Serum vitamin D level in type 2 diabetic subjects: relation to glycemic control, insulin resistance and proinflammatory markers

Background: Type 2 diabetes mellitus [DM] is one of the most common diseases worldwide. Early diagnosis and management has a significant role in reducing complications. Vitamin D is a fat-soluble vitamin that showed important functions regarding calcium and phosphate homeostasis, immunity and insulin resistance. There is a well-established link between vitamin D level and type 2 DM

Objective[s]: The aim of this study was to assess serum 25[OH] vitamin D3 level in type 2 diabetic subjects and to investigate its relation to glycemic control, proinflammatory markers and insulin resistance

Methods: The study included 60 type 2 diabetic subjects in the age group 40-70 years and 30 controls matched for age and gender. Pregnant females, renal, hepatic and cancer patients were excluded from the study. All participants were subjected to detailed history taking, anthropometric measurements including weight, height and waist circumference, full clinical examination and laboratory investigations including serum 25[OH]vitamin D3, FSG, HbA1c, serum insulin, and CRP.HOMA-IR was calculated using FSG and serum insulin values

Results: The mean serum concentration of 25[OH] vitamin D3 was significantly lower in type 2 diabetics compared to controls [2.91 +/- 4.20 ng/ml, 12.04 +/- 7.74 respectively] [p<0.001]. There was a significant increase in BMI, WC, FSG, HbA1c, serum insulin, and HOMA-IR in type 2 diabetics compared to controls [p<0.05]. A statistical significant negative correlation was found between 25[OH] vitamin D3 level and the following parameters: BMI [r=-0.584, p<0.001], WC [r=-0.233, p=0.027], FSG [r=-0.735, p<0.001], HbA1C [r=-0.387, p<0.001], HOMA-IR [r=-0.729, p<0.001], serum insulin [r=-0.272, p=0.010]. Meanwhile, 25[OH] vitamin D3 did not significantly correlate with the proinflammatory marker CRP [r=-0.126, p=0.238]

Conclusion: Subjects with type 2 DM have low 25[OH] vitamin D[3] level compared to healthy normal individuals. The negative association of 25[OH] vitamin D3 with glycemic control and its irrelevance to the prionflammatory markers suggest that vitamin D may be an important determinant in the pathogenesis of type 2 DM. Hence cautious Vitamin D supplementation may have a therapeutic potential in prevention and management of Type 2 DM

Study of some fibrinolytic parameters in diabetics with and without vascular complications

Aim: Hypofibrinolysis is a common finding in patients with diabetes and a risk factor for the occurrence of micro- and macroangiopathy. Type 2 diabetic patients have a high incidence of atherosclerosis and thrombosis leading to increased morbidity and mortality from coronary artery disease, cerebrovascular disease and peripheral vascular disease. The superimposition of thrombosis or atherosclerosis is associated with hypercoagulation, hypofibrinolysis and/or platelet alteration, which is caused by several factors including endothelial dysfunction, disturbed lipid metabolism, monocyte invasion and smooth muscle proliferation. The aim of the present work was to study the level of plasminogen activator inhibitor-1 [PAI-1] and D-dimer in diabetic patients with vascular complications and to compare these results with a group of diabetic patients without vascular complications. Subjects and The study was carried out on 60 female subjects; 20 healthy normal controls, 20 type 2 diabetic subjects without vascular complications and 20 type 2 diabetics with vascular complications, subdivided into 10 subjects with diabetic proliferate retinopathy as a microvascular complication and 10 subjects with coronary heart disease as a macrovascular complication. The results showed that PAI-1 and D-dimer were higher in type 2 diabetic patients as compared to the control group. Diabetic subjects with vascular complications showed higher level of PAI-1 and D-dimer as compared to those without vascular complications. The euglobulin clot lysis time [ECLT] was prolonged in type 2 diabetics in comparison to the controls. The diabetic patients with vascular complications showed also prolongation of ECLT as compared to those without vascular complications Conclusions: There is a generalized hypercoagulable state in diabetics with vascular complications and this state may play a significant role in the pathogenesis of vascular complications Therefore, good glycemic and lipid control may decrease the level of PAI-1, D-dimer and clot lysis time, so it may delay or prevent the vascular-complications of diabetes

Homocysteine in diabetic patients with and without macrovascular complications

Small and large vessel disease is characteristic of the diabetic state. The excess mortality of the patients with type 1 and type 2 diabetes is mainly due to cardiovascular disease and is not adequately explained by conventional cardiovascular risk factors. Homocysteine [Hcy] is a sulphur-containing amino acid formed during the metabolism of dietary methionine. Adequate concentrations of folic acid, vitamins B12 and B6 are essential for the metabolism and dispersal of Hcy. Recently, mild elevations of plasma Hcy have been identified as an independent risk factor for early atherosclerotic vascular disease. The aim of this work was to measure the plasma level of Hcy in diabetic patients with and without macrovascular complications. Subjects and We studied 60 diabetic patients [30 with macrovascular complications and 30 without macrovascular complications] together with 30 healthy subjects as controls. For each patient and control we did history taking, clinical examination and laboratory investigations including glycemic parameters, lipid profile, Hcy, folic acid, vitamin B12 measurement and evaluation for macrovascular complications. We found that Hcy level was significantly higher in diabetic with macrovascular complications than those without and than controls. Also, Hcy level was positively correlated with the number of complications and lipid profile, but negatively correlated with vitamin B12 and folic acid concentration [P<0.005]. Conclusions: Homocysteine is an important risk factor for macrovascular complications of diabetes

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

Clinical significance of measurements of serum and urinary thrombomodulin and serum e-selectin in diabetic patients with and without complications

Serum and urinary levels of soluble thrombomodulin [TM] and the serum levels of the soluble leucocyte adhesion molecule E-selectin, were measured in 80 diabelic patients. Fourty patients with insulm-dependent diabetes mellitus [IDDM] were divided into 20 non-complicated patients [group I] and 20 complicated patients [group II]. Ten age-matched healthy subjects were used as a control [group III] for the IDDM patients. Another 40 patients with non-insulin-dependent diabetes mellitus [NIDDM] comprised 20 non-complicated patients [group IV] and 20 complicated patients [group V]. Ten more age-matched healthy subjects were selected as a control [group VI] for the NIDDM patients. Serum and urinary concentrations of TM were significantly higher in diabetic patients compared with controls. Moreover, serum and urinary TM levels were significantly increased in complicated IDDM and NIDDM patients compared with the non-complicaied patients and the control subjects. Similarly, serum concentrations of E-selectin were found to be significantly higher in complicated diabetic patients versus the non-complicated patients and the control groups. In all diabetic patients of the four studied groups and in each separale group, serum and urinary levels of TM and serum E-selectin concentrations correlated positively with the duration of diabetes, fasting and postprandial blood glucose, HbA[IC] and urinary albumin excretion. A significant positive correlation was also found between urinary and serum levels of TM in the four studied groups of patients. Furthermore, serum and urinary levels of TM together with serum E-selectin concentrations correlated positively with the frequency of complications in complicated IDDM and NIDDM patients. The results suggest that serum and urinary TM levels could be a sensitive and predictive marker for the generalized vascular endothelial mjury induced by hyperglycemia and/or premicroangiopathy in diabetic patients. The present data point to a functional role for the soluble leucocyte adhesion molecule E-selectin in the development and progressions! complications in diabetic patients. The results also indicate that the concentrations of TM and E-selectin may be retated to metabolic control

Stiffness index beta of the common carotid and femoral arteries: relation to insulin resistance

This work was intended to study the association between arterial wall stiffness indexes beta of the common carotid and femoral arteries and insulin resistance in type 2 diabetic patients as well as patients with imparied glucose tolerance compared with age and sex matched control subjects. The study included 60 subjects classified into 3 groups; I] included 20 patients with type 2 diabetes, II] included 20 patients with IGT and III] included 20 matched controls. All patients and controls were subjected to the followings: complete history taking, thorough clinical examination, laboratory investigations including HBA1C, uric acid, complete lipid profile, microalbumin assay, renal and liver function tests. Measurement of insulin sensitivity by oral glucose tolerance test. Stiffness indexes beta of the common carotid and femoral arteries were measured by high resolution ultrasonography. The results of the present work can be summarized as follows: the stiffenss index beta [SI] of the common carotid and femoral arteries was significantly higher in diabetic group than those with IGT and controls [P< 0.001] for each], still those with IGT was insignificantly higher than controls [P < 0.05]. Also, stiffness index [SI] of the common carotid and femoral arteries was positively and significantly correlated with relative insulin resistance, total cholesterolm serum tryglycerides, LDL-C, uric acid, age and the duration of diabetes [P < 0.05]. Our results suggest that the stiffness indexes beta of the common carotid and femoral arteries were associated with insulin resistance in type 2 diabetic patients and such insulin resistance plays an important role in the pathogenesis of these sclerotic changes

Helicobacter pylori in diabetics with and without neuropathy: relation to metabolic control and gastric emptying

This work was carried out on 60 diabetic patients and 20 healthy subjects as control. For each diabetic patient and for the control, the followings were done: history and clinical examination, laboratory investigations including fasting blood sugar, post-prandial blood sugar, HBA1c, lipid profile, liver and kidney function tests. Also, assessment of autonomic functions, gastroscopy and biopsy for rapid urease test, estimation of serum gastrin and gastric scintigraphy for evaluation of gastric motility. The results were as follow: patients with autonomic neuropathy demonstrated a higher prevalence of Helicobacter pylon [HP +ve] than those without and controls. Patients with motility disorder also showed a significant higher level of HP +ve than those without and controls. Diabetic patients had a significantly higher level of serum gastrin than controls. Conclusion: H. pylon prevalence was higher in diabetics and it was higher in those with autonomic neuropathy and dysmotility. Serum gastrin was significantly higher in those H. pylon positive patients. H.pylori infection tends to cause antral gastritis or pangastritis in diabetics rather than peptic ulcer especially in those with autonomic neuropathy. Non-ulcer dyspepsia is common in diabetics. Treatment of H. pylon infection may be of great benefit for metabolic control