Serum Fibroblast Growth Factor 21 and Its Relation to Diabetic Kidney (DKD) Disease and Cardiovascular Risk (ASCVD) in Type 2 Diabetic Patients

Background: In both industrialized and developing nations, diabetic nephropathy is a major contributor to renal failure and the primary cause of death for those with diabetes. Fibroblast Growth Factor 21 (FGF21) mainly regulates metabolism to improve cellular glucose absorption, insulin sensitivity, and lipid metabolism. It also plays a crucial role in maintaining βcell activities. Moreover, in individuals with type 2 diabetes, FGF21 levels rise in direct proportion to the advancement of the albuminuria stage. Aim: This study aimed to investigate relation of serum level of FGF21 to different degrees of albuminuria in T2DM and to detect its impact on cardiovascular risk in those patients. Patients and methods: This case-control study included 120 volunteer subjects who were divided into: Group A that included 30 healthy control subjects and group B that included 90 T2DM patients. Group B was further classified according to urinary albumin excretion into: Group B1: with normoalbuminuria, group B2: microalbuminuria and group B3: with macroalbuminuria. FGF21 was measured by ELISA and ASCVD risk score was calculated for all subjects. Results: Highly statistically significant increase in serum FGF21 levels and ASCVD risk were found in group B1, B2 & B3 compared to group A, in group B3 compared to group B1 & B2 and in group B2 compared to group B1. Serum level of FGF21 is positively correlated with the ASCVD risk score in type 2 diabetic patients. Conclusion; Elevated FGF21 and prolonged duration of diabetes are the main independent predictors of albuminuria in T2D patients. Increased FGF21 was associated with the ASCVD risk in type 2 diabetic patients.