Prevalence of elevated hepatic transaminases among upper Egyptian patients with type 2 diabetes mellitus

The prevalence of liver transaminases in type 2 diabetics upper Egypt patients with type 2 diabetes is unknown. To estimate the prevalence of elevated liver transaminase levels among upper Egyptian patients with type 2 diabetes and to determine the associated risk factors. We recruited130 patients with type 2 diabetes from the diabetic outpatient clinic of internal medicine department, or those admitted in tropical medicine department, Assiut university hospital. For all participants, the following was recorded; body mass index, waist circumference, lipid profile, and hepatic transaminase levels. HBsAG, anti-HCV and abdominal US examination was done in all patients. Risk factors of raised transaminases were identified using univariate then multivariate analysis. Amoung the 130 patients enrolled in this study. 22.3% [n-29] were males and 77.7% [n=101] were females. The mean age was 47.35 +/- 9.36 years. One hundred and eighteen [90.8%] were obese. The prevalence of elevated AST was 7.7% [n=10] with the gender-wise prevalence of 13.8% [n=4] in men and 5.9% [n=6] in women, p value= 0.157, odds ratio - 0.39 [95% CI: 0.103-1.51]. The prevalence of elevated alanine transaminase [ALT] was 11.5% [n=15] with the gender-wise prevalence of 13.8% [n=4] in men, and 10.9% [n=11] in women, p value = 0.441, odds ratio=0.764 [95% confidence interval [CI]: 0.224-2.61]. Only 3.8% [n=5] showed elevated levels of both ALT and AST. Patients with high waist circumference had elevated ALT levels [13.8%] versus 4% only in those with normal waist circumference [odds ratio=3.6. 95%, CI: 0.462-29.49, and p value = 0.035]. Insulin use was associated with a high odds ratio for elevated ALT levels [OR=18.85. CI: 2.39-148.3]. High ALT levels were significantly associated with the duration of diabetes: 14.85% in those with DM dating to <10 years versus 0% in those with DM dating to >/= 10 [odds ratio= 0.748.CI: 0.673-0.832 and p value=0.018]. Younger patients [less than 45 old] and a higher tendency to have elevated ALT compared to those over 45 years [OR= 1.19. p value=0.003]. on multivariate analysis. Young age and insulin use was only independent predictor for isolated rise in ALT or AST were obese [P value= 00.043 and 0.045 respectively]. The risk factors for elevated levels of both ALT and AST in univariate analysis were male gender. Patients less than 45 years old and insulin use. Elevated ALT and AST levels are found in 11.5% and 7.7% of type 2 diabetic patients re-spectively. Elevated ALT level is observed more in relatively younger diabetic patients with isolated rise of either ALT or AST were obese. One multivariate analysis, young age and insulin use were only independent predictor for isolated rise in ALT levels. Hyperinsulinemia and insulin resistance should be considered as the key mechanism leading to hepatic steatosis

Glycemic control effect on diabetic neuropathy and antioxidants in type 2 diabetes mellitus

To assess the relationship between glycemic control, the oxidative stress and antioxidant vitamin status and their influence on diabetic neuropathy. Thirty six type 2 diabetic patients with diabetic neuropathy were included in this study. They were classified into good and poor glycemic controlled groups [12 and 24 patients respectively]. All patients underwent multiple nerve conduction parameters including F wave latencies. Fasting serum glucose and glycosylated hemoglobin [HbAcl%], Lipogram, malondialdehyde [MDA], nitric oxide [NO] and antioxidants vitamin C and E plasma levels were determined. Poor glycemic controlled group recorded significant longer F wave latency of ulnar nerve, slower sensory conduction velocities of median nerve [P<0.05] and segmental motor conduction velocities of ulnar and median nerves [P <0.05; 0.01; 0.001], compared with that of good glycemic controlled group. Poor glycemic controlled group had significant rising oxidative stress markers [MDA] and reducing NO and vitamins [E and C] plasma level compared to that of good glycemic controlled group [P<0.001]. HbAlc% is significantly correlated with plasma MDA, vitamin C and E levels and segmental conduction velocities [P<0.001; 0.05]. Poor glycemic control is associated with high oxidative stress, lipid peroxidation and depletion of vitamins C and E plasma levels, that may be contributing to diabetic neuropathy progress

Short term effect of glycemic and dyslipidemia control on nerve conduction study and antioxidants status in type 2 DM

The importance of glycemic control in patients with diabetes is well known, but neurological studies suggest that dyslipidemia is actually a more significant contributor to diabetic neuropathy. Is to study the relationship between the degree of hyper glycemic and hyperlipidemic control on one hand and the degree of improvement in clinical, neurophysiological parameters, and level of oxidative stress markers and antioxidants in type 2 DM. Twenty four type 2 diabetics with hyperglycemia, dyslipidemia and diabetic neuropathy were included in this study. They received treatment for control of hyperglycemia and dyslipidemia for 3 months. Clinical assessment, nerve conduction, F-wave studies, lipid profile, oxidative stress markers as Plasma malondialdehyde [MDA] and antioxidant status [Nitric Oxide and vitamin C and E] were measured for each patient before, one and 3 months after beginning of treatment. They were classified according to percentage changes [PC] of glucosylated heamoglobin level [HbAlc%] into 2 groups. The first group had low PC of HbAlc% [< 25%] and the second group had high PC of HbAlc%[> 25%][n=11 and 13 respectively]. There were no significant differences in demographic and clinical data between both groups. Higher PC group had significant greater improvement compared to lower PC group in motor conduction velocity of median nerve [p = 0.017], serum triglyceride [p= 0.005], lipidperoxidation [MDA] and antioxidants levels [p= 0.0001 for each]. Efficient glycemic and dyslipidemia control significantly improved peripheral nerves function and antioxidant status