Assessment of serum neopterin as an inflammatory and cardiovascular marker in type 1 and 2 diabetes complicated by diabetic foot syndrome: A comparative study

Abstract

Introduction. Neopterin is a byproduct of nerve transmitter coenzyme that is synthesized and released by macrophages and T-lymphocytes. It is a useful inflammatory marker of diabetes progression, as its levels increase with the progression of the disease from prediabetes to type 2 diabetes (T2D). This study aimed to compare serum neopterin levels between type-1 and type-2 diabetes patients with diabetic foot syndrome (DFS), and assess the relation between serum neopterin levels and cardiometabolic risk factors. Materials and methods. This observational cross-sectional study was carried out in the Centre of Diabetes Mellitus in Erbil, Iraq from 1st January to 31st December 2016. A total of 30 healthy subjects and 140 patients with DFS [70 patients with type 1 diabetes (T1D) and 70 patients with T2D] were enrolled in the study. The main outcome measurements included anthropometric measurements, blood pressure, fasting serum glucose, glycated haemoglobin, lipid profile, neopterin and high sensitivity C-reactive protein (hs-CRP). Results. Serum neopterin levels of T2D patients were significantly (p < 0.001) higher than the corresponding levels of T1D patients (18.6 ± 2.1 nmol/L vs. 12.6 ± 1.3 nmol/L). The changes in the serum neopterin levels were related to cardiometabolic risk factors. In T1D, a significant positive correlation between serum levels of neopterin and diastolic blood pressure were observed, while in T2D the significant positive correlation was found between fasting serum triglyceride levels and neopterin levels. Serum levels of neopterin were insignificantly correlated with hs-CRP in T1D and T2D. Conclusions. In patients with DFS, serum neopterin levels are significantly higher in those with T2D compared with T1D patients. Neopterin levels are not related to the grading of DFS, but are invariably related to cardiometabolic risk factors. (Clin Diabetol 2018; 7, 2: 91-96).