Impact of type 2 diabetes mellitus on cardiac structure and function: the association with microalbuminuria and hyperinsulinemia

Early determination of myocardial manifestations of diabetes mellitus [DM] is of a major importance, since myocardial involvement considerably influence the prognosis of diabetic patients. Microalbuminuria [MA] and hyperinsulinemia [HI] have been shown to predict cardiovascular [CV] disease in patients with DM. However the relationship between these risk factors and both cardiac structure and function is still unclear. To assess the Echocardiographic evidence of cardiomyopathy in asymptomatic patients with type 2 DM; to relate these findings to MA and fasting plasma insulin level [FI]; and to investigate whether these observations are independent of glycemic control and other clinical CV risk factors. 63 type 2 diabetic patients without known cardiac diseases, duration of DM [mean 52.4 +/- 51.4 month], age [47.4 +/- 807 year], body mass index [BMI] [26.6 +/- 3.2], men [41/63], in addition to 20 healthy subjects matched for age, sex and BMI served as control were enrolled in the present study. Based on MA and FI, patients were subgrouped into [microalbuminuric and normoalbuminuric] and [hyperinsulinemic and normoinsulinemic] respectively. We compared Echo- derived indices of left ventricular [LV] structure and LV systolic and diastolic functions in patients versus control subjects and between the different patient subgroups. Diabetic patients had greater LV posterior wall thickness [PWT], interventricular septal thickness [IVST], and LV mass index [LVMI] [p<0.0001 for each]. LV diastolic dysfunction, manifested as reduction in E velocity and E/A ratio and prolongation in isovolumic relaxation time [IVRT] [p<0.001 for each], was documented in diabetic patients as compared with control subjects. MA was diagnosed in 15/63 [24%] patients. As compared with normoalbuminuric patients, MA was associated with higher fasting blood glucose [FBG] and FI [p<0.05 for each], greater LVPWT [p<0.05], and LVMI [p=0.02], and lower fractional shortening [FS], ejection fraction [EF], and E/A ratio [p<0.001, p=0.006 and p<0.05 respectively]. Patients with HI had lower FS [p=0.02] and lower E velocity [p=0.04] than in patients with normal FI. In multi-variate analysis, the associated findings either with MA or FI has been unchanged after adjusting for the duration of DM, glycemic control, age, gender, BMI, and BP. Type 2 diabetic patients without overt heart disease have increased LV wall thickness and LVMI and LV diastolic dysfunction suggesting subclinical diabetic cardiomyopathy [DCM]. MA and HI are independently associated with these changes, which may contribute to the relation of albuminuria and HI with increased rate of CV event among diabetics. Thus, screening of either MA or HI may identify patients at CV high risk

Epidemiology of diabetes mellitus in a rural of Assiut governorate

The objective of this study was to estimate the prevalence of DM AND IGT in a rural population in Upper Egypt and to determine the associated risk factors for DM in this population. Individuals aged >/20 years in two rural villages in the Southeast of Assiut City, Upper Egypt, during the period of 2002. The mean outcome measures included age standardized prevalence rate of DM and IGT in rural Upper Egypt, the prevalence of previously diagnosed, newly discovered diabetic cases and IGT and the predictive risk factors for diabetes in that area. The study concluded that the age standardized prevalence rate of DM and IGT is slightly higher than that reported in other rural agricultural areas. About one third of all diabetic cases were undiagnosed at the time of the study and consanguinity emerged as the most powerful predictor of diabetes risk in in the study area

Serum alpha2 macroglobulin and plasma fibrin monomer in diabetic neuropathy and retinopathy

Impairment of neural function is one of the most frequent disabling complications of diabetes mellitus. No part of the peripheral nervous system seems spared. Progressive neural impairment may occur in sensory and motor peripheral nerves producing pain, parasthesia or distal muscle weakness [Ward, 1972]. This also occurs in autonomic nervous system producing orthostatic hypotension, sexual impotence and urinary and bowel incontinence [Clarke, et al. 1979]. Although these complications are prominent, the exact cause is still unknown. However, Anderson [1976] suggested that slowing of peripheral nerve activity may be related to metabolic derangements. A relationship between hyperglycemia and peripheral nerve function as measured by nerve conduction velocity has been demonstrated to human subjects. Diabetic retinopathy is considered to be a multifactorial disorder. A relationship between duration of diabetes and development of retinopathy has long been recognised [Caird et al., 1969], mean blood glucose concentration have been reported to be higher, particularly in severe retinopathy. Data related to other factors as cigarette smoking, obesity, blood pressure and. genetic susceptibility are conflicting. William et al., [1983] stated the risk factors in diabetic retinopathy include increasing duration of the disease, presence of other microvascular complications of diabetes and probably hyperglycemia itself. Plasma fibrin-monomer and raised serum gamma 2 macroglobulin have recently been implicated [Wardle et a1., 1973]. The aim of the study is to define and evaluate the various risk factors in diabetic retinopathy and neuropathy in Assiut with particular reference to fibrin monomer and gamma 2 macroglobuin

effect of ginseng on glucose, free fatty acids and cholesterol serum levels in diabetic patients

Twenty insulin dependent and twenty non insulin dependent diabetic patients and fifteen controls were studied. Ginseng extract was administered in a dose of 85 mg. t.d.s. for forty five days. A significant decrease was observed in the serum levels of glucose, cholesterol and free fatty acids in groups of patients. It is suggested that ginseng extract contains antilipolytic and insulin like substances