D3.389 - The Role Of Metabolic Endotoxemia In The Development Of Systemic Inflammation In Patients With Type 1 And Type 2 Diabetes Mellitus

Chronic systemic inflammation is a key factor in the formation of comorbidities in patients with diabetes mellitus (DM). Endotoxemia associated with impaired intestinal barrier function significantly contributes to the development of a proinflammatory status in DM. The aim of this study was to clarify the role of endotoxemia in the development of systemic inflammation in patients with Type 1 and Type 2 diabetes.

The cross-sectional study included 177 participants: 90 patients with type 1 diabetes (DM1), 45 patients with type 2 diabetes (DM2), and 42 healthy volunteers in the control group. The exclusion criteria were age under 18 and over 70 years old, pregnancy, the presence of CKD C4 and C5, oncological and infectious diseases, as well as inflammatory arthropathies. Laboratory markers of endotoxemia and inflammation were evaluated.

Concentrations of LPS-binding protein (LBP) were significantly higher in the DM1 and DM2 groups compared with the control (p<0.001), with maximum values in the DM2 group (p<0.001). Levels of C-reactive protein (CRP) were also highest in the DM2 group (p<0.001). Concentrations of zonulin, a marker of intestinal permeability, were higher in patients with DM1 compared to both the control group and the DM2 group (p<0.001). In the DM2 group, LBP correlated with CRP (correlation strength 0.430), and CRP, in turn, with HbA1c (0.430).

In DM2, endotoxemia is predominantly metabolic in nature, associated with chronic low-intensity inflammation. In DM1, autoimmune mechanisms mediated through zonulin may play an important role.