Relationship between insulin resistance and liver function in patients with metabolic syndrome with type 2 diabetes

Abstract

One of the pathogenetic mechanisms of the development of insulin resistance (IR) in type 2 diabetes mellitus (type 2 DM) is the formation of non-alcoholic fatty liver disease (NAFLD). DM and liver pathology can be considered as interrelated processes. The aim of the study was to evaluate the indicator, secretory and excretory enzymes of blood serum in the development of IR in patients with metabolic syndrome (MS) with type 2 DM. The distribution of patients with MS with type 2 DM was carried out, depending on the presence of non-alcoholic steatohepatitis (NASH): a group of patients with NASH — 211, a group of patients without NASH — 119. In order to determine the significance of the degree of IR in the formation of metabolic links in the pathogenesis of IR, we also divided the examined patients into groups, depending on the degree of increase in the IR — HOMA IR. The group of patients with established I degree of IR (HOMA IR from 4.0 to 20.0) included 49 patients (29%) (group I of IR). The group of patients with established II degree of IR (HOMA IR from 20.0 to 50.0) included 79 patients (47%) (group of II degree IR). The group of patients with established III degree of IR (HOMA IR more than 50.0) included 40 patients (24%) (group III of IR). In patients with MS with type 2 DM with NASH, an increase in serum levels of alanine aminotransferase, sorbitol dehydrogenase, arginase, lactate dehydrogenase, alkaline phosphatase and a decrease in cholinesterase, which indicates a decrease of detoxification and synthetic function of the liver, the presence of cytolysis and disruption of glycogenization processes, especially in the formation of high (III) degree IR. The data, obtained by us, indicate the relationship of insulin resistance with the deepening of the effects of hepatocyte damage, inhibition of the synthetic function of hepatocytes, decreased detoxification function of the liver, glycolysis processes, predictors of necrosis of hepatocytes in NASH on the background of MS with type 2 DM. In addition, the data, obtained by us, indicate a link between the compensation of carbohydrate metabolism in patients with MS with type 2 DM with the functional state of the liver.