H-FABP: A beacon of hope for prediabetic heart disease.

BACKGROUND: Prediabetes is increasingly being studied in the context of its association with cardiovascular disease (CVD). Besides raised HbA1c and sugar levels, the major underlying defect seems to be insulin resistance (IR). Subclinical atherosclerosis, measured by high sensitivity C reactive protein (hsCRP) and carotid artery intima media thickness (CIMT) underlies the pathogenesis of CVD in prediabetes. Heart-type fatty acid binding protein (H-FABP), a novel cardiac biomarker also might have a role in predictin prediabetic heart disease. AIMS: The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with the atherosclerotic markers, hsCRP and CIMT. SETTING AND DESIGN: 50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum F & PPBS, (HbA1c), fasting insulin levels were measured in cases and controls. Serum H-FABP was measured in both cases and controls. All cases and controls were subjected to bilateral CIMT measurements and Serum hsCRP levels. The values were compared between both the groups and subjected to appropriate statistical analysis. STATISTICAL ANALYSIS USED: Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. Normality of data was tested by Kolmogorov-Smirnov test. If the normality was rejected then non parametric test was used. Quantitative variables were compared using Independent t test/Mann-Whitney Test (when the data sets were not normally distributed) between the two groups. Qualitative variables were correlated using Chi-Square test/Fisher's Exact test. Spearman rank correlation coefficient was used to find out the correlation of various parameters with each other. Univariate linear regression was used to find out the cause and effect relationship between various parameters. A p <0.05 was considered statistically significant. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. RESULTS: The mean serum levels of H-FABP among cases and controls were 6.38± 2.76ng/ml and 3.24 ± 2.47 ng/ml respectively (p <0.0001). Mean CIMT was found to be higher in prediabetics (0.59 ± 0.11 mm ) compared to controls (0.45 ± 0.07mm) (p<0.0001). Serum hsCRP levels were also statistically higher in prediabetics (5.75± 4.16 mg/l) then that of controls (1.86± 1.67 mg/l) (p <0.0001). The correlations of the two variables, hsCRP and CIMT with H-FABP were both strongly positive (r = 0.687) & (r = 0.779) respectively [both cases (p < 0.0001)]. CONCLUSION: The novel cardiac biomarker H-FAPB might be a good predictor of cardiovascular risks in prediabetics.

Serum Heart Type Fatty Acid Binding Protein Levels in Prediabetes-An Invaluable Cardiovascular Biomarker.

BACKGROUND: The pathophysiological effects of diabetes on the heart and the rest of the cardiovascular system begins much earlier in its precedent stage of prediabetes and one major underlying defect is insulin resistance. Heart-type fatty acid binding protein (H-FABP) is a recently studied molecule inherent to the cardiac myocytes found to rise in both coronary and non-coronary heart diseases. The utility of the molecule in prediabetes and its relationship with insulin resistance is being studied. OBJECTIVE: The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with Homeostatic model assessment - insulin resistance (HOMA-IR). METHODS: 50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum fasting and postprandial blood sugars, glycosylated hemoglobin (HbA1c), fasting insulin levels were measured in cases and controls. HOMA-IR index was calculated from fasting glucose and insulin values. Serum H-FABP was measured in both cases and controls using Immunoturbidimetric method with anti- H-FABP coated latex reagent kits. The values were compared between both the groups. RESULTS: The mean serum fasting insulin level among cases was 12.22mIU/ml and that of the control group was 5.37mIU/ml (p value <0.0001). HOMA- IR mean values were 3.31 ± 1.56 and 1.16 ± 0.44 in cases and controls respectively (p- <0.001). The mean serum levels of H-FABP among cases and controls were 6.38± 2.76ng/ml and 3.24 ± 2.47 ng/ml respectively (p <0.0001). The correlation between the two variables, HOMA-IR and H-FABP was also found to be strongly positive (r=0.675). Linear regression analysis showed that for 1 unit increase in HOMA-IR, H-FABP increased by 1.095 and for 1 unit increase in Fasting insulin, H-FABP increased by 0.038. CONCLUSION: Prediabetics have a higher risk of cardiovascular morbidity when compared to normoglycemics with insulin resistance being the single most important contributor. Serum H-FABP levels are elevated in prediabetes representing a marker of subclinical cardiovascular disease (CVD).

Disseminated pulmonary mucormycosis with concomitant tuberculosis infection in a diabetic patient.

Patients with diabetes are often susceptible to various opportunistic infections such as tuberculosis and mucormycosis. However, the occurrence of both these infections simultaneously is rare. We present one such case of pulmonary tuberculosis with disseminated pulmonary mucormycosis in a patient with diabetes, which was successfully managed.

Neuropathy in Prediabetics: Is Oxidative Stress to Contribute?

OBJECTIVE: To assess the association of oxidative stress and serum vitamin D levels in sensory neuropathy in prediabetes. METHODS: Serum and urine levels of 8-OHdG (a marker of oxidative stress) and serum levels of vitamin D were compared in prediabetic patient having sensory neuropathy to those who did not have sensory neuropathy as determined by VPTs measured by Digital Biothesiometer and MNSI (Michigan Neuropathy Screening Instrument). RESULT: A total of 60 prediabetic cases between 35 years to 60 years were included in this study. Among all the prediabetic subjects, 43.3 % subjects had neuropathy according to VPTs measured by Biothesiometer. T-test analysis suggested that serum levels of 8-OHdG were significantly higher in subjects with neuropathy than subjects without neuropathy (1006.58 ± 511.8 vs 688.6 ± 607.3, p value = 0.035). Urinary levels of 8-OHdG were also significantly higher in subjects with neuropathy than subjects without neuropathy (699.35 ± 419.5 vs 474.57 ± 402.5, p-value = 0.04). No such significant difference however was present in serum levels of vitamin D between neuropathic and non-neuropathic prediabetics (20.13 ± 18.44 vs 16.96 ± 11.72, p value = 0.419. VPTs were found to have statistically significant positive correlation with serum 8-OHdG {, Pearson Correlation Coefficient= 0.317(R), 0.307(L); p-value=0.014(R),0.017(L)} and urine 8-OHdG levels{Pearson Correlation Coefficient= 0.288(R), 0.255(L); p-value=0.026(R), 0.049(L),}. According to MNSI physical assessment score (> or = 2), 38.3 % subjects (23 subjects) had neuropathy. MNSI score is positively correlated with serum 8-OHdG (Pearson Correlation Coefficient = 0.308; p-value = 0.017). Correlation with urine 8-OHdG was not statistically significant (Pearson Correlation Coefficient= 0.687; p value = 0.06). Correlations of MNSI scores {Pearson Correlation Coefficient=0.14, p-value=0.287} and VPTs{Pearson Correlation Coefficient= 0.058(R), 0.189(L); p-value=0.660(R), 0.148(L)} with serum vitamin D levels were not statistically significant. CONCLUSION: Oxidative stress, as confirmed by the biomarker, 8-OHdG, has a important role in the development of this sensory neuropathy.