How Diabetes and Other Comorbidities of Elderly Patients and Their Treatment Influence Levels of Glycation Products

Abstract

Medical care for geriatric patients is a great challenge, mainly due to various overlapping deficits relevant to numerous coexisting diseases, of which the most common are diabetes mellitus and atherosclerosis. In the case of diabetes, the glycation process is intensified, which accelerates atherosclerosis development and diabetic complications. Our goal was to investigate the relationship between the classical biochemical parameters of diabetes and atherosclerosis, as well as parameters which may indicate a nephropathy, and the parameters strictly related to glycation, taking into account the pharmacological treatment of patients. Methods: We analyzed the patients' serum concentrations of fluorescent glycation product-pentosidine, concentrations of soluble receptors for advanced glycation products (sRAGE), lipoprotein receptor-1 (LOX-1), galectin 3 (GAL3), scavenger receptor class A (SR-A), and scavenger receptor class B (SR-BI), as well as the level of lipid peroxidation and free amine content. Among the identified correlations, the most interesting are the following: sRAGE with triglycerides (r = 0.47, p = 0.009), sRAGE with SR-BI (r = 0.47, p = 0.013), SR-BI with LOX-1 (r = 0.31, p = 0.013), and SR-BI with HDL (r = -0.30, p = 0.02). It has been shown that pentosidine and reactive free amine contents are significantly higher in elderly patients with ischemic heart disease. Pentosidine is also significantly higher in patients with arterial hypertension. Malondialdehyde turned out to be higher in patients with diabetes mellitus type 2 that was not treated with insulin or metformin than in those treated with both medications (p = 0.052). GAL3 was found to be lower both in persons without diabetes and in diabetics treated with metformin (p = 0.005). LOX-1 was higher in diabetic patients not treated with metformin or insulin, and lowest in diabetics treated with both insulin and metformin, with the effect of metformin reducing LOX-1 levels (p = 0.039). Our results were the basis for a discussion about the diagnostic value in the clinical practice of LOX-1 and GAL3 in geriatric patients with diabetes and also provide grounds for inferring the therapeutic benefits of insulin and metformin treatment.

Keywords: aging; diabetes mellitus type 2; elderly diseases; geriatric care; glycation markers.

Figure 1

Scatterplots for selected pairs of analyzed parameters. Scattering of results between GAL3 and HbA1c (panel A), between GAL3 and BMI (panel B), between GAL3 and GFR (panel C), between pentosidine and GFR (panel D), between pentosidine and creatinine (panel E), between pentosidine and LOX-1 (panel F), between sRAGE and triglycerides (panel G), between SR-BI and HDL (panel H), and between LOX-1 and SR-BI (panel I).

Figure 2

Group comparison between variables (box and whisker plots). Comparison of pentosidine (panel A) and reactive free amine content (panel B) in patients with and without ischemic heart disease. Comparison of pentosidine (panel C) in patients with and without hypertension. Comparing the level of reactive free amine content in patients with and without stroke (panel D).

Figure 3

Group comparison between variables (box and whisker plots). Comparison of GAL3 levels in patients with and without diabetes (panel A). Comparison of GAL3 levels in patients taking and not taking metformin (panel B). Comparison of LOX-1 levels in diabetic patients not treated with insulin or metformin, those treated with insulin, those treated with metformin, and those treated with both medications simultaneously (panel C). Comparison of MDA levels between diabetic patients not treated with insulin or metformin, those treated with insulin or metformin, and those treated with both medications simultaneously (panel D). An asterisk (*) indicates between which groups the difference is statistically significant.