الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is an independent risk factor for CAD and it is
responsible for the morbidity and mortality allover the world.
Insulin resistance syndrome also is a risk factor in non-insulin diabetes
mellitus as it is usually associated with obesity, hypertension and dyslipidemia
which are independent risk factors for CAD.
The aim of this study is to evaluate the relation between insulin resistance
in non-insulin dependent mellitus diabetes and CAD.
In the present study, patients were selected from the
cardiology department at Benha university hospital during the period
between 1/7/2004 and 1/6/2005. The study included 40 patients who were cross
matched for age, sex and duration of diabetes. These 40 patients were divided
into two groups:
Group A who were included 20 patients who are diabetic (NIDDM) and
ischemic (IHD was diagnosed and evaluated by the clinical examination, resting
ECG and coronary angiography).
Group B who were included 20 patients who are diabetic (NIDDM) and not
ischemic (IHD was excluded by history, clinical examination, resting ECG
and exercise ECG).
Summary
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All the patients underwent full history taking (duration of diabetes, family
history of CAD and smoking) and full clinical examination (especially waist
circumflex) and the following laboratory examinations, which include:
1- Fasting insulin (for both groups).
2- Fasting glucose (for both groups).
3- HOMA-IR equation (for both groups) to measure the degree of insulin
resistance by the equation:
HOMA–IR = Fasting bl. Insulin (μu/ml) x Fasting bl. Glucose (mmoL/L) .
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4- Lipid profile (for both groups) and includes:
a- Total triglycerides.
b- Total cholesterol.
c- LDL-C.
d- HDL-C.
5- Fibrinogen (for both groups).
6- Resting ECG (for diagnosis of IHD in the ischemic group and for exclusion of
IHD in the non-ischemic group) .
Summary
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7- Exercise ECG (for exclusion of ischemic heart disease in the non-ichemic
group) .
8- Coronary angiography ( in the ischemic group only).
It was found, through the comparison between the ischemic group
and the non ischemic group, that there was an association between CAD and
positive family of CAD, smoking , increased waist circumflex, dyslipedemia
and hyperfibrinogenemia.
It was also found that the number of insulin resistant patients is much
higher in the ischemic group than that in the non ischemic group, also the mean
HOMA-IR in the ischemic group is higher than that in the non ischemic group
which proves the association between the insulin resistance and CAD.
We also found, through the comparison between the insulin resistant
patients and the insulin sensitive patients, that there is an association between
insulin resistance and increased waist circumflex, increased total T.G., decreased
HDL-C and hyperfibrinogenemia.
Coronary angiography revealed that there is a positive correlation
between the degree of HOMA-IR and the severity of CAD (represented by the
number of affected great vessels).
Coronary angiography also revealed the more prevalence of three-vessel
disease in the diabetic patients and that insulin resistance is frequently associated
with moderate to severe CAD.
So, the more increase in insulin resistance in diabetic patients, the more
CAD association and severity.