To the Editor: Dr Pradhan and colleagues1 found that elevated levels of interleukin 6 (IL-6)
were associated with the risk of developing type 2 diabetes mellitus in a
large cohort of apparently healthy middle-aged women. Their data are consistent
with the results of others.2,3
According to Pradhan et al, type 2 diabetes mellitus may be a manifestation
of a long lasting and ongoing cytokine-mediated acute phase response involving
IL-6. However, the mechanisms of the diabetogenic action of IL-6 are far from
clear. Modulation of insulin secretion by IL-6 does not seem to be a major
factor; on the other hand, there is recent evidence that IL-6 may produce
insulin resistance.2,3 Cytokines
can exert their effects either directly or indirectly, although a direct effect
of IL-6 on the insulin–receptor transduction pathway has not been demonstrated.
Indirect effects on insulin resistance have been attributed to the stimulatory
action of IL-6 on the hypothalamic-pituitary-adrenal axis, hence to induction
of a hypercortisolemic state.3 In fact,
hypercortisolism leads to insulin resistance in a number of conditions.
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