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CORRELATION BETWEEN SERUM LEVELS OF ADIPONECTIN AND TUMOUR NECROSIS FACTOR-ALPHA WITH INSULIN RESISTANCE INDEX IN GESTATIONAL DIABETES MELLITUS
Abstract
Background: Gestational Diabetes Mellitus results from an imbalance between insulin resistance and insulin secretion capacity during pregnancy. Adiponectin and TNF- are cytokines that are proposed to be involved in the pathogenesis of the insulin resistance; but findings from studies across different ethnic groups are inconsistent or even conflicting.
Objectives: The purpose of this study is to determine the relationship between serum levels of Adiponectin, TNF- and insulin resistance index in Nigerian pregnant women with gestational diabetes mellitus.
Design: A cross sectional analytical study involving 100 pregnant women with gestational diabetes mellitus and another 100 apparently healthy pregnant women with normal glucose tolerance.
Method: Participating pregnant women were evaluated between 24-30 weeks gestation using interviewer-administered questionnaire, anthropometric measurement and a 75g Oral Glucose Tolerance Test (OGTT). Diagnosis of GDM was based on the WHO criteria. Fasting blood samples were taken during the OGTT session to measure insulin, adiponectin and TNF- levels. Insulin resistance index was calculated as HOMA-IR. The serum levels of adiponectin, TNF- and the degree of insulin resistance were compared between pregnant women in the GDM and control groups, and a multivariate correlation analysis was used to determine the relationship between serum levels of adiponectin, TNF- and the insulin resistance index.
Results: Both GDM patients and controls have a similar mean age, parity and gestational age of (25.6 ± 5.4 vs. 26.9 ± 5.4 years, p > 0.05), (2.3 ± 1.5 vs. 2.6 ± 1.7, p > 0.05) and (26.5 ± 1.7 vs. 26.7 ± 1.6 weeks, p > 0.05) respectively. GDM patients have significantly greater mean pregnancy BMI than the controls (25.4 ± 4.0 vs. 23.4 ± 3.7 kg/m2, p < 0.05). Mean serum adiponectin level was significantly lower in the GDM patients than in the controls (8.1 ± 1.6 vs. 10.2 ± 2.5 µg/ml, p < 0.05). Mean serum TNF- was significantly higher in the GDM patients than in the controls (2.49 ± 0.30 vs. 2.05 ± 0.28 ng/ml, p < 0.05). Pregnant women with GDM were more insulin resistant than the controls (3.14 ± 0.19 vs. 2.89 ± 0.20, p < 0.05). Decreased adiponectin level was associated with higher insulin resistance in the GDM patients (r = -0.58, p < 0.05). There was also a positive correlation between TNF- level and insulin resistance in the GDM group (r = 0.49, p < 0.05). These associations remained significant even after adjustment for age and body mass index. Multiple linear regression analysis indicated that adiponectin and TNF- were independent predictors of insulin resistance in pregnancies complicated by GDM.
Conclusion: Decreased serum adiponectin and increased serum TNF- levels are associated with higher insulin resistance independent of age and BMI in pregnant Nigerian women with GDM; and therefore might play a role in the pathogenesis of the insulin resistance leading to GDM.
