Journal of Medical and Dental Science
Volume 12~ Issue 1 (2025) pp: 01-10
ADIPONECTIN AND GLUCOSE METABOLISM IN DIABETIC
AND CARDIOVASCULAR DISEASE PATIENTS IN PORT
HARCOURT, NIGERIA
Ogamba MI1, *Kiyesi AL2, Owamagbe EM2, Ezeifeh V3
1
Department of Chemical Pathology, Faculty of Basic Clinical Sciences, PAMO University of Medical Sciences,
Port-Harcourt
2
Department of Chemical Pathology, Faculty of Basic Clinical Sciences, Rivers State University, Port-Harcourt
3
Internal Medicine Department, University of Port-Harcourt Teaching Hospital, Rivers State
*Corresponding author: Kiyesi AL.
ABSTRACT
Background: Adiponectin, an adipocytokine predominantly secreted by adipose tissue, is known
for its anti-inflammatory and insulin-sensitizing properties. It plays a critical role in glucose
metabolism and cardiovascular health. However, its relationship with glycemic control and body
mass index (BMI) in individuals with type 2 diabetes mellitus (T2DM), cardiovascular disease
(CVD), or both remains understudied, particularly in sub-Saharan Africa.
Objective: This study aimed to evaluate the relationship between serum adiponectin levels,
fasting blood glucose, and BMI among individuals with T2DM, CVD, or combined T2DM and
CVD in Port Harcourt, Nigeria.
Methods: A cross-sectional study was conducted among 333 participants aged 30–75 years
recruited from tertiary hospitals in Port Harcourt. Participants were classified into three groups:
T2DM only, CVD only, and combined T2DM and CVD. Serum adiponectin levels and fasting
blood glucose were measured. Correlations between adiponectin and metabolic variables were
assessed using Pearson correlation coefficients. Differences across groups were analyzed using
one-way ANOVA.
Results: The combined T2DM and CVD group exhibited the lowest mean serum adiponectin
levels (5.9 ± 2.8 µg/mL) and the highest fasting blood glucose levels (9.1 ± 2.6 mmol/L),
compared to the T2DM-only (8.4 ± 3.2 µg/mL; 7.9 ± 2.4 mmol/L) and CVD-only groups (9.1 ±
3.5 µg/mL; 7.8 ± 2.5 mmol/L). Significant differences were observed across groups for both
variables (ANOVA F=23.45,p<0.0001 for adiponectin and F=8.92,p<0.0001for fasting glucose).
Adiponectin correlated inversely with fasting blood glucose (r=−0.42,p=0.0001) and BMI
(r=−0.51,p=0.0001). The correlation between adiponectin and fasting blood glucose was
strongest in the combined T2DM and CVD group (r=−0.52,p<0.001).
Conclusion: Serum adiponectin levels are inversely associated with fasting blood glucose and
BMI in individuals with T2DM, CVD, or both. The strongest association was observed in
participants with combined T2DM and CVD, suggesting a compounded metabolic impact. These
findings underscore the potential of adiponectin as a biomarker for metabolic dysregulation and
the need for targeted interventions in high-risk groups.
Keywords: Adiponectin, type 2 diabetes mellitus, cardiovascular disease, glucose metabolism,
BMI,
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1.0 INTRODUCTION
Adiponectin, an adipocytokine secreted predominantly by adipose tissue, plays a pivotal role in
glucose and lipid metabolism. It has garnered significant attention for its protective effects
against insulin resistance, type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVD)
due to its anti-inflammatory, insulin-sensitizing, and vasculo-protective properties.[1, 2] Despite
its importance, variations in adiponectin levels and their relationship with glucose metabolism
among individuals with diabetes and cardiovascular conditions remain understudied, particularly
in populations within sub-Saharan Africa.[3, 4]
The global burden of T2DM and CVD continues to rise, with low- and middle-income countries,
including Nigeria, bearing a disproportionate share of the burden. According to the International
Diabetes Federation, Africa is projected to experience one of the fastest-growing rates of
diabetes prevalence, exacerbating the risk of related complications such as CVD.[3, 5, 6] Both
conditions are associated with metabolic dysregulation, where adiponectin has been identified as
a critical player.[5, 7, 8] Understanding how adiponectin influences glucose metabolism could
provide insights into improving disease management and therapeutic interventions tailored to
resource-limited settings.
Port Harcourt, a prominent urban center in southern Nigeria, exhibits a rising prevalence of
diabetes and cardiovascular conditions, driven by increasing urbanization, dietary shifts, and
sedentary lifestyles. However, research exploring the biochemical and molecular mechanisms
underlying these diseases in this region is limited. Specifically, the relationship between
adiponectin levels and glucose metabolism in individuals with diabetes and CVD in Port
Harcourt remains unexplored.
On its part, adiponectin improves energy metabolism (enhances energy utilization by body
tissues) and insulin sensitivity. It acts by sensitizing the body to insulin, with the later inhibits the
endogenous production of glucose.[6, 9, 10] Adiponectin is therefore implicated in some
metabolic disorders like diabetes mellitus type 2, dyslipidemia, hypertension and
atherosclerosis.[11, 12] The co-existence of these diseases results in metabolic syndrome, but for
atherosclerosis. Adiponectin is also linked to obesity, a subset of metabolic syndrome responsible
for medical disorders like cancer.[9, 13]These interconnections underscore the importance of
adiponectin as a therapeutic target. Interventions aimed at increasing adiponectin levels, such as
weight loss, physical activity, and pharmacological agents, may provide dual benefits in reducing
BMI and improving glycemic control.[14, 15]
This study aims to investigate adiponectin and glucose metabolism among diabetic and
cardiovascular disease patients in Port Harcourt, Nigeria. By assessing this relationship, the
research seeks to contribute to a better understanding of the pathophysiology of these diseases
and inform region-specific clinical strategies for disease prevention and management.
2
2.0 METHOD
2.1 Study Population
The study involved 333individuals newly diagnosed with type 2 diabetes mellitus (T2DM),
cardiovascular diseases (CVD), or both, receiving care at tertiary healthcare facilities in Port
Harcourt, Nigeria Between January 2023 to December 2023. Participants were adults aged 18
years and above, representing a diverse demographic profile in terms of age, gender, and
socioeconomic status. Inclusion criteria included a confirmed diagnosis of T2DM or CVD based
on medical records and the availability of relevant clinical data. Exclusion criteria included
pregnant individuals, those with acute illnesses, or patients undergoing treatments known to
directly influence adiponectin levels, such as corticosteroid therapy.
2.2 Study Procedure
This cross-sectional study employed a combination of clinical evaluations, biochemical analyses,
and structured interviews. Participants were recruited through systematic sampling during
routine clinic visits. After obtaining informed consent, detailed sociodemographic and clinical
information, including age, gender, medical history, and medication use, was collected using a
structured questionnaire.
Anthropometric measurements, including height, weight, and BMI, were recorded using
standardized procedures. Blood samples were drawn under aseptic conditions after an overnight
fast for biochemical analysis. Serum adiponectin levels were quantified using enzyme-linked
immunosorbent assay (ELISA), while fasting blood glucose levels were measured using a
glucose oxidase method. All procedures adhered to standard laboratory protocols to ensure
accuracy and reliability.
2.3 Data Analysis
Data were analyzed using SPSS version 25. Descriptive statistics summarized participant
characteristics, including means, standard deviations, and proportions. The relationship between
serum adiponectin levels, blood glucose, and BMI was examined using Pearson correlation
coefficients. The Analysis of Variance was used to compare average levels of adiponectin and
fasting blood glucose in the different disease sub-groups. All analysis was done at a 95%
confidence level and a p-value less than 0.05 was considered to be statistically significant.
2.4 Ethical Considerations
The study adhered to the ethical principles outlined in the Declaration of Helsinki. Ethical
approval was obtained from the institutional ethics review board of the participating healthcare
facility. Written informed consent was obtained from all participants after providing detailed
information about the study's purpose, procedures, potential risks, and benefits.
Participant confidentiality was maintained by anonymizing data and storing it securely. Blood
sample collection and laboratory analyses were conducted using standardized procedures to
minimize risks to participants. Participants retained the right to withdraw from the study at any
3
time without repercussions. The findings were shared with relevant stakeholders to enhance
understanding and management of T2DM and CVD in the study population.
3.0 RESULTS
Table 1: Socio-demographic characteristics of subjects
Variable Frequency (n=333) Percent (%)
Age (years)
20-30 27 8.1
31-40 273 82.0
41-50 24 7.2
51-60 9 2.7
Sex
Female 204 61.3
Male 129 38.7
Marital status
Married 182 54.7
Single 135 40.5
Divorced 2 0.6
Widow/widower 12 3.6
Separated 2 0.6
Level of education
Primary 64 19.2
Secondary 166 49.8
Graduate 100 30.0
Post-graduate 3 0.9
Religion
Christianity 333 100.0
Table 1 above shows that they were mostly aged 31 - 40 years, 273 (82.0%), more females, 204
(61.3%), mostly married, 182 (54.7%), all Christians, 333 (100.0%) and mostly had secondary
school education, 166 (49.8%).
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Table 2 shows the mean BMI of the study subjects was 28.7 ± 5.3kg/m², the average fasting
blood glucose was recorded as 8.2 ± 2.6mmol/L and the average Serum Adinopectin was 7.8 ±
3.4µg/mL.
Table 2: Summary of metabolic variables of subjects
Metabolic Variable Mean ±SD
BMI (kg/m²) 28.7 ± 5.3
Fasting Blood Glucose (mmol/L) 8.2 ± 2.6
Serum Adiponectin (µg/mL) 7.8 ± 3.4
The distribution of diagnoses among the subjects as shown in Figure 1 shows that 92 (28.5%)
had combined type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). 98 (29.4%)
had CVD only and 140 (42.0%) had T2DM.
Figure 1:Distribution of T2DM and Hypertension among study subjects
95, 28.5%
140, 42.0%
98, 29.4%
T2DM Only CVD Only Combined T2DM and CVD
5
Table 3 shows the comparison of serum adiponectin and fasting blood glucose in the different
disease categories. The study revealed significant differences in serum adiponectin levels and
fasting blood glucose concentrations among the disease groups. Participants with T2DM only
had a mean serum adiponectin level of 8.4 ± 3.2 µg/mL, which was significantly lower than the
9.1 ± 3.5 µg/mL observed in the CVD-only group but significantly higher than the 5.9 ± 2.8
µg/mL recorded in participants with combined T2DM and CVD. Similarly, fasting blood glucose
levels were highest in the combined T2DM and CVD group (9.1 ± 2.6 mmol/L), significantly
exceeding the levels in the T2DM-only group (7.9 ± 2.4 mmol/L) and the CVD-only group (7.8
± 2.5 mmol/L), which were comparable. These findings indicate that individuals with combined
T2DM and CVD experience more severe metabolic dysregulation, underscored by both reduced
adiponectin levels and poorer glycemic control compared to those with either condition alone.
Table 3: Comparison of serum adiponectin and fasting blood glucose in disease groups
Serum Adiponectin Fasting Blood Glucose
Group (µg/mL) (mmol/L)
T2DM Only 8.4 ± 3.2a,b 7.9 ± 2.4
CVD Only 9.1 ± 3.5c 7.8 ± 2.5
Combined T2DM and CVD 5.9 ± 2.8 c 9.1 ± 2.6c
ANOVA F=23.45, p<0.0001 F=8.92, p<0.0001
T2DM: Type 2 Diabetes, CVD: Cardiovascular disease, ANOVA: Analysis of Variance,
a:Difference between T2DM only and CVD only is statistically significant (p<0.05)
b:Difference between T2DM only and Combined T2DM and CVD is statistically significant
(p<0.05)
c: Difference between CVD only and Combined T2DM and CVD is statistically significant
(p<0.05)
The correlation analysis revealed a statistically significant inverse relationship between serum
adiponectin levels and key metabolic variables. Adiponectin was negatively correlated with
fasting blood glucose and BMI indicating that lower adiponectin levels were associated with
higher blood glucose and greater BMI.
Table 4: Correlation of Adiponectin and metabolic variables in study subjects
Adiponectin vs Pearson's correlation p-value
Fasting blood glucose -0.42 0.0001
BMI -0.51 0.0001
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Table 5 shows the correlation of adiponectin and fasting blood glucose in the different disease
groups. In the T2DM-only group, a moderate negative correlation was observed, highlighting the
link between adiponectin and glycemic control in this group.In the CVD-only group, a weaker
but statistically significant negative correlation was found, suggesting that the relationship
between adiponectin and glucose regulation is less pronounced in individuals with only CVD.In
the combined T2DM and CVD group, a strong inverse correlation was evident indicating a more
robust association between lower adiponectin levels and poorer glycemic control in this
subgroup.
Table 5: Correlation of Adiponectin and blood glucose in study subjects by disease category
Adiponectin vs Fasting blood glucose
Disease Group
Pearson Correlation (r) p-value
T2DM Only -0.38 < 0.001
CVD Only -0.25 0.016
Combined T2DM and CVD -0.52 < 0.001
4.0 DISCUSSION
The clinical implications of the study results are profound, particularly in understanding the
metabolic dysregulation in individuals with type 2 diabetes mellitus (T2DM) and cardiovascular
disease (CVD).
The mean BMI of 28.7 kg/m² indicates that the study population is generally overweight.
Overweight and obesity are well-established risk factors for both T2DM and CVD. Elevated
BMI is associated with increased insulin resistance, which can exacerbate hyperglycaemia and
contribute to the development of T2DM.[16–18] Additionally, higher BMI is linked to increased
cardiovascular risk due to factors such as hypertension, dyslipidaemia, and systemic
inflammation.
The average FBG of 8.2 mmol/L suggests poor glycaemic control among the subjects, as normal
FBG levels are typically below 5.6 mmol/L. Elevated FBG is a hallmark of diabetes and is
associated with an increased risk of complications such as nephropathy, retinopathy, and
neuropathy.[17, 19] Effective management of blood glucose levels is crucial to prevent these
complications and improve overall health outcomes in diabetic patients.
The average serum adiponectin level of 7.8 µg/mL is relatively low. Adiponectin is an anti-
inflammatory and insulin-sensitizing hormone, and lower levels are linked to a higher risk of
metabolic syndrome, T2DM, and CVD.[20–22] Adiponectin enhances insulin sensitivity and has
7
protective cardiovascular effects, making it a critical biomarker for metabolic health. Studies
have consistently shown that serum adiponectin levels are inversely related to the severity of
T2DM.[17, 22–24] For instance, a study by Lei et al.[24] found that adiponectin levels were
significantly lower in T2DM patients compared to controls, and negatively correlated with
fasting blood glucose and BMI. This aligns with the current study's findings where lower
adiponectin levels were associated with higher FBG and BMI. The inverse relationship between
adiponectin and glycemic control underscores the hormone's role in modulating insulin
sensitivity and glucose metabolism.
Research indicates that adiponectin has protective cardiovascular effects. A study by Choi et
al.[25] demonstrated that lower adiponectin levels were associated with higher BMI and poorer
glycemic control in obese females with T2DM. This supports the current study's observation that
individuals with combined T2DM and CVD had the lowest adiponectin levels and highest FBG.
The anti-inflammatory properties of adiponectin may help mitigate the risk of atherosclerosis and
other cardiovascular complications.[26–28]
The current study highlights that subject with both T2DM and CVD had significantly lower
adiponectin levels and higher FBG compared to those with either condition alone. This is
consistent with findings from other studies that show combined metabolic disorders exacerbate
insulin resistance and inflammation, leading to more severe metabolic dysregulation.[26, 29, 30]
The synergistic effect of T2DM and CVD on metabolic health necessitates a comprehensive
approach to management, addressing both glycaemic control and cardiovascular risk factors.
The inverse correlation between adiponectin and FBG (r = -0.42) and BMI (r = -0.51)
underscores the role of adiponectin in metabolic regulation. Lower adiponectin levels are linked
to higher blood glucose and greater BMI, indicating worse metabolic health. This is supported by
various studies that have reported similar correlations.[28–30] The correlation analysis further
reveals that the relationship between adiponectin and metabolic variables is more pronounced in
individuals with combined T2DM and CVD, highlighting the importance of adiponectin as a
biomarker for metabolic dysregulation.[2, 31]
5.0 CONCLUSION
The study's findings emphasize the importance of monitoring adiponectin levels, BMI, and FBG
in patients with T2DM and CVD. Lower adiponectin levels are indicative of poorer metabolic
health and higher risk of complications. These results are consistent with existing literature,
reinforcing the need for integrated management of metabolic disorders to improve patient
outcomes. Effective interventions should focus on weight management, glycaemic control, and
enhancing adiponectin levels through lifestyle modifications and pharmacological treatments.
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