Screening of insulin resistance in patients with hemodialysis

Abstract

Insulin resistance (IR) is defined as a violation of the biological response to stimulation of the heart, skeletal muscle, liver, and adipose tissue. The reasons for the formation of the syndrome are diverse, and clinical diagnosis is difficult since there is no generally accepted test available to determine it. For the diagnosis of IR directly and indirectly developed test groups. The complexity of their implementation in some cohorts of patients led to the development of a number of glycemic indices. However, no consensus has yet been reached on which one should be preferred. THE AIM: to compare IR screening methods in a cohort of hemodialysis patients. PATIENTS AND METHODS. 124 patients were examined, including 66 men and 58 women aged 57.6 ± 13.6 years, receiving HD treatment for 75.4 ± 44.5 months. For the screening of IR, the HOMA-1 and HOMA-2 glucose homeostasis model, QUICKI index, and triglycerides/glucose (TriH) were used. RESULTS. When conducting a nonparametric correlation analysis for fasting insulin plasma concentrations, statistically significant relationships were revealed only in men: with BMI (Rs = 0.258 p = 0.049), waist circumference to height ratio (Rs = 0.316 p = 0.015), and amount of dietary protein (Rs = 0.271 p = 0.039), systolic blood pressure (Rs = 0.308 p = 0.018), diastolic blood pressure (Rs = 0.290 p = 0.027), C-reactive protein level (Rs = 0.579 p = 0.0001). In women, no statistically significant correlations were found. The value of the Charlson index, as well as tobacco smoking, currently or in the history of the indicators of insulin resistance had no effect. According to the results of logistic regression analysis, the risk of developing clinical manifestations of atherosclerotic lesions of any vascular pool increased by 4.5 times (χ2 = 4.582 p = 0.032) with IR in the HOMA-1 model of more than 2.7 units, however, only in men. The relationship of other indicators of IR with atherosclerosis was not identified. CONCLUSION. A comparison of surrogate models of IR, from our point of view, allows us to distinguish HOMA-1 and HOMA-2. Probably, for the cross-sectional studies it is advisable to use the first of them, and for longitudinal – the second.

GLP-1 Analogs, SGLT-2, and DPP-4 Inhibitors: A Triad of Hope for Alzheimer’s Disease Therapy

“…Insulin resistance is a complex phenomenon that occurs when cells in the body become less responsive to the effects of insulin, a hormone produced by the pancreas. Its primary function is to facilitate the uptake of glucose from the bloodstream into cells, where it can be used as an energy source or stored as glycogen in the liver and muscles [12]. Moreover, recent research has been uncovering a compelling connection between insulin resistance and brain health, highlighting its potential involvement in various neurological and cognitive disorders [13].…”

“…This phenomenon hinders the efficient utilization of glucose. It disrupts energy metabolism within neurons, thereby compromising their ability to generate adenosine triphosphate (ATP), a crucial molecule for cell survival and proper function [12,14]. Moreover, insulin resistance is believed to exacerbate oxidative stress and trigger neuroinflammatory processes within brain cells [14].…”

“…Insulin resistance plays a key role in the pathogenesis of type 2 diabetes (T2DM) and may be associated with memory and learning disorders [12]. Brain insulin sensitivity leads to neurodegeneration due to the build-up of amyloid plaques.…”

“…Emerging research has shed light on the presence of SGLT-2 receptors in various areas of the body, including the central nervous system. This has prompted investigations into the mechanisms and potential advantages of SGLT-2 inhibitors within the central nervous system (CNS) [11,12]. Recent studies have identified SGLT-2 receptors in choroid plexus epithelial cells and ependymal cells of the brain.…”

“…Some research suggests that SGLT-2 inhibitors may influence atherosclerotic risk factors and pathways involved in both the acute and late stages of stroke, indicating a broader impact on cerebrovascular health [12]. Notably, a 2020 study conducted by Hierro-Bujalance et al delved into the impact of empagliflozin, a representative drug from the SGLT2 inhibitor group, on vascular damage and impairment in a mixed murine model of Alzheimer's disease and type 2 diabetes.…”