Background
Every year a steady increase of type 2 diabetes mellitus (T2DM) is observed all over the world. Obesity - the main reason in 80 % cases of T2DM development, it increase possibility of dyslipidemia. According to EAOS estimated that 23% of women and 20% of men currently have obesity. The study of liver dysfunction in patients with T2DM and obesity is becoming increasingly important. Insulin growth factor-1 (IGF-1) is produced mainly by the liver in response to the production of growth hormone and has the potential impact on proliferation and differentiation of cells of all tissues. It possesses an insulin-like properties and causes a positive effect on carbohydrate metabolism. IGF-1 can be used as a marker of hormonal and metabolic state of the liver.

Aim
The purpose of the study was to establish the relationship between IGF-1levels and indexes of lipid profile, carbohydrate metabolism and body mass index (BMI) in patients with T2DM and various BMI values in order to improve the access to hormone and metabolic function of the liver.

Method
60 patients with T2DM were examined (30 men, mean age 56.48 ± 6.9 years), mean duration of T2DM-8.95 ± 4.4 years. Patients were divided into three groups according to BMI: group 1 - patients with BMI≤24.9 kg / m2 (n = 20), group 2 - patients whose BMI was 25.0 - 29.9 kg / m2 (n = 20 ), group 3 – BMI ≥30.0 kg / m2 (n = 20). All patients didn’t take hypolipidemic treatment for 3 months.The control group included 10 healthy volunteers. Observation period lasted 3 months. The state of carbohydrate metabolism was determined using the following assays: fasting plasma glucose (FPG), immunoreactive insulin (IRI), glycosylated hemoglobin (HbA1c). HOMA-IR index was calculated after the formula HOMA-IR = fasting glucose (mmol / L) x fasting insulin (mcU/ mL) / 22.5. Assessment of lipid profile included determination of total cholesterol (TC), high density lipoproteins (HDL), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL). The level of IGF-1 - a marker of metabolic and hormonal state of the liver was determined by ELISA using a set of reagents produced by «DRG» company.

Results
A significant (p <0.01) decrease of IGF-1 was determined in all groups (group 1-198.2±4.92 ng / ml, group 2–155.5±4.71 ng/ml; group 3–139.1±2.72 ng/ml) in comparison with the control group (242.30±11.90 ng/ml); the lowest level of IGF-1 was observed in patients with T2DM and obesity. Certain correlations were found between levels of IGF-1 and FPG (r = -0.24, p> 0.05 – group 1; r = -0.35, p <0.05 - group 2; r = -0.45, p <0.05 - group 3), IGF-1 and IRI (r = -0.30, p <0.05 – group 1; r = -0.42, p <0.05 - group 2; r = -0.50, p <0.05 - group 3), IGF-1 and HOMA-IR (r = -0.29, p <0.05 – group 1; r = -0.42, p <0.05 - group 2; r = -0.51, p <0.05 - group 3), IGF-1 and TC (r = -0.25, p <0.05 – group 1; r = -0.33, p <0.05 - group 2; r = -0.40, p <0.05 - group 3); IGF-1 and LDL (r = -0.32, p> 0.05 – group 1; r = -0.38, p <0.05 - group 2; r = -0.42, p <0.05 - group 3) ; IGF-1 and VLDL (r = -0.34, p <0.05 – group 1; r = -0.37, p <0.05 - group 2; r = -0.40, p <0.05 - group 3) ; IGF-1 and TG (r = -0.33, p <0.05 – group 1; r = -0.35, p <0.05 - group 2; r = -0.39, p <0.05 - group 3); IGF-1 and HDL (r = 0.14, p> 0.05 – group 1; r = 0.21, p <0.05 - group 2; r = 0.28, p <0,05 - group 3).

Discussion
A negative relationship was determined between IGF-1 levels and indexes of carbohydrate metabolism, BMI and lipid profile in patients with T2DM, except of HDL, which demonstrated positive correlation. Especially pronounced results were obtained in patients with increased body weight. The decrease of IGF-1 level in all groups evidences even without increased body weight (1 group), the presence of derangements of hormonal and metabolic function of the liver against the background of dyslipidemia and increased BMI.
I have no potential conflict of interest to disclose

The relationship of insulin-like growth factor-1 and dyslipidemia in patients with type 2 diabetes depending on the BMI