Article Text
Abstract
Objective Our objective is to identify the potential factors associated with serum Diacron’s reactive oxygen metabolites test (D-ROM) levels of patients with type 2 diabetes mellitus (T2DM) by conducting cross-sectional and longitudinal analyses in two large cohorts and further strengthening these results by performing a meta-analysis.
Methods Serum D-ROM concentrations were measured in 1045 and 1101 patients with T2DM from two independent cohort studies from Germany at baseline and repeatedly 3–4 years later. The cross-sectional and longitudinal associations of various potential determinants with D-ROM levels were assessed with a backwards selection algorithm in multivariable adjusted models.
Results In the meta-analysis of the cross-sectional analysis, female sex, low education, obesity, smoking, high total cholesterol, hemoglobin A1c ≥7%, no diabetes medication, a history of myocardial infarction, heart failure, a history of cancer and C reactive protein levels (CRP) >3 mg/L were statistically significantly associated with increased D-ROM levels in patients with T2DM. The meta-analysis of the longitudinal analysis revealed that old age, female sex, obesity, smoking, physical inactivity, high alcohol consumption, ≥5 years since diabetes diagnosis and CRP levels between 3 mg/L and 10 mg/L were statistically significantly associated with D-ROM levels measured 3–4 years later.
Conclusions (validity, limitations and clinical applicability) This comprehensive analysis confirmed that several modifiable risk factors are being associated with oxidative stress in patients with T2DM within an observational study design. We discuss potential prevention measures against these risk factors that might help to reduce oxidative stress and to prevent some cases of premature mortality in patients with T2DM.
- oxidative Stress
- reactive oxygen species
- lipid peroxidation
- D-ROM
- type 2 diabetes mellitus
- determinants
- risk factors
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Footnotes
Contributors AA conducted the statistical analyses. AA wrote the first draft of the paper and BS edited it. EHJMJ contributed to the measurement of the oxidative stress biomarkers. HB, XG, DCL and YX reviewed the manuscript draft and contributed to the interpretation of the results and the discussion.
Funding This study was funded by a grant from the German Research Foundation (grant No. SCHO 1545/3-1). The Epidemiologische Studie zu Chancen der Verhütung, Früherkennung und optimierten Therapie chronischer Erkrankungen in der älteren Bevölkerung (ESTHER) study was funded by grants from the Saarland state Ministry for Social Affairs, Health, Women and Family Affairs (Saarbrücken, Germany), the Baden-Württemberg state Ministry of Science, Research and Arts (Stuttgart, Germany), the Federal Ministry of Education and Research (Berlin, Germany) and the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany). The Diabetes mellitus: Neue Wege der Optimierung der allgemeinärztlichen Betreuung (DIANA) study was funded by a grant from the Federal Ministry of Education and Research (Berlin, Germany).
Disclaimer The funders were not involved in any of the steps in rendering this project be it design, execution, analysis, data interpretation or writing of the manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The protocol of the ESTHER and DIANA study have been approved by the ethics committee of the Medical Faculty of the University of Heidelberg. Moreover, the ESTHER study has been approved by the ethics committee of the Medical Association of Saarland and the DIANA study by the ethics committee of the Chamber of Physicians of Baden-Württemberg. Both studies are being conducted in adherence with the declaration of Helsinki and written informed consent has been obtained from all study participants.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. The ESTHER and DIANA data cannot be made publicly available due to legal restrictions. However, data can be shared on the basis of research proposals that are in accordance with the study’s aims.