الفهرس 
DIABETES MELLITUS
Criteria for the diagnosis of diabetes mellitusOnly 14 pages are availabe for public view
 |  | from | 265 |  |  |
| | | from | 265 | | |
Abstract
Diabetes mellitus (DM) is a multisystem disease with
both biochemical and anatomical/structural consequences. It is
a chronic disease of carbohydrate, fat, and protein metabolism
caused by the lack of insulin, which results from the marked
and progressive inability of the pancreas to secrete insulin
because of autoimmune destruction of the beta cells.
Diabetes is a group of chronic diseases characterized by
hyperglycemia. chronic hyperglycemia injures the human body
in many different ways. One of the chief injuries arising from
hyperglycemia is injury to vasculature, which is classified as
either small vascular injury (microvascular disease) or injury to
the large blood vessels of the body (macrovascular disease).
Oxidized LDL has been implicated as a major factor in
the atherosclerotic process in humans and in animal models
because of its biological effects on endothelial cells,
macrophages and smooth muscle cells.
A number of studies suggest the Ox-LDL is a more
potent pro-atherosclerotic motivator than the native unmodified
LDL. Ox-LDL has been observed to be increased in diabetic
patients and this may contribute to the increased atherogenesis
in diabetes, regardless of normal lipid levels. Endothelium
exposed to Ox-LDL develops alterations such as early signs of
injury in the form of apoptosis. The oxidized low density
lipoprotein (Ox-LDL) levels have been regarded as one of the
independent determinants of intima media thickness (IMT) of
the common carotid artery, a surrogate marker of atherosclerosis. Ox-LDL induces foam cell formation from
macrophages that plays a key role in early atherogenesis.
Oxidation of LDL occurs primarily in the vessels wall, thus
activating many inflammatory and atherogenic reactions.
Inflammatory mediators may be pathogenic by inducing
vascular endothelial dysfunction. Leukocyte recruitment and
adhesion to vascular endothelium, mediated by cell adhesion
molecules such as intercellular adhesion molecule-1 (ICAM-1),
play an important role in the development of atherosclerosis. In
several studies have shown that circulating ICAM-1 may serve
as a molecular marker for atherosclerosis and development of
CHD. In vitro studies show that Ox-LDL induces dose
dependent expression of ICAM-1 on endothelial cells and
stimulates ICAM-1-dependent adhesion of monocytes.
The aim of this study was to assess the level of oxidized
low density lipoprotein (Ox-LDL) in children and adolescents
with type 1 diabetes milletus, Investigate the association of the
marker level with the occurrence and severity of both microvascular and macro-vascular complications, and Investigate the
relation between intracellular adhesion molecules and Ox-LDL
in IDDM.
This study was carried out on 90 subjects (38 male and
52 female). They included 60 type 1 diabetic patients; 26
(43.3%) males and 34 (56.7%) females compared to 30 ageand sex-matched healthy subjects served as controls. The
control group consisted of 12 (40%) males and 18 (60%)females. The mean age of patients was 14.58 ± 1.87 years while
that of controls was 14.27 ± 1.89 years.
All patients and controls were subjected to history
taking, thorough clinical examination and laboratory
investigations including blood glucose, glycated haemoglobin,
lipid profile, and Urinary albumin excretion. Oxidized LDL
using ELISA technique.
Imaging study: CIMT was done for all the subjects
included in the study by ultrasound.
The study revealed the following results:
1. 18 patients out of 30 had nephropathy in the form of
microalbuminuria (60%), 7 patients had neuropathy
(23.33%), and 5 patients had retinopathy (16.67%), while 4
patients had both nephropathy and neuropathy (13.3%), and
3 patients had both nephropathy and retinopathy (10%).
2. There was a statistically significant difference between
diabetic patients (complicated and non complicated) and
controls regarding systolic and diastolic blood pressure
(p< 0.05)
3. Complicated diabetics had statistically significantly high
systolic and diastolic blood pressure and insulin dose
compared to non- complicated diabetics
4. Complicated diabetic patients were elder and had lower
height and BMI than non complicated group. Disease
duration was statistically significant longer in complicated
patients compared to non-complicated patients (p<0.001)Diabetic patients (complicated and non complicated)
showed significantly higher mean blood glucose,
Triglycerides, total cholesterol, low density lipoprotein,
oxidized LDL, ICAM1, compared to controls (p<0.001).
In addition, HDL level were significantly lower in patients
compared to controls (p=0.049).
6. Complicated diabetics had significantly high RBS,
HbA1c, urinary albumin, TG, TC, Ox-LDL, ICAM1 and
low density lipoprotein compared to non complicated
patients.
7. Oxidized LDL has been highly significant in diabetic
group (complicated and non complicated) compared to
control one.
8. Oxidized LDL was statistically significant high in diabetic
patients with complications (95.32 ± 31.13) than diabetic
patients without complications (64.33 ± 22.56).
9. Oxidized LDL is significantly higher in diabetic patients
with nephropathy and is higher in diabetics Neuropathy
and Retinopathy although there values didn’t reach
statistically significant levels.
10. Statistically significant correlation between oxidized LDL
and LDL and HbA1c.
11. Intercellular adhesion molecule1 was statistically significant
in diabetics (complicated and non complicated) compared to
controls, as well as ICAM1 statistically significant in
complicated group compared to non complicated group
12. Carotid intima media thickness was statistically significant
in diabetics (complicated and non complicated) compared to controls, whereas no significant difference between
complicated group and non complicated group
13. A Positive significant correlation between ICAM1 and
HbA1c, CIMT and urinary Alb and negative correlation
with HDL in uncomplicated diabetics.
14. A positive significant correlation between ICAM1 and
HbA1c, CIMT and urinary Alb and negative significant
correlation with HDL in complicated diabetics.
15. A positive significant difference between ICAM1 and
disease duration in both groups. While insulin dose is
significant in non complicated group only.
16. Carotid intima media thickness was found to have a
positive statistically significant correlation with laboratory
variables in diabetic group without complication except
HDL a non statistically significant negative correlation.
17. Carotid intima media thickness was found to have a
positive correlation with laboratory variables in diabetic
group with complication except HDL a negative
correlation, and statistically significant correlations with
HbA1c, ICAM1, TG, TC, LDL, OX LDL and Urin Alb.
Further longitudinal studies are needed to detect the
correlation between Ox-LDL and ICAM1 and cardiovascular
risk factors in T1DM children and adolescents.