Relationship Between Plasma Growth Differentiation Factor 15 Levels and Complications of Type 2 Diabetes Mellitus: A Cross-sectional Study

Published:September 13, 2022DOI:



      Our aim in this study was to identify the associations between growth differentiation factor 15 (GDF15) and type 2 diabetes mellitus (T2DM) complications in a community-based population in China.


      Based on a cross-sectional study registered in the National Basic Public Health Service for disease management of Changshu in China, a total of 1,689 T2DM patients were enrolled and tested further for plasma GDF15 levels. Macrovascular (cardiovascular disease and diabetic foot) and microvascular (diabetic kidney disease [DKD], diabetic retinopathy and neuropathy) complications were evaluated. Logistic regression models were conducted to identify the associations of GDF15 with the risk of diabetic complications, and linear regression models were used to assess relationships between GDF15 and other clinical features.


      Overall, 459 of the 1,689 T2DM patients (27.18%) had complications. GDF15 levels were significantly higher in patients with any type of complication compared with their counterparts. With each standard deviation increase of base 10 logarithms of GDF15 (lg-GDF15), the risk of overall complications increased by 1.17-fold (95% confidence interval [CI], 1.03 to 1.32). In contrast to macrovascular complications, associations of GDF15 with microvascular complications appeared to be stronger (adjusted odds ratio [OR], 1.24; 95% CI, 1.08 to 1.43), especially for DKD (adjusted OR, 1.51; 95% CI, 1.19 to 1.93). Subgroup analyses showed that the strength of association between GDF15 and complications varied by distinct age and T2DM duration subgroups. Patients with 2 or more types of complications had higher levels of GDF15 than those with fewer types of complications. Also, linear relationships were identified between GDF15 and several liver and kidney function indices.


      Higher GDF15 levels were associated with T2DM complications, especially DKD. GDF15 may serve as a biomarker for monitoring the deterioration of T2DM.



      L’objectif de notre étude était de cerner les associations entre le facteur de différenciation de croissance 15 (GDF15, de l’anglais growth differentiation factor 15) 15 et les complications liées au diabète sucré de type 2 (DST2) d’une population chinoise.


      Selon une étude transversale sur la prise en charge de la maladie du National Basic Public Health Service de Changshu, en Chine, les 1689 patients atteints du DST2 inscrits ont subi des analyses de laboratoire pour déterminer les concentrations plasmatiques du GDF15. Nous avons évalué les complications macrovasculaires (maladie cardiovasculaire et pied diabétique) et microvasculaires (néphropathie diabétique [ND], rétinopathie et neuropathie diabétiques). Nous avons effectué une régression logistique pour cerner les associations entre le GDF15 et le risque de complications liées au diabète, et utilisé une régression linéaire pour évaluer les relations entre le GDF15 et les autres caractéristiques cliniques.


      Dans l’ensemble, 459 des 1689 patients atteints du DST2 (27,18 %) avaient des complications. Les concentrations du GDF15 étaient significativement plus élevées chez les patients de tout type de complications que leurs homologues. À chaque augmentation de l’écart type des logarithmes de base 10 du GDF15 (lg-GDF15), le risque de complications globales augmentait de 1,17 fois (intervalle de confiance [IC] à 95 %, de 1,03 à 1,32). Contrairement aux complications macrovasculaires, les associations du GDF15 aux complications microvasculaires semblaient être plus fortes (rapport de cotes ajusté [RC], 1,24; IC à 95 %, de 1,08 à 1,43), particulièrement pour la ND (RC ajusté, 1,51; IC à 95 %, de 1,19 à 1,93). Les analyses en sous-groupes montraient que la force de l’association entre le GDF15 et les complications variaient en fonction des sous-groupes d’âge distincts et de durée du DST2. Les patients qui avaient 2 types ou plus de complications avaient des concentrations plus élevées de GDF15 que ceux qui avaient un moins grand nombre de types de complications. De plus, nous avons observé des relations linéaires entre le GDF15 et plusieurs paramètres des bilans hépatique et rénal.


      Les concentrations plus élevées de GDF15 étaient associées aux complications liées au DST2, particulièrement la ND.


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