CORRELATION OF HYPOTHALAMIC-PITUITARY-ADRENAL AXIS ACTIVITY WITH CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES

Selma Jusufović; Alma Halilčević; Šefkija Balić; Enra Đešević; Alma Horozić; Vedad Herenda

doi:10.35120/medisij030301j

Authors

Selma Jusufović Clinic for Endocrinology and Diabetes, University Clinical Centre Sarajevo, Bosnia and Herzegovina
Alma Halilčević Department of Nephrology, Hemodialysis and Transplantation, Internal Medicine Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina
Šefkija Balić Clinic for Endocrinology and Diabetes, University Clinical Centre Sarajevo, Bosnia and Herzegovina
Enra Đešević Clinic for Endocrinology and Diabetes, University Clinical Centre Sarajevo, Bosnia and Herzegovina
Alma Horozić Clinic for Endocrinology and Diabetes, University Clinical Centre Sarajevo, Bosnia and Herzegovina
Vedad Herenda Clinic for Nephrology, University Clinical Centre Sarajevo, Bosnia and Herzegovina

DOI:

https://doi.org/10.35120/medisij030301j

Keywords:

Diabetes type 2, chronic complications, cortisol, dexamethasone, ACTH

Abstract

For the successful prevention of chronic diabetic complications, it is crucial to identify novel etiopathogenetic factors that contribute to their development. We evaluated the association of hypothalamus pituitary adrenal axis activity (HPA) with the presence of chronic diabetic complications and glycemic control in 107 patients with type 2 diabetes and 29 healthysubjects, matched for age and sex. The study included 107 type 2 diabetic patients and 29 healthy control subjects who were hospitalized at the Internal Medicine Clinic of the University Clinical Center Tuzla. Patients with diabetes were evaluated for chronic complications and divided into two groups according to the presence (group 1, n = 57) and absence (group 2, n = 50) of complications. We determined the parameters of the HPA axis as follows: a level of 08 h cortisol and ACTH and a level of 09 hcortisol after a short dexamethasone test (DEX cortisol) and compared those among the groups. We determined the parameters of glycemic control and compared them with the parameters of the hypothalamus pituitary adrenal axis. In group 1, the values of cortisol were 454 (368–561), ACTH 12.6 (8.7–23), and DEX cortisol 37.5 (23-52), significantly higher compared to group 2 [320 (230–387), 7.9 (3.3–16.4), 26 (22–36), p <0.05, and higher compared to healthy subjects [312 (233–342), p = 0.001, 12 (6–16.7), p = 0.1, 24 (19–29), p = 0.126, respectively]. Evaluating the parameters of glycemic control, we found a higher HbA1C in group 1, 7.9 (6.55-9.45) compared to group 2, 7.5 (5.97-10), p = 0.498, while correlation analyses showed a significant positive relationship between HbA1C and cortisol (R = 0.242, p = 0.012). CONCLUSION: Patients with type 2 diabetes have HPA axis dysfunction. Higher cortisol levels are associated with poor glycemic control and the presence of diabetic complications. To better understand the etiology and provide practical solutions for addressing this issue, additional studies are required.

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