in a Clinical Setting: A Case Study of Patients with Diabetes Type 2

Abstract

Background: The role of the cytokine interleukin-37 (IL-37) has been recognized in reversing inflammation-mediated metabolic costs. The aim was to evaluate the clinical utility of this cytokine as a diagnostic and prognostic marker in patients with type 2 diabetes (T2D). Methods: We included 170 older (median: 66 years) individuals with T2D (females: 95) and classified as primary care attenders to assess the association of factors that describe patients with plasma IL-37 levels (expressed as quartiles) using multinomial regression models. We determined the diagnostic ability of IL-37 cut-offs to identify diabetes-related complications or patient subgroups by using Receiver Operating Characteristic analysis (c-statistics). Results: Frailty status was shown to have a suppressive effect on IL-37 circulating levels and a major modifying effect on associations of metabolic and inflammatory factors with IL-37, including the effects of treatments. Situations in which IL-37 reached a clinically significant discriminating ability included the model of IL-37 and C-Reactive Protein in differentiating among diabetic patients with low–normal/high BMI ((<25/≥25 kg/m2), and the model of IL-37 and Thyroid Stimulating Hormone in discriminating between women with/without metabolic syndrome. Conclusions: The study has revealed limitations in using classical approaches in determining the diagnostic and prognostic utility of the cytokine IL-37 in patients with T2D and lain a foundation for new methodology approaches.

The Reasons for the Low Uptake of New Antidiabetic Drugs with Cardiovascular Effects—A Family Doctor Perspective

“…Studies that assess the feasibility of using clustering techniques from data science application areas are underway, wanting to identify subcategories of patients with T2D that can be discriminated against in terms of CV and other poor outcomes and responses to treatment. Our research group has contributed to these efforts [ 32 , 33 , 89 ]. Regarding treatment, precision medicine looks at variations in drug effectiveness in specific patient subgroups and seeks markers (especially genetic markers) that can predict adverse drug events [ 87 ].…”

“…The unpublished results from our research that is cited in refs. [ 32 , 33 ] (N = 170, F:M = 95:75, age 50–89 years, median 66). The simplified criteria for prescribing GLP-1ra or SGLT2inh: C1: Atherosclerotic CVD (Coronary artery disease, Periphery artery disease or Cerebrovascular disease); C2: Age ≥ 55 years + chronic heart disease; C3: estimated glomerular filtration rate ((eGFR) < 60 mL/min).…”

A Patient-Centered Management of Patients with Diabetes Type 2: Are All Diabetic Patients the Same?

“…In elderly people with T2D, we recognize at least two metabolic types of frailty: one characterized by obesity and high insulin resistance (sarcopenic obesity phenotype) and another characterized by muscle and body mass loss and low insulin resistance (anorexic malnourished phenotype). So far, it has not been clarified whether a lower BMI (<25 kg/m 2 ) reflects the presence of frailty or only reduced body mass without the presence of frailty (Figures 1 and 2) [30,31]. Also, it is still not clear how many phenotypic forms women with MS can have, considering possible differences in BMI, renal function, and the existence of CVD and frailty [30].…”

“…So far, it has not been clarified whether a lower BMI (<25 kg/m 2 ) reflects the presence of frailty or only reduced body mass without the presence of frailty (Figures 1 and 2) [30,31]. Also, it is still not clear how many phenotypic forms women with MS can have, considering possible differences in BMI, renal function, and the existence of CVD and frailty [30].…”