Insulin secretion and insulin resistance in patients with chronic hepatitis C

The prevalence of type 2 diabetes mellitus is significantly higher in patients with chronic hepatitis C than in those with chronic hepatitis B or even healthy subjects. Although insulin resistance appears to play an important part in the pathogensis of diabetes in these patients, the exact mechanism of this finding is not completely known. High levels of pro-inflammatory cytokines was suggested as a possible mechanism. This work was conducted to detect the primary mechanism of development of diabetes in individuals with HCV infection. A total of 30 non-diabetic non-cirrhotic patients with chronic hepatitis C were included in the study and 15 non-diabetic non-cirrhotic patients with chronic hepatitis B served as the control group. Both groups were closely matched by age, gender, BMI and transaminases. Insulin resistance, beta-cell function, and proinflammatory cytokines [TNF-alpha and 1L6] were evaluated in both .groups. There was no difference between the patients with chronic hepatitis C and those with chronic hepatitis B as regards Beta cell function as determined by HOMA-beta [3 16 +/- 184 vs 248 +/- 225, P>05] but insulin resistance as determined by HOMA-IR [6.5 +/- 4.4 vs 2.8 +/- 1.6, P<.05] and serum levels of TNF-alpha [7.3 +/- 2.8 vs 5.l +/- o.9, p<.01] and IL-6 [419.2 +/- 137.6 vs 302.2 +/- 80.6, P<.05] were significantly higher among the patients with chronic hepatitis C than those with chronic hepatitis B. There was no correlation between HOMA-IR and each of age of patients, FPG, ALT, viral load as measured by HCV PCR and levels of TNF-alpha and IL-6 [P>05]. Insulin resistance may be the primary mechanism of development of diabetes in patients with chronic hepatitis C. Although pro-inflammatory cytokines are increased in these patients, other causes and mechanisms may also be implicated in development of the insulin resistance in these patients

Anthropometric criteria of type-2 diabetics attending national institute of diabetes and endocrinology [NIDE]

Egyptian people have a body shape and cardiovascular risk profiles different from that of other ethnic populations. This study aimed at assessment of anthropometric indices of type-2 diabetics attending National Institute of Diabetes and Endocrinology [NIDE] and to examine the association of these anthropometric indices with hypertension, dyslipidemia, and uncontrolled DM among type-2 diabetics. Besides, to determine which indices can best predict these individual risk factors among these patients. A total of 500 type-2 diabetic patients [79.2% females and 20.8% males], of which 79.6% were obese and 20.4% non obese were enrolled in this work. Their mean age was 51.2 +/- 6.36 year and their mean duration of DM was 11.5 +/- 6.26 year. The anthropometric indices [BMI, WC, WHR and WHTR] of our type-2 diabetics were measured. The history taking, a thorough physical examination and blood sampling for fasting plasma glucose, lipid profile, glycated hemoglobin and creatinine were done for every patient. The prevalence of obesity, central obesity, hypertension, dyslipidemia and uncontrolled DM among our patients were of 79.6%, 89.6, 49.9%, 93.0% and 87.0%, respectively. Most of anthropometric indices [all except WHR] were associated with blood pressure [systolic and diastolic] but all of them were associated with some types of blood lipids. Binary logistic regression revealed that WC was the only anthropometric predictor of hypertension and dyslipidemia among our type-2 diabetics. Both obesity and central obesity are very common among our type-2 diabetics particularly in females. Although most of anthropometric indices are associated with high blood pressure and blood lipids levels, waist circumference is the only anthropometric predictor of hypertension and dyslipidemia among our type-2 diabetics

Profile of the thyroid function and ultrasound among patients with type-2 diabetes mellitus

Both diabetes mellitus and thyroid disorders are common in the general population. A lot of studies in different countries have tried to estimate the prevalence of thyroid disorders among type-2 diabetics. The aim of our work was to evaluate thyroid function, autoimmunity and morphology among patients with type-2 diabetes attending medical clinics at National Institute of Diabetes and Endocrinology [NIDE]. The study subjects included 250 type-2 diabetics and 50 healthy non-diabetic persons of matched age and gender who were recruited from medical clinics of [NIDE]. Routine and related specialized investigation [HbA1c, lipids profile, thyroid function tests and anti-thyroid autoantibodies] and thyroid ultrasound were done for all study subjects. Both thyroid dysfunction [13.1%] and abnormal thyroid ultrasound findings [47.6%] were significantly higher among diabetic patients than control subjects with higher frequency among females than males. The ratio of frequency of thyroid dysfunction in females to males was [14.7%: 7.5%], while the abnormal thyroid ultrasound findings female to male ratio was [51.5%: 34.5%]. Thyroid autoimmunity was comparable among both type-2 diabetics and control subjects. Hypothyroidism [subclinical 6.3% and overt 3.4%] was the most common thyroid dysfunction and nodular [multinodular and solitary] disorders were the most frequent abnormal thyroid morphology among diabetic subjects. While female sex, fasting plasma glucose, LDL, freeT4 and free T3 were associated with TSH [as a marker of thyroid dysfunction], linear regression revealed that the fasting plasma glucose, free T4 and free T3 were the independent risk factors for thyroid dysfunction. High prevalence of both thyroid dysfunction and abnormal thyroid morphology were determined among type-2 diabetics. These conditions not only occurred more frequently among female than male diabetics but also were associated with comparable lipid profile to non-diabetics. The frequency of thyroid autoimmunity was high among type-2 diabetics with thyroid dysfunction denoting the important role of autoimmunity in development of thyroid dysfunction among type-2 DM. Hypothyroidism [subclinical and overt] was the most common type of thyroid dysfunction while nodular [multinodular and solitary] disorders were the most abnormal thyroid morphology reported among these patients. The fasting plasma glucose, free T4, free T3 and anti-TPO antibodies were predictors for thyroid dysfunction while patient's age was the only predictor of abnormal thyroid morphology

Echocardiographic evaluation of diastolic dysfunction in normotensive patients with type-2 diabetes mellitus

Diastolic dysfunction in diabetic patients is believed to represent an earlier stage in the natural history of diabetic cardiomyopathy. Previously published reports on the prevalence of LV diastolic dysfunction in diabetics are conflicting, mainly because of the confounding effect of systemic hypertension and coronary artery disease [CAD] and neglecting to account for pseudonormal patterns of ventricular filling. This study was conducted to estimate the prevalence of diastolic functions in patients with type-2 diabetes without co-existing hypertension or known CAD and to assess the risk factors for the development of diastolic dysfunction in such patients. A total of 100 normotensive patients with type-2 diabetes without any history of cardiac illnesses and 50 age and sex matched healthy controls, were enrolled in this work. All patients and controls underwent conventional Doppler echocardiography, color M-mode echocardiography and tissue Doppler imaging [TDI]. In the diabetic group, 76% had diastolic dysfunction. Impaired relaxation and pseudonormal filling pattern were observed in 30% and 46% of our diabetics respectively. On the other hand, impaired relaxation and pseudonormal filling pattern were observed in 8% and 2% of the controls. The diabetics with diastolic dysfunction were older and had more central obesity than those with normal diastolic function. Both age and waist circumference were associated with the presence of diastolic dysfunction but age was the only independent risk factor for such condition. The prevalence of diastolic dysfunction is very high in normotensive type-2 diabetics, who are free of clinically detectable heart disease. Patient's age appears to be an independent risk factors for such condition in such patients

Impact of obesity on micro-angiopathic complications among article type-2 diabetics

Obesity is characterized by impaired microvascular function that may contribute to develop obesity-related microangiopathy, hypertension as well insulin resistance. Only a few investigations have focused on the role of obesity in the development or progression of microvascular complications among type-2 diabetics. This was conducted to investigate whether obesity has an impact on the risk of diabetic retinopathy, nephropathy and neuropathy in type-2 diabetic persons. Our work is a retrospective study in which we reviewed and analyzed the data of randomized 2715 type-2 diabetics who attended the medical outpatient clinics of NIDE. According to BMI, patients were randomized into 3 groups: normal-weight, over-weight and obese. For all patient funduscopy was performed to detect retinopathy, the diagnosis of nephropathy was made when urinary albumin excretion exceeded 30 pg/mg creatinin and neuropathic complications were assessed by vibratone for determining vibration sensation. High prevalence of obesity was determined among our patients [67%] and is more frequent among females than males [64.3% vs 35.7%]. The prevalence of retinopathy, nephropathy and neuropathy in our patients was 23.3%, 23.4% and 46.9%, respectively. Obese patients had higher prevalence of retinopathy [3 1.2%], nephropathy [28.3%] and neuropathy [48.6%] than normal-weight [23.4%, 3.1% and 41.1%, respectively] and in over-weight patients it was [26.6%, 18.5% and 44.1%, respectively]. Logistic regression analysis showed that age >50 years, male sex, duration of diabetes> 10 years and glycated hemoglobin >7 were independent risk factors for retinopathy, while age >50 years, obesity and glycated hemoglobin >7 were independent risk factors for nephropathy, and age >50 years. Female sex, obesity, duration of diabetes> 10 years, glycated hemoglobin >7 and hypertension were independent risk factors for diabetic neuropathy. Obesity is prevalent in our type-2 diabetics particularly among females. Obesity has some impact on diabetic micro-angiopathic complications, especially it is an independent risk factor for diabetic nephropathy and neuropathy

Effects of oral calcium supplements on metformin -induced decreased vitamin B12 levels in Egyptian type 2 diabetic patients

Metformin is a drug increasingly used as a first-line treatment for diabetes. The drug is well tolerated in most patients. A well documented but little discussed adverse effect is metformin-induced de- creased levels of vitamin B12 . Metformin-induced decreased levels of vitamin B12 may lead to increase of serum homocysteine level, a risk factor for atherosclerosis and may cause peripheral nerve and spinal cord damage. Vitamin B12 - intrinsic factor complex uptake by ileal cell surface receptors is known to be a process dependent on calcium availability. Metformin affects calcium dependent membrane actions. The objective of this work was to study the effects of increased intake of calcium on metformin- induced decreased serum total vitamin B12 levels in Egyptian type 2 diabetic patients. The study was conducted on 40 type 2 diabetic patient who were receiving oral sulfonylurea. After withdrawing the initial blood samples, 24 of the total 40 subjects were switched from their sulfonylurea therapy to metformin while the remainder 16 patients continued to receive their usual sulfonylurea and served as a control group . Both groups were subjected to full history taking, thorough physical examination and laboratory in- vestigations including the usual routine investigations in addition to estimation of HbA1c, [at baseline], serum triglyceride and cholesterol [at baseline and 3 months after metformin therapy] and serum total vitamin B12 [at baseline, after 3 months of metformin therapy and after another one month of adding oral calcium supplement to metformin therapy]. After 3 months of metformin therapy, there was a significant reduction in both serum cholesterol and triglyceride levels, which may explain at least partly, the cardioproctive effect of metformin. In metformin-treated patients group there was a highly significant reduction of serum total vitamin B12 levels after 3 months of metformin therapy in com- parison to levels at baseline. However calcium supplement intake for one month in metformin treated patients group revealed a highly significant improvement of serum total vitamin B12 levels. These results suggest that metformin- induced decreased vitamin B12 levels may be at least partially reversible with oral calcium supplements. Patients with type 2 diabetes treated with metformin should be encouraged to increase their intake of calcium as well as to be closely monitored for vitaminB12 deficiency

Evaluation of bone turnover in adolescent male patients with type 1 diabetes mellitus

A major consequence of metabolic derangement in diabetic patient is the defective bone mineralization. To evaluate the bone turnover in type 1 diabetic male adolescents, 20 male adolescents with type 1 diabetes and 10 age and sex matched healthy adolescents were subjected to a detailed history taking, thorough physical examination and serum investigations including fasting glucose, creatinine, albumin, total protein, fructosamine, total calcium, corrected calcium, ionized calcium, phosphorus, alkaline phosphatase, total testosterone, free testosterone, albumin-bound testosterone, parathyroid hormone [PTH], calcitonin, osteocalcin [OS], carboxy-terminals propeptide of type 1 procollagen [PICP], type 1 collagen cross-linked carboxy terminal telopeptide [ICTP] and beta 2 microglobulin [beta 2 M]. All values were expressed as mean +/- SD and significance was calculated according to unpaired students test. It was concluded that male adolescents with type-1 diabetes had a low bone turnover state due to decreased bone formation and increased bone resorption. The reduced bio-available testosterone in these patients plays as important role in this process and is negatively correlated with the duration of the disease. However, parathyroid hormone plays a nonsignificant role in this process

Effects of oral calcium supplements on metformin-induced decreased vitamin B12 levels in Egyptian type 2 diabetic patients

The objective of this work was to study the effects of increased intake of calcium on metformin-induced serum vitamin B12 levels in Egyptian type 2 diabetic patients. The study was conducted on 40 type 2 diabetic patients who were receiving oral sulfonylurea. After withdrawing the initial blood samples, 24 of the total 40 subjects were switched from their sulfonylurea therapy to metformin, while the remainder 16 patients continued to receive their usual sulfonylurea and served as a control group. Both groups were subjected to full history taking, through physical examination and laboratory investigations including the usual routine investigations, in addition to estimations of HbA1c, [at baseline], serum triglyceride and cholesterol [at baseline and 3 months after metformin therapy] and serum total vitamin B12 [at baseline, after 3 months of metformin therapy and after another one month of adding oral calcium supplement to metformin therapy]. After three months of metformin therapy, there was a significant reduction in both serum cholesterol and triglyceride levels, which may explain, at least partly, the cardioprotective effect of metformin. In metformin-treated patients group, there was a highly significant reduction of serum total vitamin B12 levels after three months of metformin therapy in comparison to levels at baseline. However, calcium supplement intake for one month in metformin-treated patients group revealed a highly significant improvement of serum total vitamin B12 levels. These results suggested metformin-induced decreased vitamin B12 levels may be at least partially reversible with oral calcium supplements. Patients with type 2 diabetes treated with metformin should be encouraged to increase their intake of calcium as well as to be closely monitored for vitamin B12 deficiency

Detection of antigliadin antibodies [AGA] as a serological marker of silent celiac disease among young type 1 diabetic Egyptian patients

This work aimed to study the prevalence of serum AGA-IgA [immunoglobulin] as a marker of celiac disease [CD] in 150 asymptomatic young type 1 diabetic patients. The control group consisted of 100 healthy comparable subjects. Both groups had no gastrointestinal symptoms. They were subjected to full history taking, thorough clinical examinations, full laboratory investigations including the estimation of AGA-IgA using ELISA method. The results showed that seven type 1 diabetic patients were positive for AGA, while there were no positive AGA cases among the control group. Six out of seven positive AGA patients showed villous atrophy after doing intestinal biopsy. The level of serum AGA was not correlated to age, fasting as well as postprandial blood glucose levels, glycated HbA1c, microalbuminuria and duration of diabetes. It was concluded that in young type 1 diabetic patients, the prevalence of CD is higher than that in general population

Changes of homocysteie levels in type 2 diabetic patient with diabetic nephropathy and its relation to albumin excretion rate

Hypercysteinemia has been established as an independent risk factor for coronary atherosclerotic disease which is the most common cause of mortality in patients with type 2 DM. This study explores the relationship among homocysteine [tHcy], renal function as presented by creatinine clearance [CrCl] and albumin excretion rate [AER] as a marker of nephropathy in a population'of type 2 DM.A total of 50 patients with type 2 DM were screened: 15 patients had normo-albulminuria, 23 patients had inicro-albuminuria and the remainder 12 patients had macro-albumimiria. While there was no significant differences in tHcy levels between micro and nonno-albuminuric patients [15.7 +/- 4 vs 146 i 3.3. P=NS], there were significantly higher levels of tHcy Im macro -alhuminuric patients in .comparison to normoalbuminuric patients [25j6 +/- 7.5 vs 14.6+3.3, P<0.001].To explore these relationships further, these groups were subdivided based on CrCl in those with normal CrC3 [CrCl > 80 niL/inin] and those with low CrCl [CrCl