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On the fringe of understanding the diabetes disease paradox: A multidisciplinary approach in combining clinical practice and immunology
Tuesday, November 5, 2013
Roselande Marcellon, MA, MPH,
School of Public Health and School of Medicine, Division of Graduate Medical Sciences, Boston University, Boston, MA
Background: Type 2 Diabetes (T2D) is a growing epidemic in the United States and around the world. Despite evidence in support of lowering hemoglobin A1c (A1c) to 7% or less, some studies have found that T2D patients who achieve these levels still experience adverse outcomes. We evaluate B lymphocyte production of proinflammatory chemokine interleukin 8 (IL-8) in order to profile T2D patients. Methods: B cells were isolated from whole blood samples of T2D patients (N=48) and IL-8 (basal and stimulated) production was measured. Subjects were grouped by basal IL-8; high (Group 1), intermediate (Group 2), and no response (Group 3). Clinical data was obtained and used to complete the Diabetes Severity Index (DSI). Estimates for odds ratios and 95% confidence intervals were obtained using logistic regression. Results: Clinically, Group 1 had the lowest A1c (median =7.7%) and highest DSI (mean=7.4). Immunologically, Group 1 had the highest mean basal and stimulated IL-8 levels (p< 0.001 and p< 0.03, respectively). Group 1 had 1.23 times the odds of having renal disease and 1.06 times the odds of having cardiovascular disease compared to other groups (95% CI: (0.202, 7.506) and (0.285, 3.924)). Conclusion: The findings profile a unique subgroup of T2D patients by IL-8 levels. T2D patients with the highest IL-8 production may be at higher risk for adverse outcomes despite having the lowest A1c. The data suggests IL-8 production and DSI score can help profile T2D patients by characterizing additional risks that may be overlooked when using parameters like A1c.
Learning Areas:
Basic medical science applied in public health
Chronic disease management and prevention
Clinical medicine applied in public health
Epidemiology
Learning Objectives:
Describe subgroups of patients with type 2 diabetes based on immunological parameters
Evaluate disease severity in patients with type 2 diabetes using a combination of clinical and immunological parameters
Identify measures that can be used by clinicians to monitor and effectively intervene in patients with type 2 diabetes that may be at risk for experiencing adverse outcomes when lowering hemoglobin A1c
Keyword(s): Diabetes, Disease Management
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have assisted in and presented on research that focuses on type 2 diabetes. I have worked on an industry sponsored study focused on type 2 diabetes. In addition, my scientific and academic interests have been focused on diabetes research and increasing knowledge in this area.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
