role of proinsulin in gestational diabetes mellitus

To look for any increase in proinsulin or proinsulin/insulin ratio in women suffering GDM as an additional factor to their insulin resistance state during pregnancy; and to test for its reversibility in the post partum period. The study was conducted on 30 pregnant age matched women in their second or third trimester and 10 age matched non pregnant normoglycemic women as a reference group. The pregnant women were divided into 3 groups each of ten as follow: normoglycemic women with normal OGTT as a control group, obese women with GDM and lean women with GDM. All women were subjected to full history taking and complete clinical examination. The following parameters were measured: diagnostic OGTT using 100 gm glucose, fasting serum proinsulin, fasting serum insulin, serum C-peptide, proinsulin/insulin ratio and insulin sensitivity. All these tests were repeated 4-8 weeks postpartum. The results of the study revealed that the serum levels of proinsulin and the proinsulin/insulin ratio were significantly higher in obese and lean women with GDM than the control and reference groups during pregnancy and also after delivery. The insulin sensitivity index was significantly lower and the relative resistance for insulin was significantly higher in GDM women compared with normal glucose tolerant pregnant women during pregnancy, while after delivery the sensitivity index was significantly higher than during pregnancy in GDM women as well as pregnant women with normal OGTT. The mean values of C-peptide were significantly higher in GDM patients versus control and reference groups during pregnancy. After delivery these mean values of C-peptide were significantly lower than during pregnancy in the three pregnant studied groups. Women with GOM are characterized by elevated serum proinsulin concentrations and increased proinsulin/insulin ratio which reflect beta-cell decompensation. These precursors molecules might thus serve as a marker for the disease and potentially even identify the subjects of high risk for development of type 2 diabetes. Also, it may be possible to detect such beta-cell stress earlier in pregnancy and to use this phenomena in the assistance of better prediction of GDM

Eotaxin and other immunological markers, metabolic and anthropometric factors in relation to circulating adiponectin level in type 2 diabetic patients and individuals with impaired glucose metabolism

Hypoadiponectinemia is associated with insulin resistance and predicts the incidence of type 2 diabetes and coronary artery disease. Chronic subclinical inflammation and activation of innate immunity are involved in the pathogenesis of type 2 diabetes. Since obesity is associated with hypoadiponectinemia and with increased circulating levels of various immunological markers, which are both major risk factors for the development of type 2 diabetes, so the aim of this study was to investigate the association of hypoadiponectinemia and low grade systemic inflammation in type 2 diabetic patients as well as subjects with impaired glucose tolerance. Sixty male age matched subjects were included in the study. They were divided into 3 groups each of twenty as follows: newly diagnosed patients with type 2 diabetes mellitus [group I], patients with impaired glucose tolerance [group II] and healthy subjects with normal glucose tolerance [group Ill] as a control group. Patients and controls were subjected to full history taking, clinical examination stressing on blood pressure, BMI and WHR; laboratory investigations including FPG, PPG, HbA1C, fasting insulin and HOMA-IR index, lipid profile [TG, total cholesterol, HDL-C, LDL-C], serum uric acid, serum adiponectin and some immunological markers including WBC, acute phase reactants [CRP], TN F-alpha and eotaxin. In type 2 diabetic patients, plasma adiponectin levels were strongly negatively correlated with CRP, fasting TG, fasting insulin, HOMA-IR and fasting glucose [P < 0.001] and strongly positively correlated with HDL-cholesterol [P < 0.001]. Inverse correlations were found between adiponectin levels and WHR, postprandial glucose, and TNF-alpha [P < 0.05]. No significant correlation was found between adiponectin level and eotaxin [P > 0.05]. In subjects with IGT, an inverse relation was found between adiponectin and fasting glucose [P < 0.05]. The mean values of immunological markers [eotaxin, TNF-alpha, CRP and WBC] were significantly higher in type 2 diabetics versus control group. Subjects with IGT showed significant lower levels of eotaxin and TNF-alpha than diabetic patients, while they showed significant higher levels of eotaxin, TN F-alpha and CRP than controls [P < 0.05]. The mean value of adiponectin was significantly lower in type 2 diabetic patients than in subjects with IGT and the control group [P < 0.05]. The studied clinical and anthropometric parameters, lipid profile, parameters of glycemic control, fasting insulin and HOMA-IR were significantly higher in group I versus group II and the control group [P < 0.05]. Our results support the hypothesis that hypoadiponectinemia may be associated with low grade inflammation, metabolic abnormalities and dyslipidemia. Therefore, adiponectin may be an important link between inflammation and type 2 diabetes as it was negatively correlated with markers of inflammation in such patients

Plasma total homocysteine levels in patients with tType 1 diabetes: effect of chronic cigarette smoking

Aim: The purpose of this study was to compare plasma total homocysteine [tHcy] levels, a recognized cardiovascular risk factor, in non-diabetic subjects and type 1 diabetic patients, and to evaluate whether chronic cigarette smoking had a deleterious effect on plasma tHcy levels in these patients. Subjects and To achieve this aim, plasma tHcy concentrations were measured in 50 young type 1 diabetic patients without clinical evidence of macroangiopathy and in 50 healthy control subjects who were matched for age, sex, BMI and smoking habit. It was found that plasma tHcy levels were significantly higher in type 1 diabetic patients than in control subjects [12.5 +/- 4.9 vs 10.3 +/- 2.3micro mol/l, P<0.01]. Comparing the clinical and biochemical characteristics of diabetic subjects grouped according to smoking status, diabetic smokers had higher levels of plasma triglycerides, but no significant differences were found in age, sex, BMI, total cholesterol, creatinine, glycometabolic control, blood pressure, duration of diabetes, and the presence of chronic microvascular complications. Nevertheless, plasma tHcy levels were markedly elevated in diabetic smokers [by -50%] versus nonsmokers, [15.5 +/- 5.6 vs 10.6 +/- 2.9 micro mol/l, P<0.0001] in a dose-dependent fashion, when subjects were categorized for the number of cigarettes smoked daily. Conclusions: We concluded that chronic cigarette smoking seems to adversely affect plasma tHcy levels in young adults with type 1 diabetes

Prognostic value of serum leptin in patients with acute myefogenous leukemia

Aim: Leptin is a hormone secreted by adipocytes that regulates body weight and energy expenditure. Leptin receptors can be expressed by acute myelogenous leukemia [AML] cells and leptin may affect leukemic hematopoiesis. In addition, leptin may function as a stress-related hormone and may contribute to the anorexia and wasting syndrome of cancer and infections. The present work aimed at estimating the serum leptin level in patients with AML at presentation and after induction chemotherapy in order to extrapolate its possible alteration with infection in these patients and its role in influencing hematopoietic recovery following chemotherapy. Subjects and Thirteen newly diagnosed AML patients, 7 males and 6 females [mean age: 40.54 +/- 13.5 years] and ten healthy age- and sex-matched controls were enrolled in the study. Serum leptin was estimated by the ELLSA technique. In AML patients, the pretreatment mean serum leptin [15.8 +/- 19.8 ng/ml] did not differ significantly from the controls [8.25 +/- 7.25 ng/ml]. Post-chemotherapy, the mean serum leptin level [12.1 +/- 14 ng/ml] decreased compared to the pre-therapy level. However, this decrease was not statistically significant. A significant positive correlation was found between serum leptin and body mass index [BMI], both at presentation [r=0.777, P=0.002] and post-chemotherapy [r=0.557: P=0.048], and serum leptin was significantly higher in female as compared to male patients before and after chemotherapy [P=0.001 and P=0.024, respectively]. No significant correlation was found between serum leptin and any of the studied parameters [hemoglobin, total leukocytic count, platelet count, bone marrow blast percent, absolute neutrophilic count and days to hematopoietic recovery]. Also, no significant difference was found between patients who achieved complete remission [n=6] and those who achieved partial remission [n=5] regarding the serum leptin both before and after therapy. Comparing the mean serum leptin levels in patients who developed chemotherapy-induced neutropenic sepsis [n=11] and those who did not develop sepsis [n=2], the level was significantly higher in the former than in the latter, both before [P-0.005] and after [P=0.012] chemotherapy. Conclusions: The findings of the present study support the hypothesis that leptin is a stress-related hormone involved in the host defense of acute inflammation and may be important for survival. However, further studies are warranted to clarify the potential diagnostic, prognostic and therapeutic roles of leptin in patients with AML

Axial bone mineral density and peripheral neuropathy in type 1 diabetic patients

To investigate whether peripheral neuropathy [PN], as part of the microangiopathic complex, can affect bone mineral density [BMD] of the axial skeleton in patients with type 1 diabetes. Material and Three studied groups where examined. Group 1 comprised 15 males with type 1 diabetes and severe PN, with a mean duration of diabetes of 11.07 +/- 2.31 years and an HbA1c of 9.40 +/- 1.01%. Group 2 comprised 15 male type 1 diabetic patients with absent or mild PN, matched to patients of group 1 regarding age, weight, and duration of diabetes. Group 3 comprised 15 control subjects. BMD was measured by dual energy X-ray absorptiometry [DEXA] of the axial skeleton. In group 1, BMD was significantly reduced in the axial skeleton compared with an expected Z score of 0 [spine -1.26 +/- 0.52]. To a lesser extent, but still significantly reduced, group 2 also showed reduced BMD values [spine -0.54 +/- 0.16], whereas group 3 had normal BMD values [spine, -0.19 +/- 0.23]. Group 1 had lower mean BMD level than group 2 and group 3 at the measured sites, which was statistically significant [P< 0.001]. No significant differences in physical activity levels or serum calcium, serum phosphorus, alkaline phosphatase, were demonstrated between the two patient groups. Conclusions: The present results suggest that in patients with type 1 diabetes PN may be an independent risk factor for reduced BMD in the axial skeleton