Metabolic consequences of concomitant Strongyloides stercoralis infection in Type 2 diabetes mellitus.

Background: Human and animal studies have demonstrated that helminth infections are associated with a decreased prevalence of Type 2 diabetes mellitus (T2DM). However, very little is known about the biochemical and immunological interactions between the two.

Methods: To assess the relationship between a soil-transmitted helminth, Strongyloides stercoralis (Ss) and T2DM, we examined a variety of analytes associated with glycemic control, metabolic processes and T cell driven inflammation at the time of Ss diagnosis and then 6 months after definitive anthelmintic treatment. We thus measured plasma levels of HbA1c, glucose, insulin, glucagon, adipocytokines and Th1-, Th2- and Th17- associated cytokines in those with T2DM with (INF) or without Ss infection (UN). In INF individuals, we again assessed the levels of these analytes 6 months following anthelmintic treatment.

Results: INF individuals exhibited significantly diminished levels of insulin and glucagon compared to UN individuals, that increased significantly following therapy. Similarly, INF individuals exhibited significantly diminished levels of adiponectin and adipsin that reversed following therapy. INF individuals also exhibited significantly decreased levels of the Th1- and Th17- associated cytokines in comparison to UN individuals; again, anthelmintic therapy augmented the levels of these. As expected, INF individuals had elevated levels of Th2-associated and regulatory cytokines that normalized following definitive therapy. Multivariate analysis revealed that these changes were independent of age, gender, body mass index, liver and renal function.

Conclusions: Thus, Ss infection is associated with a significant modulation of glycemic, hormonal and cytokine parameters in T2DM and its reversal following anthelmintic therapy. Hence, Ss infection has a protective effect on diabetes-related parameters.