PREDICTIVE PERFORMANCE OF LEPTIN/ADIPONECTIN RATIO IN IDENTIFYING CARDIOMETABOLIC RISK AMONG DIABETICS

Background: Cardiometabolic risk is a complex of comorbidities, featuring insulin resistance, hypertension, dyslipidemia, and central obesity, and predisposes cardiovascular diseases as well as type 2 diabetes mellitus (T2DM). Adipokines-leptin and adiponectin are crucial in the process of regulating metabolism homeostasis and inflammation. Leptin, a hormone released mainly by adipose tissue, stimulates pro-inflammatory processes and is upregulated in obesity and insulin resistance, whereas adiponectin is anti-inflammatory and insulin sensitizing and depleted in most diseases involving the metabolism. As a ratio of the opposing adipokines, the leptin/adiponectin ratio (LAR) is an attractive biomarker that captures the interplay between two suppressive adipokines and may predict heart disease risk even better than the levels of an individual adipokine. Methods: The purpose of this cross-sectional study was to assess the predictive value of LAR in predicting cardiometabolic risk in patients who already have established diabetes mellitus. Two hundred diabetic persons between 30 and 65 years were recruited at out-patient clinics. The participants received thorough clinical examination, including anthropometric assessment, blood pressure, fasting glucose, lipid profile, leptin, adiponectin, and insulin analysis. Cardiometabolic risk was based on standard criteria taking into consideration metabolic syndrome components. Results: The statistical analysis included correlation of LAR with individual cardiometabolic risk factors, receiver operating characteristic (ROC) curve analysis of its diagnostic accuracy, and multivariate regression to account possible confounders. The findings revealed that LAR scored positively with waist circumference, systolic and diastolic blood pressure, fasting glucose and triglycerides and negatively with high-density lipoproteins cholesterol. Based on the ROC curve, which provided an area under the curve (AUC) of 0.87 (95% CI: 0.81-0.92), LAR exhibit ideal predictive ability over cardiometabolic risk. Besides, LAR demonstrated better risk prediction than leptin and adiponectin separately. Conclusion: The study also supports the usefulness of the leptin/adiponectin ratio as a robust and non-invasive tool capable of early detection of cardiometabolic risk in diabetic individuals to provide timely treatment and achieve the best results in preventing cardiovascular type diseases. Adding LAR to regular clinical evaluation can supplement risk stratification into the parameters beyond conventional markers. It requires additional longitudinal studies in order to confirm its predictive role and potential therapeutic interventions against imbalances of adipokines to alleviate cardiometabolic sequelae.