Experience of using mineral waters in patients with type 1 diabetes mellitus for the correction of endotoxinemia

Background. In recent years, special attention has been paid to the role of endotoxemia in the pathogenesis of chronic inflammatory processes and vascular complications of type 1 diabetes mellitus (DM1) — increased levels of circulating bacterial lipopolysaccharide (LPS). Endotoxemia occurs due to increased permeability of the intestinal barrier (“leaky gut syndrome”) and/or decreased activity of its elimination systems. Correction of endotoxemia is a promising direction in the complex therapy of DM1. Traditional approaches include strict glycemic control and the use of certain pharmacological agents, however, the search for effective non-pharmacological methods, such as the use of natural mineral waters, remains relevant. Despite the theoretical background, data on the effect of a course of mineral water intake on markers of endotoxemia and systemic inflammation in patients with DM1 are extremely limited. Aims: to evaluate the effect of mineral waters on the state of LPS-binding systems, the level of circulating lipopolysaccharide and markers of inflammation in patients with type 1 diabetes mellitus. Material and methods. The study included 53 patients with a verified diagnosis of type 1 diabetes mellitus. The intervention group (n=25), in addition to standard DM1 therapy, received non-carbonated therapeutic table mineral water “Krymskaya mineralnaya” produced by JSC “Beer and Alcohol Plant “Crimea” for 150—200 ml 3 r/d. The second group was a control group, and consisted of 28 patients who were comparable in gender and age to the experimental group. ELISA kits were used to determine the level of C-reactive protein (CRP), interleukin-6 (IL-6), zonulin, lipopolysaccharide (LPS), lipopolysaccharide-binding protein (LBP), and low-density lipoproteins (LDL), including apolipoprotein B-100 (apoB-100) manufactured by Cloud Clone Corp. (Wuhan, Hubei, China). Results. In patients of group 1, after the use of mineral waters, a significant decrease in circulating LPS (p=0.029) and apoB-100 (p=0.002) was detected, as well as a statistically significant increase in LBP (p=0.009). There were no significant changes in the studied indicators in the control group. Conclusions. The study demonstrates that a 30-day course of taking “Krymskaya” mineral water in addition to standard insulin therapy in patients with type 1 diabetes mellitus leads to a statistically significant decrease in the level of circulating lipopolysaccharide (LPS), a key trigger of endotoxemia and chronic inflammation. The results obtained justify the expediency of further studying the use of mineral waters, in particular bicarbonate-chloride-sodium, as a component of complex non-pharmacological therapy aimed at correcting endotoxemia and improving the metabolic profile in patients with type 1 diabetes mellitus.