Impact of intensive insulin treatment on the development and consequences of oxidative stress in insulin-dependent diabetes mellitus

摘要

Background/Aim. The aim of this study, which included patients with insulin-dependent diabetes mellitus, was to determine the influence of the application of various treatment modalities (intensive or conventional) on the total plasma antioxidative capacity and lipid peroxidation intensity expressed as malondialdehyde (MDA) level, catalase and xanthine oxidase activity, erythrocyte glutatione reduced concentration (GSH RBC), erythrocyte MDA level (MDA RBC), as well as susceptibility of erythrocyte to H2O2-induced oxidative stress. Methods. This study included 42 patients with insulin-dependent diabetes mellitus. In 24 of the patients intensive insulin treatment was applied using the model of short-acting insulin in each meal and medium- acting insulin before going to bed, while in 18 of the patients conventional insulin treatment was applied in two (morning and evening) doses. In the examined patients no presence of diabetes mellitus complications was recorded. The control group included 20 healthy adults out of a blood doner group. The plasma and erythrocytes taken from the blood samples were analyzed immediately. Results. This investigation proved that the application of intensive insulin treatment regime significantly improves total antioxidative plasma capacity as compared to the application of conventional therapy regime. The obtained results showed that the both plasma and lipoproteines apo B MDA increased significantly more in the patients on conventional therapy than in the patients on intensive insulin therapy, most probably due to intensified xanthine oxidase activity. The level of the MDA in fresh erythrocytes did not differ significantly between the groups on intensive and conventional therapy. The level of GSH and catalase activity, however, were significantly reduced in the patients on conventional therapy due to the increased susceptibility to H2O2-induced oxidative stress . Conclusion. The presented study confirmed positive effect of intensive insulin therapy on metabolic control expressed through glycemia level, glycolysed hemoglobine (HbAlc) and fructosamine, as well as through antioxidative/prooxidative homeostasis. This is the confirmation that an adequate treatment choice can prevent numerous diabetes mellitus complications induced by free radicals. .