Study of Lipid Profile and Glycated Hemoglobin in Diabetes Mellitus.

Background: Pattern of dyslipidemia is found to be different in type-1 & type-2 diabetes mellitus(DM). Dyslipidemic pattern and its correlation with glycated hemoglobin in both types of diabetes mellitus has been well studied and might be informative to the diagnostic,therapeutic & prognostic aspects of diabetes mellitus. AIM: To study the lipid profile by using direct method for High Density Lipoprotein-Cholesterol (HDLC) & Low Density Lipoprotein-Cholesterol(LDL-C) estimation, and glycated hemoglobin(GHb) in type-1DM & type-2 DM. Material and Methods: fifty each already diagnosed patients of type-1 and type-2 diabetes mellitus along with fifty control were studied for lipid profile using direct method for Low Density Lipoprotein-Cholesterol (LDL-C) & High Density Lipoprotein-Cholesterol (HDLC) estimation and glycated hemoglobin status. Statistical Analysis: we used student t-test and Pearson’s correlation coefficient to find the statistical significance. Result: serum concentration of glycated hemoglobin and all the parameters of lipid profile except HDL-C were increased while HDL-C concentration decreased in both the types of DM as compared to that of control. Conclusion: dyslipidemia is more prominent in type-2 DM than that in type-1 DM . Glycemic control is poorer & its correlation with lipid profile is stronger in type-2 DM as compared to type-1 DM.

Influence of serum cortisol levels on glycemic control in children with type 1 diabetes

The association between plasma glucose [PG], HbAlc and serum cortisol levels in children with type 1 diabetes was investigated to determine the influence of serum cortisol on their glycemic control. A total of 45 children, aged 10-15 years, with type 1 diabetes for at least 3 years of diabetes were studied. Most of them did not have pancreatic beta-cell function. The cortisol levels among all patients were stratified according to fasting plasma glucose levels [50-99, 100-199, 200-299, and >/= 300mg/dL], and the HbAlc levels [<7.0, 7.0-7.9, 8.0-8.9, and >/= 9%]. The mean fasting PG, HbAlc and serum cortisol levels were 174 +/- 97mg/dL, 7.7 +/- 1.3% and 23.04 +/- 16.6 ug/dl, respectively. The cortisol levels were highly correlated with PG levels [r =0.553, P<0.0001] and mildly correlated with HbAlc levels [r = 0.301, P =0.0192]. Patients with high PG levels gave significantly higher cortisol levels as compared to those with lower PG levels [18.4 +/- 7.3, 26.8 +/- 18.3, 31.4 +/- 17.0 and 36.3 +/- 17.2ug/dl, P =0.0009]. There were no significant differences in serum cortisol levels among patients stratified according to HbAlc levels [P = 0.1566], however, patients with HbAlc levels >/= 9% had significantly higher cortisol levels than those with HbAlc levels <7% [32.6 +/- 14.4 vs. 21.8 +/- 11.3ug/dl,P=0.0291]

Resveratrol, a natural phytoalexin: a therapeutic promise for metabolic disorders in streptozotocin-nicotinamide induced type 2 diabetic rats

Resveratrol, a natural phytoalexin, has demonstrated a wide variety of biological activities, which make it a good candidate for treatment of diabetes mellitus. The present study was aimed to evaluate the properties of resveratrol [RSV] as an antidiabetic agent in streptozotocin-nicotinamide [STZ-NIC] induced Type2 diabetes model. Furthermore, the antidiabetic nature of resveratrol was compared with glyclazide, an oral standard antidiabetic drug. This study includes 40 male albino rats divided into 5 groups: control, control+resveratrol, diabetic, diabetic+resveratrol and diabetic+ glyclazide. The antidiabetic effect of oral administration of RSV [5mg kg/b.wt] for 45days was evidenced from the improvement in the levels of blood glucose, glycosylated hemoglobin and the calculated homeostasis model assessment of insulin resistance. The significant decrease [p<0.05] in plasma insulin level exhibited in the diabetic rats was not affected by RSV treatment, indicating that the hypoglycemic effect of RSV is independent of insulin. The altered activities of key enzymes of carbohydrate metabolism such as glucokinase, glucose-6-phosphate dehydrogenase, glucose-6-phosphatase and glycogen synthase in liver tissues of diabetic rats were all significantly reverted [p<0.05] to near normal levels by administration of RSV. Hyperlipidemia observed in the diabetic group of rats was markedly alleviated by oral treatment with RSV. Lastly, STZ-NIC induced diabetic rats orally treated with RSV had significantly lower [p<0.05] plasma homocystein level and significantly higher [p<0.05] serum folic acid and vit. B12 levels than the untreated ones indicating improvement in the endothelial function in those rats. The present study suggests that STZ-NIC induced diabetes is an excellent model for type2 diabetes, and that RSV is an effective therapeutic agent for treatment of type 2 diabetes mellitus

Effect of helicobacter pylori eradication on short-term control of glycemia in patients with type 2 diabetes mellitus

Precise control of diabetes mellitus, one of the most prevalent endocrine diseases, is important for prevention of serious vascular complications. Helicobacter pylori [H. pylori] is one of the most common chronic bacterial infections in the world and data reveals that diabetic patients with concomitant H. pylori infection require higher doses of insulin, despite which they have higher levels of HbAic than their uninfected counterparts. Our study was hence designed to assess the effect of H. pylori eradocatopmon hyperglycemia control in diabetic patients. Between January and June 2005, patients with type 2 diabetes mellitus and positive urea breath tests, were randomly allocated into two groups, the first treated for H. pylori infection [cases] and the second served as controls. HbAic and FBS were measured in all patients at initiation of study and three months later. The study included 19 cases and 22 controls. Mean decrease of HbAic and FBS in the two groups showed no significant differences. Study results indicate that treating H. pylori in patients with type 2 diabetes mellitus has no role in short-term control of the disease. In most studies numbers and types of evaluated cases have limitations, and results differ. More extensive studies, using long term randomized clinical trials-term are recommendated

effect of glycemic control on serum lipids and calcium - phosphate profiles in patients with type 2 diabetes mellitus

The present study was carried out to investigate the effect of glycemic control levels in type 2 diabetic patients on the serum lipids and lipoprotein profiles and the serum levels of calcium, phosphate and some other electrolytes. The study was conducted on 81 patients with type 2 diabetes mellitus, who were attending the Outpatient Diabetic and Endocrine Clinic in King Khaled Hospital, Hail, Kingdom of Saudi Arabia. The patients were classified into two groups depending on their glycosylated hemoglobin [HbAi]; First: those with good glycemic control [GGC] who had their HbAic 7.5% [n = 43]. The control group comprised of 52 healthy subjects. All anthropometric and biochemical measurements were carried out using the standard methods. Both control and diabetic groups showed high prevalence of obesity with BMI values > 30 [32.2% of C, 34.2% of GGC and 39.5% of the PGC]. The fasting serum glucose levels in GGC and PGC groups were significantly higher than control by 77.3% and 1.1-fold, respectively. The serum total cholesterol [Tc] in the PGC group showed a significant increase [P < 0.01] by 14.4%, whereas, the GGC was not significantly different from control. Tc showed a significant positive correlation with Hb Ale [r = 0.91, P = 0.00007]. On the other hand, the serum triglyceride was significantly higher [P < 0.01] in both GGC and PGC groups. The VLDL was elevated in the GGC by 96.5% and in the PGC by 100% compared to control, whereas, the LDLc fractions in the GGC and PGC were increased by 9.1% and 16.7%, respectively, but HDL-c was not-altered. The-Serunrrrragnesium and sodium levels were not altered in any of the diabetic groups. However, calcium was significantly raised [P0.05] in the PGC compared to control, but not significantly different in GGC. Serum phosphate in the GGC and PGC exhibited significant increases [P0.001] and [P0.01], respectively. Similarly, the potassium levels were significantly higher in both groups compared to control. The type 2 diabetic patients who had better glycemic control showed favorable lipid and lipoprotein profiles with lower risk factors for atherosclerosis and had moderate calcium and phosphate levels compared to their poorly controlled counterparts

Subclinical central nuropathy in thype 2 diabetes mellitus

Involvement of the peripheral and autonomic nervous systems is frequently encountered in diabetes mellitus [DM]. However, there is a paucity of data regarding central neuropathy in DM. To evaluate central nervous system neuropathic changes in patients with type 2 DM with and without peripheral neuropathy. The study included three groups; group 1: Fifteen patients with type 2 DM with clinical and electrophysiological findings of peripheral neuropathy, group 2: Fifteen patients with type 2 DM without any clinical or electrophysiological evidence of peripheral neuropathy and group 3: Fifteen healthy subjects as a control group. All groups were age and sex matched and subjected to physical examination, laboratory investigations including: Complete blood cell count, fasting plasma glucose. glycated hemoglobin [HbAlc], serum lipid profile, renal fitnctions and other necessary tests, in addition to the electrophysiological study including: Somatosensory evoked potentials [SEP], motor evoked potentials [MEP], visual evoked potentials [VEP] and brainstein auditory evoked potentials [BAEP]. Group I had a statistically significant higher mean values of fasting plasma glucose, HbAlc, urinary albumin excretion [UAE] and serum creatinine compared with group 2. Both diabetic groups had similar changes in VEP P100 latency and its amplitude, MEF central motor conduction time, amplitude percentage quotient and duration of the MEP, and BAEP wave II latency, with statistically significant differences compared to healthy controls. There was a statistically significant delay in all of the BAEP waves interpeak latency only in group 1. The other tested parameters of central neuropathy showed statisticasly signficant differences between all studied groups. A statistically significant positive correlation was observed between some of the studied parameters of central neuropathy in diabetic patients and each of the patient age, duration of diabetes, HbA1c, serum total cholesterol, serum triglycerides and UAE. Central neuropathy in type 2 diabetics is not uncommon even in absence of peripheral neuropathy. It is related to the patient age, duration of diabetes, glycated hemoglobin value, dyslipidemia and diabetic nephropathy. The use of more than one modality of the electrophysiological tests [multimodal evoked potential studies] can buffer the fallacies of a single mode and is advisable in evaluating central neuropathy in patients with type 2 DM. Early diagnosis of central neuropathy is recommended to offer an early opportunity for a proper management

relation between oxidative stress and adhesion molecules in Egyptian children and adolescents with type 1 diabetes mellitus

Antioxidant potential decreases while plasma lipid peroxidation products increase in type] diabetes mellitus. The vascular-endothelium is a major target of oxidative stress [OS]. Reactive oxygen species signal events leading to impairment of endothelial function and promotion of leukocyte adhesion to the vascular endothelium. To explore the relation between OS and adhesion molecules in type] diabetes and correlate it with the state of metabolic control, disease duration and microvascular complications [MVCs]. Thirty-eight type] diabetics were included: 22 patients with disease duration less than 5 years and 16 patients with duration of 5 years or more. Thirty healthy age and sex matched subjects served as controls. They were assessed clinically. Laboratory investigations included, random blood sugar [RBS], glycated hemoglobin [HbA[1]c], fasting lipid profile and measurement of serum malondialdehyde [MDA] as a marker of lipid peroxidation and serum soluble P-selectin as a marker of endothelial/platelet activation. Serum MDA and P-selectin were significantly elevated in type 1 diabetics compared to controls with the highest level in diabetics with disease duration of 5 years or more [p<0.0001]. Both MDA and P-selectin levels were significantly elevated in complicated compared to non complicated diabetics [P<0. 000] with strong relation to complication severity, Serum MDA level was positively correlated with serum P-selectin level in diabetics [p<0.000]. Serum MDA and P-selectin were positively and significantly correlated with disease duration [p<0. 0001], RBS [p<0. 0001, p-0. 00 respectively], HbA1c [p<0.000], diastolic blood pressure [p=0. 03, p-0.005 respectively], total cholesterol [p=0. 04, p-0. 02, respectively], triglycerides [p=0. 006, p<0.0001 respectively] and low density lipoproteins [p=0. 03, p=0.05 respectively] but negatively correlated with high density lipoproteins [p=0. 03]. On multiple regression analysis, HbA1c had the strongest effect on both MDA and P-selectin levels [P<0. 0001]. Cut off values for serum MDA and P-selectin equal to 8.035 nmoles/ml and 45. 15ng/dl respectively for early detection of diabetic MVCs were defined. Levels of M4D and P-selectin are elevated in type] diabetics with evident relation to disease duration, metabolic control and severity of MVCs. Hence both of them might act as good markers to identify diabetics who are more susceptible to develop vascular disease

Association of transforming growth factor-beta 1 [TGF-beta1] and monocyte chemoattractant protein-1 [MCP-1] with type II diabetic nephropathy

To estimate the levels of serum transforming growth factor-beta 1 [TGF-beta1], and urinary moncyte chemoattractant protin-1 [MCP-1] throughout the course of diabetic nephropathy [DN], and to find their possible relationship. Also, to assess the relationship between their levels and parameters of renal injury such as albumin/creatinine ratio [ACR] and estimated glomerular filtration rate [eGFR]. Serum TGF-beta1, urinary MCP-1, estimated glomerular filtration rate [eGFR] [as a parameter of renal injury] and glycosylated hemoglobin [HbA1C] [as an index of glycemic control] were measured in 60 patients with type II diabetes mellitus with different degrees of nephropathy [20 with normoalbuminuria, 20 with microalbuminuria and 20 with macroalbuminuria] and compared with 20 matched healthy control subjects. Both levels of serum TGF-beta1 and urinary MCP-1 were significantly higher in patients with micro- and macroalbuminuria [137.8 +/- 69.5 and 329.25 +/- 41.46 ng/dl, respectively for TGF-beta1] [167.41 +/- 50.23 and 630.87 +/- 318.10] ng/g creatinine, respectively for MCP-1] as compared with normoalbuminuric patients and healthy controls [33.25 +/- 17.5 and 29.64 +/- 10.57 ng/dl. respectively for TGF-beta1] [63.85 +/- 21.15 and 61.50 +/- 24.81] ng/g creatinine, respectively for MCP-1] p<0.001. There was a positive significant correlation between levels of serum TGF-beta1 and those of urinary MCP-1 [r=0.73, p<0.001]. Serum TGF-beta1 and urinary MCP-1 correlated positively with HbA 1C [r= 0.49 and 0.55, respectively, p<0.05 for both] and inversely with eGFR [r= -0.69 and -0.60, respectively, p<0.001 for both]. The progression of diabetic nephropathy may he associated with increased levels of serum TGF-beta1 and urinary MCP-1 that are closely- inked to renal damage and the degree of glycemic control. Thus, it seems possible that adequate glvcemic control and TGF-beta1 and MCP-1 antagonists might be helpful in attenuating the progression of nephropathy in diabetic patients

influence of serum LDL-Cholesterol and HDL-Cholesterol on systolic blood pressure of type II diabetic patients with various Kidneys function not yet on dialysis

This study was undertaken to elucidate whether and how in patients with type II diabetes the serum lipid concentrations affect the blood pressure of the patients. Blood pressure [BP] of the patients were measured. For patients glycosylated hemoglobin [HbAlc] and serum lipids consisting of Triglycerides, cholesterol, High density lipoprotein were measured using standard methods. Serum LDL-was calculated. The present study included 122 patients [f=82, m=40]. The mean patient's age was 63 [ +/- 10] years. The mean length of the time they were diabetic was 7.4 [ +/- 5.8] years [median: 6 years]. The duration of hypertension was 3.2 [ +/- 4.6] years [median: 96 months] The mean serum LDL-chol was 112 [ +/- 37] mg/dl [median: 112 mg/dl]. The mean serum HDL-c was 47 [ +/- 18] mg/dl [median: 44 mg/dl] .In this study a significant inverse correlation of serum HDL with mean systolic BP.In this study also a significant positive correlation of serum LDL-c with mean systolic BP was found too. This study has important implications for the increased susceptibility to vascular disease associated with LDL-c in diabetic patients. Hence, higher plasma concentrations of LDL-c though within the normal range, could be an independent risk factor for developing hypertension or its aggravation. This study addressed the hypothesis the new therapeutic methods like statin groups may be identified to reduce LDL-C levels, which may prove to be useful in diabetic patients even in earlier onset of type II diabetes

Postprandial glucose as marker of glycemic control in type II Sudanese diabetics

To compare the accuracy of fasting blood glucose, two hour post breakfast glucose and three hour post breakfast glucose [FBG, 2hPBG, 3hPBG] in inferring glycemic control as judged by glycaled hemoglobin [HbAlc]; and to evaluate their association with diabetic complications and medications used. A comparative cross sectional study was carried at Gaber Abuetez diabetic center, Khartoum. 99 Patients aged 30-70 years, [55% females], with type II dIabetes on oral therapy were enrolled at this study. FBG, 2hPBG, 3hPB3 were measured three times one-week apart; by the end of the month HbAlc was measured Patients were evaluated for clinical evidence of complications; drugs used, haemoglobin, serum creatinine and ECG were done. Sensitivity, spectficity, positive predictive values. The patients control profile was poor in the majority. Only drugs targeting basal glycemia were used. Correlations among different parameters showed FBG to be strongly correlated with HbAlc [r=0. 601; P=0.000]. 2hPBG correlated weakly if at all with HbAlc [r=0.202; p=0.102] but has good prediction of poor control [p = 0.000]. 3hPBG correlation with HbAlc [r=0.547; p=0.000] was less than PBG. 2hPBG, 3hPBG correlated together very well both on single determination and means of the three values [r=0,912, 0.900. P=0.000]. Correlations with PBG had been less r=0.830, 0.841 respectively. Poor correlation was shown between levels afglycemia and long term diabetic complications except for erectile dysfunction [P=0. 035]. When correlated with current oral therapy only measures of basal glycemia correlated signflcantly, on other hand postprandial glucose and glucose excursions correlated poorly. Sudanese diabetics should have their posiprandlal glucose measured, in addition to fasting glucose and/or HbAlc. 2 and 3-hour post breakfast blood glucose can be used alternatively Medications specifically designed at the management of postprandial hyperglycemia [i.e. repaglinide, acarbose] should be included in the routine treatment of Sudanese diabetics

Glycosylated hemoglobin and lipoproteins in patients with premature hair grayness

The aim of this study was to estimate glycosylated hemoglobin, fasting blood sugar and lipid profile in patients with premature grayness of hair. This study was carried out from October 1999 and May 2000, at the Dermatology and Venereology Outpatient Clinic of Baghdad Teaching Hospital, Iraq. Sixty patients with premature grayness of hair and 20 healthy individuals were included in this study. The levels of glycosylated hemoglobin, fasting blood sugar, serum triglyceride, total serum cholesterol, high-density lipoprotein-cholesterol, and atherogenic index were assessed for both patients and control. The mean level of glycosylated hemoglobin in patients with premature grayness of hair was 4.84 +/- 0.46, and the mean level of fasting blood sugar in patients with premature grayness of hair was 83.25 +/- 8.67. Both these parameters were significantly higher in patients with premature grayness of hair than that of the control. Also, it was found that these parameters were positively correlated to the severity of the disease. The level of high-density lipoprotein-cholesterol was significantly lower in patients with premature grayness of hair compared to control. The discovery of elevated glycosylated hemoglobin in patients with premature grayness of hair was similar to what has been reported in diseases with possible auto-immune etiology such as vitiligo. These changes together with the well-documented association between premature grayness of hair and autoimmune diseases can support the autoimmune etiology of premature grayness of hair

Serum levels of leptin, insulin-like growth factor-1 and growth hormone in children with insulin dependent diabetes mellitus: the effect of metabolic control and pubertal development

The existing literature on the relation between serum leptin and growth hormone [GH] / insulin like growth factor-1 [IGF-1] axis in insulin dependent diabetes mellitus [IDDM] is conflicting. The present study included 45 children and adolescents with IDDM [22 recently diagnosed and 23 old known diabetics], aged from 6-14 years, they were 26 girls and 19 boys, together with 16 apparently healthy control children of matchable age and sex. All patients and controls were subjected to complete medical history and clinical examination including calculation of body mass index [BMI] and pubertal staging. The serum levels of leptin, C-peptide, CH and IGF-1 were determined in all patients and controls. Glycemic control was assessed by glycosylated hemoglobin [HbA1C]. Diabetic children showed significantly higher mean values of serum levels of leptin and GH than controls. This was true for the diabetic children in general, for those with poor metabolic control [HbA1C>9%], for the old diagnosed diabetics as well as the pubertal diabetic adolescents. On the other hand, the whole diabetic cases, prepubertal adolescent diabetics, the recently diagnosed ones and those with poor metabolic control showed significant lower serum levels of IGF-1 than their comparable partners. In all diabetic cases, serum levels of leptin as well as lGF-1 were positively correlated with BMI and C-peptide. However, leptin and GH showed significant positive correlation in pubertal diabetics only. IGF-1 levels were negatively correlated with HbA1C in the studied diabetic children, while no correlation could be detected between serum leptin and IGF-1 or between GH levels and either of IGF-1 or BMI in diabetic cases. Leptin and GH /IGF-1 system are altered in IDDM in relation to the degree of metabolic control and the pubertal changes. The improvement of glycemic control may help to correct such ulterations. The effect of these changes needs further studies to be settled

Autoantibodies against glutamic acid decarboxylase and insulin: role of immunological markers in type 1 diabetes mellitus and their relatives

This study was performed on 180 child classified into three groups. Group I, consisted of 50 newly diagnosed type 1 diabetes mellitus [DM], group II included 65 non-diabetic child with a positive family history of type 1 DM and group III contained 65 non diabetic child with negative family history for type 1 DM. All individuals were subjected to routine blood investigations for diabetes [fasting and post-load serum glucose and HbAlc] in addition to the measurement of insulin autoantibodies [IAA] and glutamic acid decarboxylase autoantibodies [GADA]. The aim of this work was to assess the sensitivity and specificity of IAA and GADA as immune markers in type 1 DM as well as their role in the prediction of the disease among individuals with positive family history for type 1 DM. Results of this study showed significant positive correlation between IAA against fasting serum glucose, post-load serum glucose and HbAlc. Stronger positive correlation was found between GADA and the same parameters. GADA showed better sensitivity, specificity, positive and negative predictive values and test efficiency when compared to IAA. Combined assay [GADA and IAA] gave the same sensitivity, specificity, positive and negative predictive values and test efficiency when compared to GADA alone. It may be concluded from the present study that GADA has more significant role than IAA in predicting the risk of developing DM in individuals with positive family history of type 1 DM

prevalence of abnormal results of annual investigations among diabetic patients with different risk factors

The basic theme of this study was to promote the use of risk approach and encourage selectivity in requesting laboratory investigations. The objective was to estimate the proportion of abnormal results obtained from routinely requested annual investigations among the whole study population, and the odds ratios of abnormal test results among patients with certain risk factors. Patients and A total of 459 diabetic patients aged 12 years and over, attending the primary care clinics of a university hospital in Riyadh, Saudi Arabia, were included in the study. In this cross-sectional study, analysis of the association between patients' demographic characteristics and clinical findings [independent variables], and the results of the annual investigations were conducted. A multiple logistic regression analysis was carried out to identify certain independent variables associated with abnormal investigations. The proportion of patients who had abnormal electrocardiogram [ECG] was 23%, chest x-ray [CXR] 26%, and liver function test [LFT] 9%. High systolic blood pressure [BP] and age were found to be important determinants of abnormal ECG and CXR. Patients who had high systolic BP [>140 mm Hg] were found to be 2.39 times more likely to have abnormal ECG [OR=2.39], and their odds ratio of abnormal CXR was 2.33. Furthermore, for each 10-year increment in age, there was a 43% increased likelihood of abnormal ECG and 29% increase of abnormal CXR. Smokers were nine times more likely to have abnormal LFT [OR=9.26, 95% CI=2.29 to 37.5]. The disease duration and obesity were not found to have an independent association with the possibility of having abnormal results. The study results led to some tentative suggestions on guidelines for clinicians in their decision either to request annual investigations for all diabetic patients, or to restrict some investigations to certain groups of patients. This was discussed and compared with the findings from the literature and other authorities' recommendations

Comparison of fructosamine and glycosylated hemoglobin in a non-insulin dependent diabetic population

In an attempt to determine the clinical value o fructosamine assay for monitoring type II diabetic patients, correlation of fructosamine with glycosylated hemoglobin was studied. 100 patients with type 11 diabetes mellitus were compared with 100 normal subjects. Fasting blood glucose, glycosylated hemoglobin, albumin and fructosamine were measured in all subjects. In the diabetic patients, a significant correlation was observed between fasting blood glucose and glycosylated hemoglobin [r = 0.64, P < 0.01] and serum fructosamine [r = 0.7, P < 0.01]. There was also a significant correlation between glycosylated hemoglobin and serum fructosmine [r = 0.94. P<0.01]. Fructosamine, assay can be used as an index of diabetes control

Platelet aggregation and von willebrand factor in children with insulin dependent diabetes mellitus

Microvascular complications of diabetes mellitus represent the most serious complications that burden normal life in insulin dependent diabetic patients. It has been speculated that platelet activation and von Willebrand factor [vWF] activity might contribute to the evolution of microvascular complications in patients with insulin dependent diabetes mellitus [IDDM]. In this study, platelet aggregation [in response to ADP and ristocetin] and vWF activity were measured in 20 children with IDDM who were clinically free from demonstrable microvascular complications, and in 10 normal healthy children of matched age and sex served as control group. The results showed an abnormal platelet behavior in diabetic children that was characterized by irreversible aggregation with low dose of ADP and significant increase in peak wave length of platelet aggregation with both ADP and ristocetin. Also the activity of vWF which is a marker of endothelial cell function was significantly higher in diabetic children compared to control group. The studied parameters, were compared with the state of metabolic control, namely glycemic control by measurement of glycated haemoglobin [Hb A1c] and the lipidemic state assessed by serum total cholesterol levels. Platelet aggregation was positively correlated with the serum cholesterol level while vWF was positively correlated with the level of glycated haemoglobin. Meanwhile vWF activity was positively correlated with platelet aggregation. To conclude; the results of this study suggest that diabetic children who are clinically free from detectable microvascular complications might be at the onset of preclinical microangiopathy manifesting itself by the enhanced platelet aggregation and endothelial cell dysfunction [high vWF activity]. Both the glycemic and lipidemic states seem to affect the enhanced platelet activation and increased vWF

Uninary aibumin excretion rate in patients with type 2 diabetes mellitus and retinopathy

To determine whether a relationship between retinopathy and nephropathy in patients with type 2 diabetes mellitus; 47 subjects with type 2 diabetes mellitus and retinopathy, and a control group formed of 65 subjects with type 2 diabetes mellitus but without retinopathy were examined for urinary albumin excretion per 24 hour, fasting blood glucose, 2 hour post prandial blood glucose, glycosylated HbA1c, fasting serum cholesterol, fasting serum triglycerides, blood urea, serum creatinine and glomerular filtration rate The two groups of patients were matched for age and sex. They were above 5 years diabetes duration and had a within normal renal function. Results of this study showed that subjects with diabetic retinopathy had mostly nonprolifertive type [41 [87.23%]] and there was an increase in their urinary albumin excretion per 24 hour [19 [40, 43%]] which was mainly in the form of microalbuminuria. Comparing the frequency and mean values of micro albuminuria and macro albuminuria in the two groups of patients, there was a significant increase in the diabetic subjects with retinopathy. Also, these patients had a significant increase in the mean values of fasting blood glucose, post prandial blood glucose, fasting serum cholesterol, fasting serum triglycerides, glycosylated HbAlc, diabetes duration and both systolic and diastolic blood pressure. For the other studied parameters, there was a non significant increase in the mean values of fasting serum insulin, blood urea, serum creatinine, glomerular filtration rate, body mass index and age of the patients in the diabetics with retinopathy in comparison to those without retinopathy. These results suggest that patients with type 2 diabetes mellitus and retinopathy have an increase in the rate of urinary albumin excretion and there is a strong association between background retinopathy and microalbuminuria. Consequently microalbuminuria can be considered as a risk factor for diabetic retinopathy as well as fundus examination can be a useful and rapid bed side diagnostic tool for diabetic nephropathy

Subclinical peripheral neuropathy in patients of insulin dependent [Type 1] diabetes mellitus

Motor and sensory nevre conduction velocities in the upper and lower limbs were evaluated in 30 patients of type I [insulin-dependent] diabetes mellitus and 15 age matched non-diabetic controls having no symptoms of peripheral neuropathy. Fasting blood glucose and glycosylated haemoglobin [HbA1C] levels were estimated to assess the glycaemic control in diabetic patients. Motor and sensory nerve conduction velocities were very highly significantly [P< 0.001] reduced in diabetic patients as compared to those in non-diabetic controls. A significant inverse correlation [P< 0.05] between duration of the disease and motor nerve conduction velocity of median nerve was demonstrated. There was also a significant inverse correlation [P< 0.05] between motor and sensory conduction velocities and fasting blood glucose level. This suggests a metabolic basis for the pathogenesis of diabetic neuropthy. Subclincal peripheral neuropathy was present in 36.67% of insulin-dependent diabetics

Clinical profile of non-insulin dependent [Typ-II] diabetes mellitus at Mayo Hospital Lahore

Non-Insulin Dependant Diabetes Mellitus [NIDDM] is a major metabolic disorder. Insulin resistance is the primary abnormality predisposing to NIDDM. Genetic factors as well as environmental agents cause NIDDM in man. Hyperglycemia leads to development of complications. Present study was aimed to investigate NIDDM from a population perspective as a risk factor for development of complications. The study was conducted on 48 subjects. They were NIDDM patients and non-diabetic relative of type-II diabetics. Clinical symptoms, complications and blood glucose levels were recorded. Fifteen percent [15%] of NIDDM patients did not have a positive family history of diabetes. On diet control alone presented with more complications. There was statistically highly significant difference [p<0.01] in age of onset and total duration of diabetes between patients on oral hypoglycemics and on diet control. Body Mass Index [BMI] was higher in diabetics as compared to non-diabetics [p< 0.01]. Complete physical examination and routine glycosylated haemoglobin [HbA1C] should be carried out on regular basis to avoid development of complications

Patients educational program in non-insulin dependent diabetics

This study included 40 patients: 32 females and 8 males. All are non-insulin dependent diabetics with an age ranging from 40 to 60 years. They were subjected to history taking and clinical examination and educational program for three months. Estimations of the levels of glycosylated haemoglobin, fasting blood sugar, fasting serum cholesterol and fasting serum triglycerides were done and after the education program. Statistical analysis revealed that total HbA[1c], fasting blood sugar and fasting serum cholesterol levels were significantly decreased in all patients after educational program. An improvement in triglycerides level was observed in 47% of all patients after the educational program. Body mass index and blood pressure [both systolic and diastolic] significantly decreased in all patients after the educational program. There was a significant improvement in the clinical status of patients regarding number of clinical hypoglycemic attacks, number of patients suffering from tinea pedis and degree of fatigue on doing ordinary effort after educational program. We compared females and males in all studied parameters and we found an insignificant correlation. There was a significant positive correlation between HbA [1c]% and fasting blood sugar in all patients before and after education program. We concluded that educational program for NIDDM [diet education, urine self-monitoring and weight reduction] is considered as the cornerstone of therapy for NIDD patients. Further similar educational programs of longer duration is recommended to asses its long term effect on glycemic cnotrol of NIDDM