Issue: Vojnosanit Pregl 2017; Vol. 74 (No. 6)

Insulin resistance in drug naive patients with multiple sclerosis

Authors:
Smiljana Kostić, Ivana Kolić, Ranko Raičević, Zvezdana Stojanović, Dejan Kostić, Evica Dinčić

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Background/Aim. Due to the fact that there is a relatively small number of data related to systemic insulin abnormalities in the multiple sclerosis (MS), the main objective of our study was to determine whether a dysbalance of glucose and insulin metabolism exist in patients with natural course of MS. Our hypothesis was that the metabolic disorder that characterizes state of the insulin resistance (IR) and reduced insulin sensitivity (IS) in un-treated patients with MS could play a role in disease pro-gression and degree of functional disability. Methods. The study included 31 patients with relapsing-remitting (RR) MS and 14 healthy controls from the same geographic area matched by age, ethnicity and number of smokers. The glucose tolerance, IS, and IR were examined using an oral glucose tolerance test (OGTT) and using basal plasma glucose and insulin levels. The functional disability and disease progression were evaluated by the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Severity Score (MSSS). Results. The MS patients tolerated glucose equally well as the healthy controls. Basal concen-trations of insulin were significantly higher in the MS group (p < 0.05), as well as insulin plasma level 30 min after oral glucose load (p < 0.01). The patients with MS had signifi-cantly higher values of homeostasis model assessment in-dexes of IR (HOMA-IR) (p = 0.027; p = 0.028). The per-centage of IS (HOMA2 %S) and whole body IS index (ISI Matsuda) showed significantly lower values in the MS pa-tients than in the controls (p = 0.005; p = 0.001). The insu-linogenic index in the first 30 min of OGTT was signifi-cantly higher in MS patients (p = 0.005). The measures of functional disability and MS progression did not correlate significantly with the investigated parameters of IR and IS indexes. Conclusion. This study demonstrates for the first time the existence of hyperinsulinemia, reduced insulin sen-sitivity and normal glucose tolerance that indicate the initial phase of IR in the natural course of MS. Additional research is necessary in order to define the mechanisms of occur-rence and the impact of IR on the complex pathophysi-ological processes in MS.