Serum Levels of Plasmalogens and Fatty Acid Metabolites Associate with Retinal Microangiopathy in Participants from the Finnish Diabetes Prevention Study

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, and retinal microaneurysms (MA) are one of the first detected abnormalities associated with DR. We recently showed elevated serum triglyceride levels to be associated with the development of MA in the Finnish Diabetes Prevention Study (DPS). The purpose of this metabolomics study was to assess whether serum fatty acid (FA) composition, plasmalogens, and low-grade inflammation may enhance or decrease the risk of MA. Originally, the DPS included 522 individuals (mean 55 years old, range 40–64 years) with impaired glucose tolerance who were randomized into an intervention (n = 265) or control group (n = 257). The intervention lasted for a median of four years (active period), after which annual follow-up visits were conducted. At least five years after stopping the intervention phase of DPS, participants classified as MA negative (n = 115) or MA positive (n = 51) were included in the current study. All these participants were free of diabetes at baseline (WHO 1985) and had high-sensitive C-reactive protein (hs-CRP), serum FA composition, and selected lipid metabolites measured during the active study period. Among the markers associated with MA, the serum plasmalogen dm16:0 (p = 0.006), the saturated odd-chain FA 15.0 (pentadecanoic acid; p = 0.015), and omega-3 very long-chain FAs (p < 0.05) were associated with a decreased occurrence of MA. These associations were independent of study group and other risk factors. The association of high serum triglycerides with the MA occurrence was attenuated when these MA-associated serum lipid markers were considered. Our findings suggest that, in addition to n-3 FAs, odd-chain FA 15:0 and plasmalogen dm16:0 may contribute to a lower risk of MA in individuals with impaired glucose tolerance. These putative novel lipid biomarkers have an association with MA independently of triglyceride levels.

STUDI LITERATUR EFEK MODIFIKASI GAYA HIDUP SECARA INTENSIF PADA PREDIABETES

Prediabetes adalah kondisi sebelum terjadinya diabetes mellitus tipe 2. Impaired Fasting Glucose (IFG) dan Impaired Glucose Tolerance (IGT) merupakan kondisi prediabetes. Prevalensi diabetes mellitus tipe 2 yang terus meningkat disebabkan karena setiap tahunnya 4-9% orang dengan prediabetes akan berkembang menjadi diabetes. IGT mempunyai risiko lebih tinggi untuk berkembang menjadi diabetes mellitus tipe 2. Sehingga upaya pencegahan agar tidak berkembangnya prediabetes menjadi diabetes mellitus tipe 2 menjadi sangat penting. Modifikasi gaya hidup secara intensif merupakan upaya yang dapat dilakukan pada prediabetes. Diabetes Prevention Program (DPP) di Amerika Serikat dan Finnish Diabetes Prevention Study (DPS) melakukan uji klinis yang menunjukkan bahwa modifikasi gaya hidup efektif dalam mengurangi atau menunda onset diabetes mellitus tipe 2 sebesar 4058% pada individu yang mempunyai risiko tinggi. Adapun modifikasi gaya hidup yang dapat dilakukan seperti, penurunan berat badan pada prediabetes dianjurkan sebesar 5-10% dari berat badan awal, perubahan pola makan dengan mengurangi konsumsi karbohidrat sederhana dan memperbanyak konsumsi serat, dan aktivitas fisik dilakukan selama 30-60 menit setiap hari. Modifikasi gaya hidup secara intensif pada prediabetes mempunyai efektivitas yang bagus.