Study of metabolic and some hormonal aspects among pubertal type-1 diabetic girls

The onset of type-1 diabetes before menarche was a risk factor for the subsequent development of hyperandrogenic disorders. It has been also suggested that the use of exogenous insulin to treat type-1 diabetes mellitus in those patients may contribute to the development of PCOS. Abnormal lipid levels were also reported in children with type-1 diabetes mellitus during pubertal years. This study was designed to investigate metabolic and some hormonal changes in relation to puberty among type-1 diabetic girls. The study was carried out on 60 girls, 40 of them were type-1 diabetic patients [the diabetic group], subdivided into two groups [according to age and Tanner breast staging] and 20 of them were normal healthy girls [the control group], also subdivided into two groups [according to age and Tanner breast staging]. All girls were subjected to full history taking thorough clinical examination, estimation of fasting blood glucose and HbAIc [as an estimation for glycemic control], lipid profile, hormonal profile [FSH, LH and free testosterone] in addition to pelvic ultrasound. There is an increased frequency of dyslipidemia in the form of hypercholesterolemia and increased levels of LDL among type-I diabetic girls and pubertal type-I diabetic girls show higher BMI and cholesterol levels compared to controls and also show higher levels of LDL compared to prepubertal type -I diabetic children. Age at menarche is delayed in pubertal type-I diabetic girls having PCOS, while not delayed in those without PCOS but positively correlated to the longer duration of diabetes and with the level HbA Ic. Both the frequency of PCOS and the level of free testosterone are higher in pubertal type-I diabetic girls compared to their normal controls

Vascular endothelial growth factor and diabetic nephropathy in type-2 diabetic patients

Diabetes usually accompanied with multiple complications affecting both the microvasculature and macrovasculature. Vascular endothelial growth factor [VEGF] has been implicated in the pathogenesis of diabetic nephropathy. This study was designed to investigate serum and urinary VEGF in type-2 diabetic patients and assess whether serum and urinary VEGF levels are related to the severity of diabetic nephropathy. The study included 80 type-2 Egyptian diabetic patients [46 female, 34 male] attending the outpatient clinics of NIDE and 30 normal controls. Blood pressure, BMI, FBS, HBA1c, lipid profile, urea, creatinine, uric acid, microalbuminurea and VEGF [serum and urine] were measured. Fundus examination, chest X-ray and ECG were performed for all subjects and echocardiography was done when indicated. There was a significant increase in plasma VEGF concentrations in diabetic patients than in normal controls. Patients with higher levels of serum VEGF concentrations had a significant increase in systolic BP, diastolic BP, FBS, HbA1c, serum creatinine, albumin/creatinine ratio and retinopathy than those with lower levels of serum VEGF concentrations. There was also a significant increase in urinary VEGF concentrations in diabetic patients than in normal controls. Urinary VEGF levels appeared to be positively correlated with both urinary ACR and serum creatinine. These data demonstrate the ability to reveal new markers for diabetic nephropathy, an important step forward in advancing accurate diagnosis and understanding of disease mechanisms

Serum ferritin level in poorly and well-controlled type 2 diabetic patients attending the outpatient clinics of NIDE

Serum ferritin level is related to body iron stores and is influenced by several diseases. This study was undertaken to evaluate the association between serum ferritin concentration and glycemic control. One hundred and twenty type 2 diabetic patients attending the outpatient clinics of the National Institute of Diabetes and Endocrinology [NIDE] and one hundred and twenty normal healthy controls were involved in this study. We confirmed that serum ferritin was increased in diabetic patients as long as glycemic control is not achieved. Thus, serum ferritin can be recommended as a marker of glycemic control. However, these findings and the possible use of serum ferritin as a predictor of diabetic microangiopathic complications, especially diabetic retinopathy, must be confirmed by additional studies comprising more subjects

Waist Circumference in recently diagnosed type 2 diabetics

Body mass index [BMI] is often used to reflect total body fat amount [general obesity] whereas waist circumference [WC], waist-to-hip ratio or waist-to height ratio is used as a surrogate of body fat centralization [central obesity]. The clustering of cardiovascular risk factors in association with disturbance of glucose and lipid metabolism is referred to as metabolic syndrome. Men and women who have waist circumference > 94cm and 80 cm respectively, are considered to be at increased risk for cardio metabolic disease.The relation between waist circumference and clinical outcome is consistently strong for diabetes risk, and waist circumference is a stronger predictor of diabetes than BMI. Our study is the first study to measure waist circumference in newly diagnosed Egyptian diabetic patients. We found that, 56% of newly diagnosed Egyptians diabetic patients have metabolic syndrome. At the same time we found a statistically significant difference as regard metabolic syndrome components between low waist and high waist groups but the difference was statistically insignificant when we compared low BMI with high BMI groups in newly diagnosed diabetics. This means that waist circumference is a simple tool to predict diabetes and metabolic syndrome better than other measures

Follow up of diabetic complications

Some research found that certain diabetic complications occur more frequently in some racial minority groups. Rate of diabetic complications in real-world practice is higher than expected from the clinical trial setting, especially among patients with complications at diagnosis. This suggests that in diabetic patients racial differences may exist in macro vascular and micro vascular disease frequency. 340 diabetic patients were chosen randomly from out patients' clinic of the national institute of diabetes and endocrinology. They received conventional treatment.by different doctors with no special protocol for treatment and was examined twice once at 2004 and another at 2006. Our result showed that during three year there are significant deterioration in weight, BMI. ECG, retinopathy, FBS, AST, ALT, cholesterol, triglyceride, urea, uric acid, GFR, HBlAC.And there were significant improve as regard BP, ACR, LDL. The major complications develop by Egyptian diabetic patients within 3 years follow up was increase percent of retinopathy [27%], followed by teeth loss [23%] then IHD [5%] with no patient develop ESRD. also there are deterioration of GFR.. As regard risk factors there is deterioration in cholesterol followed by waist circumference, BMI, triglyceride then HDL.but significant improve in BP control In Egyptian diabetic patient nudus examination and lipid profile must checked regularly every three moth

Diabetic nephropathy in type 2 diabetic patients attending the outpatient clinic of N.I.D.E: prevalence and risk factors

Diabetic nephropathy is the leading cause of end-stage renal disease [ESRD] worldwide, and it is estimated that 20% of type 2 diabetic patients reach ESRD during their lifetime [2]. Incidence of diabetes in Egypt was estimated to be 9-11% [5]. Our study is the first large study which try to evaluate the prevalence of diabetic nephropathy and its risk factors in Egyptian diabetic patients. The study included 2651 type 2 Egyptian diabetic patients attending the outpatient clinics of N.I.D.E. Our results show that 74.2% of our patients [1968 patients] have chronic kidney disease. Stage 1 [normal GFR and urine abnormality] and stage2 [mild decrease of GFR] represent more than 88% of them. This is the stage where we can do our best to prevent renal failure. CKD patients have older age, longer duration of diabetes, higher systolic and diastolic BP, higher FBS, glycated Hb, triglycerides LDL, uric acid, waist circumference and low HDL compared with non CKD diabetic patients. As regard GFR, 8.9% [236 patients] of our patients have hypofiltration and 26% [689 patients] have hyperfiltration. There is an urgent need to launch a national diabetes control program to tackle the potential economic burden due to diabetic nephropathy in Egypt