Compliance of diabetic patients. Pros and cons

Diabetes is a major public health problem allover the world. Compliance refers to a patient both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other health care workers. This study was conducted to demonstrate the pattern of compliance among diabetic patients, its determinants and reasons beyond noncompliance. This cross section descriptive study was conducted at the outpatient Clinic of Diabetes, Kasr Al-Aini. Their compliance pattern were assessed using special scoring. Improper compliance to diet was more prevalent [104[34.7%]]. The significant determinants of improper compliance to diet were younger age, type 1 diabetes, long duration of illness, absence of complication, positive family history, receiving 3 or more drugs per day and improper compliance to drugs. Financial constraints and depression were beyond improper diet and drugs compliance. Compliance to appointment and drugs were better than compliance to diet. Cost and psychological depression were among the main reasons of improper compliance

Effect of low calorie diet and exercise on thyroid hormones and leptin levels

To investigate the effect of low calorie diet alone and the effect of low calorie diet and exercise on the levels of thyroid hormones, leptin, and BMI. Also we tried to investigate if there is a relation between thyroid hormones and leptin levels. Two groups of normal male subjects, each group consists of 25 person matched for age and BMI. Group I had low calorie diet program for one month [1200-1500 Kcal]. Group II had the same low calorie diet in addition to program of therapeutic exercise on treadmill with moderate intensity every other day for one month. Evaluation of free T3, freeT4, TSH, leptin levels, and BMI were done before and after the study. Correlation between thyroid hormones and leptin levels were done. This study showed significant increase in Free T3, T4, and significant decrease in TSH, leptin and BMI after one month of low calorie diet program [group I] compared to their levels before the study. After one month of low calorie diet and the exercise program [group II], a highly significant increase in free T3, T4 and highly significant decrease in TSH, leptin and BMI compared to their levels before the study. Comparing the studied parameters of both groups after the study showed that there is a more significant increase in T3 and T4 and a more significant decrease in TSH and BMI in group II compared to group I. Leptin level showed no statistically significant difference. A positive correlation between BMI and leptin was found in both groups. We found no relation between thyroid hormones and leptin levels. Low calorie diet caused increase in the level of circulating thyroid hormones, and a decrease in TSH, leptin levels and BMI. Low calorie diet and moderate intensity therapeutic exercise caused more significant increase in the level of circulating thyroid hormones, more significant decrease in TSH level and BMI. No statistically significant difference in leptin level of both groups after the study. We found no relation between leptin level and thyroid hormone levels

Ferritin and insulin resistance in patients with type 2 diabetes mellitus

Diabetes mellitus is a syndrome characterized by chronic hyperglycemia and disturbance of carbohydrate, fat and protein metabolism associated with relative or absolute deficiency of insulin secretion and/or insulin action. Ferritin is the major iron storage protein and plays a key role in iron metabolism. In general population, body iron stores are positively associated with the development of glucose intolerance, type 2 diabetes. The aim of the present study was to measure serum ferritin in patients with type 2 diabetes and to study the relationship between serum ferritin, fasting blood glucose, glycated hemoglobin, insulin level and insulin resistance in patients with type 2 diabetes mellitus. This study involved 40 female patients in child bearing period with type 2 diabetes mellitus selected from diabetes and endocrine clinic in Kasr El-Aini Hospital. Twenty healthy, age matched, females were taken as a control group. All subjects were subjected to: History taking, clinical examination and laboratory Investigation including fasting plasma glucose, glycated hemoglobin [HbAlc], fasting insulin and serum ferritin. We found that serum ferritin was significantly higher in patients with type 2 DM compared with the control group [p < 0.001] and in patients with type 2 DM ferritin level was positively correlated with fasting blood glucose [p < 0.001], glycated hemoglobin [p < 0.001], fasting insulin level [p < 0.05] and insulin resistance [p < 0.001]

Relation between insulin level and bone mineral density in patients with type 2 diabetes mellitus

The aim of this work is to measure BMD in patients with type 2 diabetes mellitus and to correlate it with insulin level and insulin resistance. This study comprised 50 premenopausal women 40 type 2 diabetic patients [20 on insulin therapy and 20 or oral hypoglycemic drugs], 10, as a control group, which were healthy non diabetic women matched for age. All studied subjects were subjected to history taking, clinical examination, including weight, height, BMI and waist/hip ratio. Laboratory investigations including fasting and post prandial blood glucose levels, HbA1c, kidney functions, liver functions, urine analysis, lipid profile, serum calcium, phosphorus, alkaline phosphatase, and fasting insulin level. Bone mineral density [BMD] was measured using DEXA on left fore-arm using Lunar PIXI densitometer. Subjects with other diseases or using drugs that affect BMD were excluded. We found that there was no statistically significant difference in BMD between patients with type 2 diabetes mellitus and the control group [T-score was -0.3 in the diabetic group and T-score was -0.2 in the control group]. In patients with type 2 diabetes mellitus, there was a significant positive correlation between BMD and both insulin level [p value <0.05] and insulin resistance [p value <0.05]. There was no difference in BMD between type 2 diabetic patients and control group. There was a significant positive correlation between BMD with both insulin level and insulin resistance [HOMA] in patients with type 2 DM

Role of serum interleukin-6 and osteocalcin in prediction of bone loss in postmenopausal women

Osteoporosis is defined as a reduction of bone mass density or the presence of fragility fracture. This reduction in bone tissue is accompanied by deterioration in the architecture of the skeleton, leading to a markedly increased risk of fracture. Interleukin-6 [IL-6] and osteocalcin have been associated with the risk of chronic disease such as osteoporosis. In this study, we assessed the relationships between interleukin-6 and osteocalcin in the prediction of postmenopausal osteoporosis. The study included 80 women whose age ranged from 18 to 80 years and were classified into the following four groups according to the duration of menopause: Control group, this group comprised 20 premenopausal healthy females, they had regular menstrual cycles. Group I [Post Menopausal Patients], this group comprised 20 patients of osteoporosis, with menopause less than 5 years. Group II [Post Menopausal Patients], this group comprised 20 patients of osteoporosis, with menopause from 5-10 years. Group III [Post Menopausal Patients], this group comprised 20 patients of osteoporosis, with menopause more than 10 years. Patients of group I showed a significant increase of both IL6 [p<0.05] and osteocalcin [p<0.001] compared to control group. On the other hand, patients of both group II and III showed non significant change of interleukin-6 while a highly significant increase of osteocalcin [p<0.001], as compared to control group. We concluded that interleukin-6 appears to be a potent osteotropic factors that may play an important role in prediction of bone loss in early menopause as it is easy to measure and can be measured routinely. We recommend for the investigation on role of interleukin-6 in pathophysiology of bone loss

Expression of wild p53, mutated p53 and hypoxia inducible factor-1 alpha in hepatocellular carcinoma

To investigate the expression of wild p53, mutated p53 and hypoxia inducible factor-1 alpha [HIF-1 alpha] genes in hepatocellular carcinoma and correlate their expression with clinicopathological data. Liver biopsy samples of 30 hepatocellular carcinoma [HCC] subjects. 20 chronic hepatitis C [CHC] and 20 liver biopsy samples from non cancerous tissue [i.e control samples] of HCC were assessed by polymerase chain reaction [RT-PCR] and restriction enzyme analysis for the three genes; wild p53 gene, mutations in p53 at codon 249, exon 7 and hypoxia inducible factor-1 alpha gene. Wild p53 gene was detected in 18/30cases of HCC [60%], 16/20 cases of CHC [80%] and 15/20 cases of control samples [75%] with no significant difference between the studied groups. Mutated p53 gene was detected in 12/30 cases of HCC [40%], 4/20 cases of CHC [20%] and 5/20 cases of control samples [25%], also with no statistically significant difference between the studied groups while HIF-lalpha gene was expressed in 20/30 cases of HCC [66.7%] in comparison to 2/20 cases of CHC [10%] and 3/20 of control samples [15%] with a highly statistically significant difference [p<0.001]. The expression of both wild p53 and the mutated p53 correlated with tumor size but did not correlate with grade of malignancy nor serum alpha fetoprotein level, while the expression of HIF-1 alpha correlated with grade of malignancy and alpha fetoprotein level but not with tumor size. No correlation between expression of all genes and capsule infiltration or presence of cirrhosis was found in all groups. HIF-1 alpha is highly expressed in HCC and is related to grade of malignancy and serum alpha fetoprotein level

New onset diabetes mellitus after renal transplantation: impact of immunosuppresssive and antihypertensive therapy

The purpose of the present study was to assess the influence of immunosuppresssive and antihypertensive therapy in the diabetic state after renal transplantation especially impaired fasting glucose [IGF], and impaired glucose tolerance [IGT]. A total of 67 consecutive renal transplant recipients without previously known diabetes underwent a 75gm oral glucose tolerance test [OGTT] 3 months after renal transplantation. BMI, daily prednisolone dose, creatinine clearance, hypertension, number of antihypertensive agents and the use of diuretics or 3 blockers were POSITIVELY associated with, impaired glucose tolerance [IGT], namely impaired fasting glucose [IGF], and abnormal glucose tolerance [ACT] [p<0.05]. After multiple regression analysis, BMI [p<0.001], daily prednisolone dose [p<0.001], cytomegalovirus infection [p<0.03], and triglycerides [p<0.034], were shown to be independent predictors of posttransplant ACT. Increasing daily prednisolone dose is an independent predictor of impaired fasting glucose after renal transplantation. Hypertension and the use of diuretics and beta blockers may also deteriorate glucose tolerance [CT] in this group of patients

Tumor necrosis factor-alpha and insulin level in obesity

The aim of this study was to measure the plasma level of TNF-alpha in obese subjects in comparison with lean ones as well as to correlate its level with the serum insulin level. Thirty-five subjects with a wide range of values for the body mass index [BMI 18.5 +/- 63 kg/m2] were included in this study. The subjects were divided into two groups according to BMI. For all subjects, serum total cholesterol triglycerides, high density lipoprotein cholesterol [HDL- C], low density lipoprotein cholesterol [LDL-C], serum insulin and plasma level of TNF-alpha were assayed. All subjects had normal glucose tolerance as determined by WHO criteria. The study concluded that the plasma level of TNF-alpha was found elevated in obese subjects and this elevation was related to BMI and insulin resistance. So, TNF-alpha can be considered as a system regulating insulin action in obesity leading to insulin resistance with all its hazards in these patients

Initial [99m]Tc thyroidal kinetics in thyrotoxicosis: patterns and usefulness in differential diagnosis of toxic nodular goiter

This prospective study included 74 untreated hyperthyroid patients as well as 25 age- matched healthy controls aiming at assessment of initial Tc 99m thyroidal kinetics' patterns in different types of thyrotoxicosis, its usefulness in differential diagnosis of toxic nodular goiter, mainly discrimination between its immune and non-immune variants, compared to CDFS and to find-out which of the parameters evaluated was the best in such issue. Patients were selected and divided into four groups according to their definitive diagnosis based on clinical laboratory data, sonography and Tc 99m static thyroid scan. Group I: included 23 patients with Graves ' disease, group 2 : included 26 patients with toxic nodular goiter, group 3: included 10 patients with single toxic adenoma, group 4-.included 15 patients with thyroiditis. All patients,except group 4 patients, had statistically significant higher FI values compared to control subjects [p<0.05]. Moreover, group 1 and 4 patients [cases with immune thyrotoxicosis] showed statistically significant higher PI values compared to other groups [non-immune thyrotoxic patients] as well as control group [p<0.05].Group 1 and group 4 patients showed almost similar PI values [p>0.05]. Also, group 2 and 3 showed almost similar PI and FI values [p >0.05]. Retrospective analysis of PI and FI values of group 2 patients [toxic nodular goiter] revealed different behaviour of their PI values. Cases with immune variants of toxic nodular goiter had higher PI values than non-immune variants [p< 0.0001] despite their almost similar FI values and hormonal levels. Regarding the sensitivity and specificity, PI showed statistically significant higher values than those of CDFS in differentiating immune from non-immune variants of toxic nodular goiters [p<0.002 and <0.0003 respectively]. our results suggest that initial Tc 99m thyroidal kinetics done as a part of the routinely done static thyroid scan is an objective, non-invasive simple methods that can be useful in discrimination between immune and non-immune variants of toxic nodular goiter with better sensitivity and specificity than CDFS

Plasminogen activator inhibitor-1, Von Willebrand factor and thrombomodulin in obesity: new cardiovascular risk factors

The objective of the present study was to investigate the presence of endothelial dysfunction in obesity by measuring the plasma levels of plasminogen activator inhibitor-1 [PAI-1] antigen, von Willebrand [vWF] and thrombomodulin [TM] in obese subjects. Fifty-five healthy subjects, aged 20-60 years with a range body mass index [BMI] of 18.5-63 kg/m2, were evaluated for waist hip ratio [WHR], plasma lipids, PAI-I antigen, vWF and TM. The subjects were divided into two groups according to BM: Group 1 [lean and overweight], 20 subjects with BMI of <30 kg/m2 and group II [obese], 35 subjects with BMI of <30 kg/m2. It was concluded that obesity is associated with an endothelial dysfunction leading to an increase in the plasma concentrations of PAI-1 antigen, vWF and TM, thus providing an additional explanation for the higher cardiovascular risk in individuals with obesity

Effects of aerobic exercise on control of hyperglycemia in type II diabetes mellitus.

This study was carried out to evaluate the effects of exercise on the diabetic control of 22 female patients with type II diabetes mellitus. A regular aerobic exercise was done every other day for 30 minutes over a period of four weeks. At the end of the study, blood sugar, blood lipids and body mass index were compared with the same parameters at the start of the study. The results showed that there was a significant decrease in fasting and postprandial blood sugar level. The fasting blood glucose was decreased from 179.6 +/- 76.3 mg/dl to reach 149.5 +/- 69.7 mg/dl, this was statistically significant. Postprandial blood glucose decreased from 239.5 +/- 88.8 mg/dl to reach 204.1 +/- 97.1 mg/dl, this was statistically significant. Also, there was a significant decrease in serum triglycerides after exercise. The fasting serum triglyceride before exercise was 122.5 +/- 42.2 mg/dl and after the exercise was 106.8 +/- 341 mg/dl, this was statistically significant. The decrease in serum cholesterol, LDL and body mass index had no statistical significance and also the changes in HDL were of no statistical significance