Diabetes, Metabolic Syndrome and Obesity (Aug 2023)
Effects of Glycemic Variability on Regulatory T Cells in Patients with Type 2 Diabetes and Kidney Disease
Abstract
Qing-Wei Gu,* Qi Sun,* Jie Wang, Wen-Sha Gu, Wei Wang, Xiao-Ming Mao Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiao-Ming Mao, Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68 ChangLe Street, Nanjing, Jiangsu, 210006, People’s Republic of China, Tel +86-18951670295, Email [email protected]: To investigate the pathogenesis of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM), we evaluated the effects of short-term glycemic variability (GV) on the profile of T cell subpopulations.Methods: A total of 47 T2DM patients with normoalbuminuria, 47 microalbuminuria, and 49 macroalbuminuria were enrolled. The continuous glucose monitoring (CGM) determined the GV of enrolled patients. Flow cytometry was used to determine the proportion of T cell subpopulations.Results: The frequency of T helper (Th) 17 and Th1 cells significantly increased while regulatory T cells (Tregs) significantly decreased in the macroalbuminuria group compared to normoalbuminuria and microalbuminuria groups (P < 0.01). The suppressive function of Tregs was significantly lower in the macroalbuminuria group than the normoalbuminuria group (P < 0.05). Compared with the normoalbuminuria group, the mean amplitude of glucose excursions (MAGE) of the macroalbuminuria group was significantly higher (P< 0.05). Furthermore, there were negative associations between the proportion of Tregs and MAGE.Conclusions: Increased GV could decrease the proportion of Tregs and may impair their function. This may lead to increases in Th1 and Th17 cells, and some inflammatory cytokines, which might contribute to the development and progression of DKD in T2DM.Keywords: type 2 diabetes mellitus, diabetic kidney disease, glycemic variability, regulatory T cells, inflammatory cytokines
