ABSTRACT
Background and aim of the work: HCV infection causes serious liver diseases including liver cirrhosis and liver cancer. It can also cause some extrahepatic diseases like diabetes mellitus. We aimed in this study to detect glucose abnormalities in patients with chronic hepatitis C and liver cirrhosis
Subjects and methods: the study was conducted on 70 subjects, 60 of them were HCV +ve and 10 apparently healthy volunteers as control. Patients were grouped into four groups. Group l: included 15 chronic hepatitis C patients[12 males, 3 females; mean age 46 +/- 8.0 years. Group 2: included 15 patients with Child A class, 9 males and 6 females with mean age 49 +/- 5.2 years. Group 3: included 15 patients with Child class B [7 males and 8 females with mean age 52.5 +/- 7.6 years. Group 4: included 15 patients with Child C class [9 males and 6 females with mean age 48.4 +/- 7.1 years]. Complete history and clinical examination, abdominal ultrasound were done. Liver function tests, fasting and postprandial blood glucose, renal function tests. HCV Ab, HBsAg, HCV RNA were done. Serum Insulin levels and C-peptide were measured by ELISA method
Results: body weight, body mass index [BMI], waist to hip ratio [WHR] in patients with chronic hepatitis C and cirrhotics were not different from the control group. 31.6% of patients were diabetics, 45% of patients had impaired glucose tolerance and 23.4% of patients had normal blood glucose. There was highly significant increase in both c-peptide and blood insulin levels in diabetic patients when compared to patients with impaired glucose tolerance and patients with normal blood glucose with p value < 0.0001
Conclusions: hyperinsulinemia and increased levels of serum C-peptide were found to be significantly more prevalent in chronic HCV patients. HCV-related liver diseases have great liability to develop disordered glucose homeostasis. Hyperinsulinemia and peripheral insulin resistance is one of the most important factors that underlie pathogenesis of hepatogenic diabetes
ABSTRACT
Background: Patients with diabetes mellitus are assumed to be at increased risk for developing diabetic retinopathy and diabetic nephropathy, probably because of diabetes mellitus associated with endothelial dysfunction. So, factors related to endothelial dysfunction may be considered as non traditional risk factors for diabetic retinopathy
Objectives: This study aimed at evaluation of the Von Willebrand factor [vWF], microalbuminuria and reduced glomerular filtration rate as predictors of developing diabetic retinopathy in patients with type 2 diabetes mellitus
Patients and Methods: The study included 126 subjects divided into two groups. Group I included 30 apparently healthy individuals served as control group, 21 males and 9 females. Group II included 96 patients known to have type 2 diabetes mellitus, 65 males and 31 females. Assessment of type 2 diabetic patients was done by history taking, clinical examination and laboratory investigations, which included: Fasting and 2-hours postprandial blood glucose, complete urine analysis, Glycated hemoglobin [HbA 1C], microalbuminuria by radioimmunoassay, plasma levels of vWF, fundus examination to determine the degree of retinopathy by direct and indirect ophthalmoscope, renal function tests, and glomerular filtration rate [GFR]
Results: In group II, microalbuminuria was found in 89 [92. 7%] patients, high vWF was found in 17 [17. 7%] patients, and low GFR was found in 49 [51%] patients, In group II, diabetic retinopathy was found in 49 [51%] patients, and 47 [49%] patients had no diabetic retinopathy changes. Non proliferative diabetic retinopathy was found in 39 [40%] patients and proliferative diabetic retinopathy was found in 1 O [11 %] patients. In group II, vWF was strongly correlated with presence of retinopathy and low GFR. Retinopathy was strongly correlated with high vWF, microalbuminuria and low GFR. Low GFR was strongly correlated with high vWF, microalbuminuria, and presence of retinopathy
Conclusions: Diabetic patients with long duration of illness, microalbuminuria, low glomerular filtration rate, and high vWF are more susceptible to the development of diabetic retinopathy. Von willibrand factor [vWF] with microalbuminuria and reduced glomerular filtration rate can be used as a predictor of developing diabetic retinopathy in patients with type 2 diabetes mellitus