ABSTRACT
BACKGROUND AND AIMS: The prosclerotic cytokine TGFbeta has been implicated as an important downstream mediator in the progression of the renal pathological changes occurring in diabetic patients. This study was undertaken to determine (1) whether serum levels of zTGFbeta1 was elevated in South Indian type 2 diabetic subjects and (2) whether treatment with oral hypoglycaemic agents/insulin and angiotensin-converting enzyme inhibitors (ACEI) and/or angiotensin receptor blockers (ARB) influenced TGFbeta1 levels in diabetic subjects. METHODS: Among the 131 study subjects, 101 were consecutive type 2 diabetic patients and the other 30 subjects were non-diabetic, normoglycaemic (NGT, M : F 15 : 15) healthy subjects who had undergone an Oral Glucose Tolerance Test (OGTT) during medical checkup. TGFbeta1 was determined using solid-phase sandwich enzyme-linked immunosorbent assay. RESULTS: Mean serum TGFbeta1 levels were significantly elevated (p < 0.0001) in the type 2 diabetic subjects (30 +/- 13.1 ng/mL) when compared with the non-diabetic subjects (19 +/- 8.3 ng/mL). Diabetic subjects who were being treated with a combination of OHA and insulin (n = 53;25.6 +/- 11.5 ng/mL) had significantly (p = 0.0009) lower levels of TGFbeta1 when compared with those who were being treated with OHA alone (n = 48;34.1 +/- 13.4 ng/mL). Nearly 36% of the diabetic subjects were being treated with ACEI/ARB, and they had significantly (p = 0.01) lower levels of TGFbeta1 (n = 36;25.4 +/- 12.6 ng/mL) when compared with those who were not being treated with ACEI/ARB (n = 65;32 +/- 12.9 ng/mL). CONCLUSION: The present study demonstrated significantly elevated TGFbeta1 levels in South Indian type 2 diabetic patients when compared with the non-diabetic subjects. Insulin and ACEI/ARB treatment appears to have a protective effect by lowering TGFbeta1 concentrations in these subjects.
Subject(s)
Diabetes Mellitus, Type 2/blood , Hypertension/blood , Transforming Growth Factor beta/blood , Administration, Oral , Adult , Aged , Angiotensin II Type 1 Receptor Blockers/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Biomarkers/blood , Diabetes Mellitus, Type 2/drug therapy , Female , Humans , Hypertension/drug therapy , Hypoglycemic Agents/administration & dosage , India , Insulin/administration & dosage , Linear Models , Male , Middle Aged , Transforming Growth Factor beta1ABSTRACT
AIMS AND OBJECTIVE: To determine the impact of the Seventh Report of the Joint National Committee recommendations on microvascular complications in South Indian type 2 diabetic patients. MATERIAL AND METHODS: In this study, 457 type 2 diabetic patients and 500 age-matched healthy control subjects, with no history of hypertension were enrolled. Based on blood pressure measurements, they were assigned as Group I: Normal (SBP < 120 and DBP < 80 mmHg); Group II: Prehypertension (SBP 120-139 or DBP 80-89 mmHg); Group III: Stage I hypertension (SBP 140-159 or DBP 90-99 mmHg) and Group IV: Stage II hypertension (SBP > or = 160 or DBP > or = 100). RESULTS: Blood pressure readings in controls and diabetics were: normal in 46.8% and 16.2% (chi2 = 101.1, p < 0.0001), prehypertension in 33.2% and 52.5% (chi2 = 35.7, p < 0.0001), stage I hypertension in 15.2% and 26.3% (chi2 = 17.3, p < 0.0001), stage II hypertension in 4.8% and 5% respectively. Prevalence of retinopathy increased with increasing incidence of hypertension (trend chi2 = 10.7, p < 0.01). In the multivariate analysis, cholesterol was associated with prehypertension, and cholesterol and family history of hypertension were associated with stage I hypertension. Albuminuria, family history of hypertension and serum triglycerides were associated with stage II hypertension. CONCLUSION: More than half of the diabetic subjects were prehypertensives. As expected prevalence of other complications increased with increasing levels of blood pressure. This emphasizes the need to have regular check up for hypertension to reduce the morbidity from other complications.
