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Abstract
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.Type 2 diabetes mellitus frequently goes undiagnosed for many years because the hyperglycemia develops gradually and at earlier stage is often not severe enough for the patient to notice any of the classic symptoms of diabetes.The metabolic syndrome consists of 6 components which is related to CVD: abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, insulin resistance, proinflammatory state, and prothrombotic state.
Diabetes associated vascular alterations include anatomic, structural and functional changes leading to multi-organ dysfunction.Microvascular complications include diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy.Macrovascular complications, include cardiovascular disease (CVD), cerebrovascular disease, and peripheral arterial disease (PAD).Atherosclerosis plays an important role in diabetic complications, because it starts unnoticed (subclinical atherosclerosis) and manifests by coronary artery disease or end stage renal failure in type 2 diabetic patients.
Cystatin C is a potent inhibitor of lysosomal proteinases and freely filtered at the glomerulus due to its low molecular weight cystatin C (13 KDa).Therefore any decline in glomerular filtration rate, the blood levels of cystatin C will increase.B-mode ultrasound of the carotid intima-media thickness is used as a non invasive imaging tool to quantify carotid atherosclerosis, which is correlated well with atherosclerosis elsewhere in the circulation and can be used as a marker of general atherosclerosis.
The aim of this work was to study the circulating level of cystatin C and to correlate this level with common carotid artery intima-media thickness measured by B-mode ultrasound in normotensive male type 2 diabetic patients
Forty subjects with type 2 diabetes mellitus (group I) and 10 non diabetic healthy controls (group II) were subjected to full history taking, complete physical examination including assessment of blood pressure, BMI, waist hip ratio (WHR) , ECG. Peripheral neuropathy ,fundus examination and laboratory investigations including FBS, PPBG, HbA1c lipid profile, renal profile, serum cystatin C and urinary microalbuminuria and ultra sonographic measurements of common carotid intima-media thickness by B-mode ultrasound.
Statistical analysis of the data obtained from the present study revealed that most of the studied parameters as BMI, FBS, PPBG, HbA1c, total cholesterol, LDL-C, Serum cystatin C, urinary microalbuminuria, common carotid intima-medial thickness were significantly higher in diabetic group (I) than that observed in group (II) controls.atheromatous plaque were found in common carotid artery only in diabetic group I (10% in the right CCA, 33.3% in the left common carotid artery). There was no stenosis in the common carotid artery in both groups.
In-group (I) there was a significant correlation between serum cystatin C level and BMI and serum triglyceride level.Cystatin C had a significant negative correlation with HbA1c. There was a significant positive correlation between serum cystatin C and serum creatinine .While a significant negative correlation between cystatin C and eGFR (as calculated by Cockcroft-Gault formula). A moderate correlation between cystatin C and urinary microalbuminuria observed.
In-group (I) there was a significant correlation between common carotid artery intima-medial thickness and duration of diabetes, HbA1C, and serum triglycerides. While there was a significant negative correlation between CCA-IMT and BMI .There was no significant correlation between cystatin C and common carotid artery intimal-media thickness (CCA-IMT), but there was a significant correlation between CCA-IMT and microalbuminuria.