[Current laboratory parameters in the differential diagnosis of type 2 diabetes mellitus. Proinsulin, adiponectin and others]

Abstract

During the recent years increasing knowledge has been obtained in the understanding of the coincidence of type 2 diabetes and cardiovascular disease. Insulin resistance and beta cell failure were shown to have a direct impact in the pathogenesis of arteriosclerosis which goes far beyond the effects of elevated glucose levels. The use of additional laboratory parameters for the characterisation of patients with type 2 diabetes on a pathophysiological basis might improve treatment strategies and might help to reduce the cardiovascular risk in patients with type 2 diabetes. Intact proinsulin is secreted from the beta cell and increasing levels of intact proinsulin serve as an indicator of beta cell failure. In addition, increased levels of intact proinsulin were shown to predict insulin resistance with a specificity of 100 % and a sensitivity of about 50 %. On the other side, adiponectin, derived from the visceral adipose tissue, serves as a marker closely correlated to insulin sensitivity. Plasma adiponectin is a very sensitive marker of insulin resistance and might be used for the judgement of therapeutical interventions aimed to improve insulin sensitivity. In addition, both markers are predictive for the estimation of cardiovascular risk in patients with type 2 diabetes. Measurement of inflammation, by high sensitive CRP might add further information about the cardiovascular risk of a patient with type 2 diabetes.