The association between glycaemic level and lipid profile with Albuminuria in Iraqi type 2 diabetes patients - A cross sectional study.

OBJECTIVE: To assess the risk factors associated with diabetes on parameters of diabetic nephropathy represented by albuminuria level. METHOD: The case-control cross-sectional study was conducted at the National Diabetes Centre for Treatment and Research, Al-Mustansiriyah University, Baghdad, Iraq, from October 2019 to March 2020, and comprised adult diabetes patients of either gender who were divide into 3 groups depending on urine albumin/creatinine ratio as normal albuminuria group A, microalbuminuria group B and macroalbuminuria group C. Besides, healthy subjects were enrolled in control group D. Urine albumin/creatinine ratio was tested using urinary test strips, while glycated haemoglobin, fasting blood glucose, blood urea, serum creatinine, serum uric acid, total cholesterol, total triglycerides, high-density lipoprotein and low-density lipoprotein were tested in the laboratory. Body mass index of each subject was also measured. Data was analysed using Graph Pad Prism 8.0.2. RESULTS: Of the 133 subjects, 100(75.2%) were diabetes patients and 33(24.8%) were controls. Among the cases, 60(60%) were in group A with a mean age of 61.27±7.64 years; 37(61.7%) females and 23(38.3%) males; 21(21%) were in group B with a mean age of 59.48±7.63 years; 8(38%) females and 13(62%) males; and 19(19%) were in group C with a mean age of 62.79±9.73 years; 7(37%) females and 12(63%) males. Among the controls in groups D, there were 20(%) females and 13(%) males with an overall mean age of 54.36±10.94 years. Among the cases, 40(40%) had some degree of diabetic nephropathy. Glycated haemoglobin and fasting blood glucose were significantly higher among the cases and were strongly positively correlated with albuminuria microalbuminuria and macroalbuminuria (p<0.01). Total cholesterol and low-density lipoprotein were positively correlated with macroalbuminuria, while high-density lipoprotein was negatively correlated with albumin/creatinine ratio in microalbuminuria and macroalbuminuria (p<0.05). CONCLUSIONS: Diabetic subjects with nephropathy usually had poor glycaemic control with dyslipidaemia.

Evaluation of Vitamin D3 and cortisol hormone levels in overt hypothyroidism sample of Iraqi patients visiting specialized National diabetes and endocrine centre.

OBJECTIVE: To determine and compare serum vitamin D and cortisol hormone levels in hypothyroidism patients and healthy controls, and to assess the correlation of vitamin D with related parameters. METHODS: The case-control study was conducted from March to October 2019 at the National Diabetic and Endocrine Centre, Mustansiriyah University, Baghdad, Iraq, and comprised overt hypothyroid patients and healthy controls. Serum 25-hydroxyvitamin D, thyroid-stimulating hormone, triiodothyronine, thyroxine and cortisol level levels were assessed using immune-chemo-luminescent assays. Data was analysed using SPSS 25. RESULTS: Of the 60 subjects, 30(50%) were cases with a mean age of 44.6±7.3 years (range: 31-61 years); 11(36.7%) males and 19(63.3%) females. The other 30(50%) were controls with a mean age of 40.6±9.5 years (range: 28-62 years); 14(46.7%) males and 16(53.3%) females. The mean vitamin D level was significantly lower than that of the controls (p<0.05). The mean cortisol level in the patients was significantly higher than that of the controls (p<0.001). There was no significant correlation between vitamin D and thyroid function parameters in either group (p>0.05). CONCLUSIONS: Subjects with primary hypothyroidism had deficiency or insufficiency of vitamin D. High level of serum cortisol was observed in hypothyroid patients compared to the controls. Vitamin D and thyroid function parameters were not found to be correlated.

Iraqi Experts Consensus on the Management of Type 2 Diabetes/Prediabetes in Adults.

Type 2 diabetes mellitus (T2DM) management differs dramatically between Iraqi public and private sectors; this variability is due to treatment access discrepancy. The aim of this consensus is to put for the first-time uniform recommendation on how to manage patients with T2DM taking in consideration the local obstacles in Iraq. These consensuses were approved by a group of Iraqi Internist and diabetologist from all over the country. Up-to-date and latest level of evidence was used throughout the recommendation.

Impaired enhancement of insulin action in cultured skeletal muscle cells from insulin resistant type 2 diabetic patients in response to contraction using electrical pulse stimulation.

AIMS: Skeletal muscle insulin resistance is a characteristic feature of type 2 diabetes. The aim of this study was to examine the effect of contraction on insulin action using electrical pulse stimulation (EPS) in cultured skeletal muscle cells from insulin resistant type 2 diabetic patients. METHODS: Skeletal muscle cell cultures were established from 6 insulin resistant type 2 diabetic subjects and age and BMI matched non-diabetic control subjects. Day 7 differentiated myotubes were treated with or without EPS for 16 h, after which glucose uptake and AS160 phosphorylation were measured in the presence or absence of insulin. RESULTS: In control myotubes, EPS resulted in increased phosphorylation of AMPKThr172 (vs no EPS; p < 0.01), and this was associated with increased glucose uptake (p < 0.05). Insulin in the absence of EPS increased glucose uptake and AS160Thr642 phosphorylation, and both effects were significantly enhanced by prior EPS. In the absence of EPS, AMPK activation was significantly increased (p < 0.01) in the diabetic vs control myotubes. Despite a comparable degree of AMPK activation following EPS, the action of insulin on glucose uptake (p < 0.05) and AS160Thr642 phosphorylation (p < 0.001) was decreased in the diabetic vs control myotubes. CONCLUSION: EPS mediated AMPK activation enhances the effect of insulin on glucose uptake and AS160Thr642 phosphorylation in control myotubes replicating key metabolic benefits of exercise on insulin action in man. Conversely, insulin mediated glucose uptake and AS160Thr642 phosphorylation remain significantly decreased in diabetic vs control myotubes despite a comparable degree of AMPK activation following EPS.

Effects of thrombin on insulin signalling and glucose uptake in cultured human myotubes.

BACKGROUND: Hyper-coagulability (elevated thrombin) is a feature of type 2 diabetes and contributes to an increased risk of thrombotic and vascular events. Skeletal muscle is the key peripheral tissue site of insulin resistance in type 2 diabetes. Cultured human skeletal muscle cells were used to explore the effects of thrombin on insulin signalling and glucose uptake. We hypothesized that thrombin affects insulin activity in human skeletal muscle cells which could link the hypercoagulability and insulin resistance in type 2 diabetes. METHODS: Human skeletal muscle cell cultures (myotubes) were treated with +/-5 units/ml thrombin for 6h. Insulin signalling pathway components and AMPK were examined by Western blotting. Real time PCR and glucose uptake assays were performed. RESULTS: There was a significant decrease (p<0.01) in insulin mediated IRS-1 and Akt phosphorylation in response to thrombin in cultured myotubes. Diminished Akt phosphorylation was alleviated by treatment with a PKC inhibitor. Thrombin directly increased basal glucose uptake (p<0.05) that involved AMPK phosphorylation (p<0.01) and this was partly repressed by compound C (AMPK inhibitor). Thrombin also significantly increased the gene expression level of both GLUT1 and GLUT4 in cultured human skeletal muscle cells. CONCLUSION: Thrombin decreased insulin signalling in skeletal muscle cells through a PKC mediated mechanism, but did not affect the net action of insulin on glucose uptake. The direct stimulatory effect of thrombin on glucose uptake was mediated, at least in part, via an AMPK dependent mechanism. We conclude that thrombin activation results in multiple metabolic effects beyond increased thrombogenicity but does not include a decrease in insulin sensitivity (glucose uptake) in cultured human skeletal muscle cells.