Inflammation‐associated insulin resistance: Differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms

Abstract

Objective. Insulin resistance is increased by inflammation, but the mechanisms are unclear. The present study was undertaken to test the hypothesis that decreased insulin sensitivity is differentially associated with mediators of inflammation by studying 2 chronic inflammatory diseases of different pathogenesis, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Methods. We measured fasting insulin, glucose, and lipid levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor ␣ (TNF␣), and coronary artery calcification in 103 patients with SLE and in 124 patients with RA. Insulin sensitivity was measured using the homeostasis model assessment (HOMA) index.Results The association between the ESR and the HOMA value in patients with SLE remained significant after adjustment for confounding covariates (P ‫؍‬ 0.008). In multivariable models, the major contributing factors to the HOMA index were the BMI in SLE patients, and IL-6 and TNF␣ levels in RA patients.Conclusion. The pathogenesis of insulin resistance and its contribution to atherogenesis varies in different inflammatory settings.

Increased Insulin Resistance and Glucagon Levels in Mild/Inactive Systemic Lupus Erythematosus Patients Despite Normal Glucose Tolerance

“…Because 30% of our SLE patients were using PRED, this could have contributed to the higher IR observed in this group. We did not observe any correlations between current dose of PRED and markers of insulin sensitivity, which is in line with previous studies, showing no association between corticosteroid intake and HOMA IR (7,15,38). However, the insulinogenic index, which takes into account the insulin response 30 minutes after food intake, was positively correlated with current PRED dose in the SLE group.…”

“…SLE patients, even with mild disease, show higher levels of inflammatory cytokines (13). However, although 1 study has observed an association between circulating inflammatory cytokines and IR in SLE patients with mild disease (14), others have not confirmed this finding (2,15).…”

Metabolic effects of high‐dose prednisolone treatment in early rheumatoid arthritis: Balance between diabetogenic effects and inflammation reduction

“…These processes are closely related: if insulin sensitivity decreases, a healthy beta cell will respond by augmenting insulin secretion, to prevent hyperglycemia (3). In RA patients, impaired insulin sensitivity, as assessed in the fasting state using the homeostatic model assessment of insulin resistance (HOMA-IR), has been reported, and this was associated with measures of disease activity and plasma levels of inflammatory proteins, including C-reactive protein (CRP), tumor necrosis factor ␣, and interleukin-6 (4,5).…”

Foxp3+t-Regulatory Lymphocytes and Autoantibodies in Patients With Arterial Hypertension, Associated With Diabetes Mellitus Type 2 and Impaired Glucose Tolerance

“…Оба варианта формирования патологического состояния являются равноверо-ятными. Так, например, было показано, что ин-сулинорезистентность развивается у пациентов с системной красной волчанкой и ревматоидным артритом [6]. Вместе с тем, появляется все больше данных в пользу того, что СД 2-го типа в отсут-ствие клинических проявлений какой-либо ауто-иммунной патологии сопровождается изменени-ем функционирования Т-и В-лимфоцитов [9,10].…”