Total and LDL combined vitamin E concentrations in plasma patient with non insulin dependent diabetes mellitus

Patients with diabetes mellitus are susceptible to oxidant-antioxidant imbalance. Diabetic complications such as nephropathy, neuropathy and retinopathy increase 'this susceptibility. Other traditional atherogenic risk factors such as hypertension, cigarette smoking and dyslipidemia can also induce oxidant stress. It is possible that the existence of two or more of the atherogenic risk factors may enhance oxidant-antioxidant imbalance. However, this proposal has not been fully studied. Aim: To determine plasma vitamin E concentrations, both total and the fraction within LDL particles in patients with sole noninsulin-dependent diabetes mellitus [N-1DDM] or N1DDM associated with one or more of the other risk factors of atherosclerosis. This study was conducted on 60 patients with NIDDM [32 males and 28 females]. They were classified into four groups: [1] sole diabetic [n=20], [2] diabetic-hypertensive [n=10], [3] cigarette smoking diabetic [n=10] and [4] diabetic with multiple atherogenic risk factors [n=20]. Also, twenty clinically healthy individuals were investigated as a control group. Vitamin E was measured by high performance liquid chromatography [HPLC] while a plasma thiobarbituric acid reactive substance [malondialde-hyde] was determined colorimetrically. Plasma total vitamin E [VE] and vitamin E in LDL [VE-LDL] concentrations were significantly decreased while plasma malondialdehyde [MDA] levels were significantly increased in sole N1DDM, diabetic hypertensive, smoking diabetic and diabetic with multiple atherogenic risk factors groups in comparison to the corresponding values of the control group. These changes were noted more frequently and more severely in patients with multiple risk factors than those with single DM or DM with another risk factor. In these groups, vitamin E content in HDL showed significant negative correlation with LDL-C concentrations and significant positive correlation with HDL-C concentrations. Multiple regression analysis showed that vitamin E in HDL particles was an independent risk factor for coronary heart disease. The subnormal vitamin E content in LDL panicles may be a result of enhanced LDL oxidation in patients

Pulmonary microangiopathy and its association with retinopathy and nephropathy in type 2 diabetes mellitus: role of ACE and ET-1

Aim: The microvascular complications in type 2 diabetes mellitus are associated with high morbidity mortality. Their pathogenesis is not fully understood in spite of recent advances. Although some authors have reported normal pulmonary function in diabetics, others found abnormalities including impaired diffusing capacity. The aim of this study was to assess the presence of pulmonary microangiopathy [as determined by lung diffusing capacity for carbon monoxide, DLco] in type 2 diabetic patients and to analyze the correlation between DLco and various diabetic factors. We also aimed to association between DLco and serum levels of ACE and ET-1 [markers of endothelial damage in various diabetic microangiopathies]. Subjects and Thirty-eight type 2 diabetic patients without over lung disease and 20 age and sex-matched :ontrols were enrolled in the study. All patients ontrols were non-smokers. Glycosylated haemoglobin [HbA-1c] was measured as an indicator of control. The presence of diabetic retinopathy was detected by ophthalmoscopic examination and the presence of diabetic nephropathy was determined by measuring the 24-hour urinary albumin excretion [UAE]. A global spirometry was performed and DLco was measured by the single-breath method corrected by alveolar volume [DLcoA/VA]. Forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1] and FEV1/FVC were within normal in diabetics. Diabetic patients showed a significant reduction of% DLcoA/VA that was greater in those not receiving insulin and those with diabetic microangiopathy. The serum levels of ACE and ET-1 were significantly higher in diabetics [ACE and ET-1 level were more elevated in those with diabetic microangiopathy]. Percent DLcoA/VA was negatively correlated with serum ACE, ET-1 and UAE values. Conclusions: These data suggest the existence of microangiopathic involvement of pulmonary vessels in type 2 diabetic patients particularly in presence of retinopathy and/or nephropathy. Elevated serum levels of ACE and ET-1 as well as microalbuminuria are significant independent predictors of the existence of pulmonary microangiopathy. Insulin resistance may be central to the pathogenesis of pulmonary microangiopathy. Exogenous insulin administration, e.g. via the inhaled route, may be used in diabetics to improve their DLco