Marmara University Medical School Section of Endocrinology and Metabolism İstanbul

1. MODIFIED ADIPOKINE LEVELS IN TYPE 1 DIABETIC PATIENTS: ASSOCIATION WITH CAROTID INTIMA MEDIA THICKNESS Dilek Yazıcı, Dilek Yavuz, Önder Şirikçi, Ahmet Toprak, Özlem Tarçın, Seda Sancak, Oğuzhan Deyneli, Sema Akalın Marmara University Medical School Section of Endocrinology and Metabolism İstanbul

2. Adiponectin • Serum adiponectin levels were shown to be decreased in type 2 diabetes melitus and in conditions associated with insulin resistance and cardiovascular diseases. Yaturu S, Cytokine 2006 ,34;219-23 Nakashima, JCEM,2006;,91, 3873-7. Kowalska, Adv Med Sci, 2006, 51,94-7 • In contrast, elevated levels have been reported in type 1 diabetic patients. Schalkwikj CG, JECM 2006, 91(1);129-35 Frystyk J, Diabetologia 2005, 48(9); 1911-8 Hadjadj S, Diabetologia 2005,48(6);1088-92

3. Adiponectin • Adiponectin is especially increased in type 1 diabetic patients with microvascular complications. Schalkwikj CG, JECM 2006, 91(1);129-35 Frystyk J, Diabetologia 2005, 48(9); 1911-8 Hadjadj S, Diabetologia 2005,48(6);1088-92 • On the other hand, there is conflicting data on the association of adiponectin with the presence of macrovascular disease in this population. Costacou,Diabetologia, 2005, 48(1);41-8. Schalkwikj CG, JECM 2006, 91(1);129-35 Frystyk J, Diabetologia 2005, 48(9); 1911-8

4. Other Adipokines • Leptin and resistin were both found to be decreased in adult patients with type 1 diabetes mellitus. Schaffler, Horm Metab Res, 2004, 36(10);702-7 Roden MI, Int J Obes Relat Metab Disord ,2000, 24(8),976-81. • The relationship of leptin and resistin with macrovascular complications is not evident in adult type 1 diabetic patients.

5. AIMS • To determine adiponectin, leptin and resistin levels in type 1 diabetic patients. • To evaluate their association with carotid intima media thickness (CIMT), an early marker of atherosclerosis and macrovascular disease.

6. Patient Selection • 50 Type 1 diabetic patients • aged 30±8 yrs, F/M:18/32 • duration of diabetes 9 ±6.8 years • 15 patients had microvascular complications • none had macrovascular complications • 48 healthy controls • aged 33±7.5 yrs, F/M:20/28

7. Fasting blood glucose, A1c, creatinine, total cholesterol, triglyceride, HDL and LDL were measured. • Adiponectin, leptin and resistin levels were determined by enzyme-linked immunosorbent assay. • Carotid intima media thickness was measured by Doppler ultrasonography.

8. Demographic characteristics of the study groups

9. Biochemical findings of the study groups

10. Adiponectin levels of the study groups p<0.05 Adiponectin (μg/mL)

11. Leptin levels of the study groups p<0.05 Leptin (ng/mL)

12. Resistin levels of the study groups Resistin (ng/mL)

13. CIMT of the study groups CIMT (mm)

14. Correlation Analysis of Adiponectin and Resistin with CIMT in Type 1 Diabetic Patients r=-0.33 p<0.05 r=0.41,p<0.01 CIMT (mm) Adiponectin (μg/mL) Resistin (ng/mL)

15. Multivariate Analysis • CIMT dependent variable • corrected for BMI, HDL, TG, A1c • relationship continues to hold for adiponectin and resistin (r2=0.44)

16. Complications • There were no differences between the patients with microvascular complications and those without in terms of adiponectin, leptin and resistin levels.

17. Conclusions • Adiponectin levels are increased and leptin levels are decreased in type 1 diabetic patients, in consistence with previous findings. • Resistin levels are not different than controls. • Adiponectin was associated negatively and resistin positively with CIMT.

18. Conclusions • Although adiponectin levels are increased in type 1 diabetic patients with microvascular complications, they seem to decrease as CIMT increases, indicating the role of a different mechanism in macrovascular complications. • This may be related to the antiatherosclerotic actions of adiponectin, but the pathogenesis of this mechanism remains to be elucidated in this population.

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