Risk of Diabetes Complications Increases with Elevated Levels of NT-proBNP
Healthy people – especially women – with elevated levels of the heart failure marker NT-proBNP have a lower risk of developing type 2 diabetes. However, if these people develop diabetes nonetheless, they are more likely to suffer from macro- and microvascular complications such as heart attack, stroke, or severe damage to eyes, kidneys, or nerves. These are the findings of a recent study by DZD researchers that has now been published in Diabetes Care.
The NT-proBNP molecule is a biomarker used to predict or diagnose heart failure. On the other hand, it has a positive effect on insulin and glucose metabolism. NT-proBNP stimulates the breakdown of fat in fat cells. In the animal model, higher levels of this peptide also showed a protective effect against overweight and glucose intolerance. Furthermore, studies suggest that people with elevated baseline levels of NT-proBNP have a lower risk of developing type 2 diabetes. But what is the effect of elevated levels of NT-proBNP in people who do develop diabetes? Do they suffer more frequently from diabetes complications? Researchers from the DZD partner German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE) investigated these questions together with colleagues from Tübingen University Hospital, University College Dublin and the Federal Institute for Risk Assessment in Berlin.
First, the researchers analyzed samples from a case cohort consisting of all the incident cases of diabetes and a random sample of EPIC Potsdam to determine whether the concentration of NT-proBNP in healthy people has an influence on diabetes risk. „We found an inverse association between NT-proBNP concentration and future risk of type 2 diabetes. With every doubling of NT-proBNP levels, the risk of diabetes decreased by about 9 percent,“ said first author Anna Birukov of DIfE. The influence of the NT-proBNP concentration is even more evident in women. There, the risk of diabetes decreased by 20 percent when the concentration of NT-proBNP was doubled.
In samples from 545 people who later developed diabetes, the researchers then investigated whether there was a correlation between elevated baseline NT-proBNP concentrations in a still healthy state and the risk of vascular complications. In this group, 133 people later developed microvascular and 50 people macrovascular complications **. “This showed that the NT-proBNP values are linearly associated with these diabetes complications,” said Prof. Dr. Matthias Schulze, head of the study, summarizing the results. With each doubling of the baseline NT-proBNP concentration, the risk of severe damage to the eyes, kidneys or nerves increased by 20 percent and the risk of a heart attack or stroke by 37 percent.
“In the future, the measurement of NT-proBNP in plasma could be informative for monitoring the risk of diabetes-associated complications,” Schulze said. The extent to which the peptide is suitable as a marker for the development of diabetes-related diseases should, however, be investigated in further prospective studies. The gender-specific associations between NT-proBNP and diabetes risk should also be validated in further prospective studies.
* EPIC-Potsdam: The European Prospective Investigation into Cancer and Nutrition (EPIC) Potsdam Study is a prospective cohort study. Between 1994 and 1998, 27,548 women and men between the ages of 35 and 65 were recruited. The EPIC Potsdam Study is part of one of the largest long-term studies in the world with a total of around 521,000 study participants from ten European countries. The aim of the study is to investigate the effect of nutrition on the development of cancer and other chronic diseases.
** In this study, the following microvascular complications were investigated: newly occurring retinopathies, blindness due to retinopathies, neuropathies, nephropathies or renal replacement therapies. Macrovascular complications encompassed heart attack or stroke after diabetes diagnosis.
Prof. Dr. Matthias Schulze
German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE)
Telefon: +49 (0)33200 88-2433
German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE)Arthur-Scheunert-Allee 114-116
phone: +49 (0)33200 88 2431
Birukov, A. et al: Opposing associations of NT-proBNP with risks of diabetes and diabetes-related complications. Diabetes Care (2020, August) DOI: https://doi.org/10.2337/dc20-0553