Serum concentrations of cortisol, interleukin 6, leptin and adiponectin predict stress induced insulin resistance in acute inflammatory reactions

Introduction Inflammatory stimuli are causative for insulin
resistance in obesity as well as in acute inflammatory reactions.
Ongoing research has identified a variety of secreted proteins that
are released from immune cells and adipocytes as mediators of
insulin resistance; however, knowledge about their relevance for
acute inflammatory insulin resistance remains limited. In this
study we aimed for a clarification of the relevance of different
insulin resistance mediating factors in an acute inflammatory
situation. Methods Insulin resistance was measured in a cohort of
37 nondiabetic patients undergoing cardiac surgery by assessment of
insulin requirement to maintain euglycaemia and repeated
measurements of an insulin glycaemic index. The kinetics of
cortisol, interleukin 6 (IL6), tumour necrosis factor alpha (TNF
alpha), resistin, leptin and adiponectin were assessed by repeated
measurements in a period of 48 h. Results Insulin resistance
increased during the observation period and peaked 22 h after the
beginning of the operation. IL6 and TNF alpha displayed an early
increase with peak concentrations at the 4-h time point. Serum
levels of cortisol, resistin and leptin increased more slowly and
peaked at the 22-h time point, while adiponectin declined, reaching
a base at the 22-h time point. Model assessment identified cortisol
as the best predictor of insulin resistance, followed by IL6,
leptin and adiponectin. No additional information was gained by
modelling for TNF alpha, resistin, catecholamine infusion rate,
sex, age, body mass index (BMI), operation time or medication.
Conclusions Serum cortisol levels are the best predictor for
inflammatory insulin resistance followed by IL6, leptin and
adiponectin. TNF alpha, and resistin have minor relevance as
predictors of stress dependent insulin resistance.