الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Visfatin has been described to exhibit insulin-like activity by exerting a great affinity to the insulin receptor. Circulating plasma visfatin levels have been found to be related with various plasma lipoproteins, including total cholesterol, low density lipoprotein cholesterol, and triglyceride levels.
Increased plasma visfatin levels have been reported in patients with carotid atherosclerosis and the metabolic syndrome, and were independently associated with the maximum carotid intima media thickness (CIMT)
The aim of the present work was to determine the relationship between serum level of visfatin and carotid intima-media thickness (IMT) in patients with type 2 diabetes mellitus.
The study was performed on 60 diabetic patients 42 of them were females and 18 were males, presented to outpatient clinic, internal medicine department, Alexandria main university hospital. Another group of 30 sex- and age-matched nondiabetic subjects were used as a control.
In our study, the obese diabetic patients showed significant correlation between visfatin levels and BMI. There were statistically significant differences between the two groups as regard BMI and WC (P <0.001). The mean of BMI of the cases was 27.71 ± 3.03, while that of the control was 22.94 ± 1.66. The mean of WC of the cases was 103.50 ± 16.71, and that of the control was 84.30 ± 4.46.
Fourty percent of the cases were suffering from dyslipidemia and 56.7% were hypertensive. The difference between the studied groups was statistically significant as regard presence of dyslipidemia and hypertension in their medical history (P value <0.001). There were no statistically significant differences between the two groups as regard family history of premature C.A.D. The comparison between the studied groups according to blood pressure either systolic or diastolic, was statistically significant
Most of the cases 40 patients (66.7%) were receiving oral hypoglycemic agents, while only 6 patients (10%) were treated with insulin and 14 patients (23.3%) were receiving both kinds of therapy.
A statistically significant difference was found between the two groups as regard FPG, HbA1C, Fasting insulin HOMAIR and hs CRP (P value <0.001). Difference between the two studied groups was statistically significant as regard cholesterol level, triglycerides, HDL and LDL (P values 0.048, <0.001, <0.001 and 0.003, respectively).
The mean of visfatin among cases was 5.08 ± 1.24, while its mean among control was 2.36 ± 0.35. So comparison between the studied groups according to visfatin was statistically significant (P value <0.001).
The mean of the IMT in cases was 1.28±0.36, while in the control group, it was 0.67 ± 0.11, and this difference was statistically significant (P value <0.001). Plaques were present in 28.3% of the cases and they were calcified in 18.3%, while they were absent among control group, so comparison between the studied groups according to presence of plaques was statistically significant (P value <0.001). Degree of stenosis among cases ranged from 25.0 – 40.0%, with a mean 30.56 ± 4.50.
Relation between visfatin and sex was statistically insignificant (P value = 0.536), but its statistical relation with smoking was significant (p<0.001). Relation between visfatin and presence of dyslipidemia, hypertension and positive family history of premature C.A.D in the medical history of the cases, was statistically significant with P values <0.001, 0.001 and 0.003, respectively. Relation between visfatin and the presence of plaques in cases group was statistically significant.
There was a statistically significant correlation between visfatin and age, duration of DM, BMI, WC, blood pressure, glycemic profile, hsCRP, lipid profile, IMT and degree of stenosis.
There was a statistically significant correlation between IMT and age, duration of DM, BMI, WC, blood pressure, glycemic profile , hsCRP , lipid profile, and degree of stenosis . But there was a statistically insignificant correlation between IMT and fasting insulin .
We concluded that:
Our study revealed elevated circulating serum visfatin in type 2 diabetics and obese subjects and these results were supported by a significant association between visfatin and insulin resistance, which indicates that visfatin may play a role in the pathophysiology of insulin resistance, this may represent a new target in the treatment of type 2 DM in the future.
Serum visfatin levels are significantly higher in patients with carotid atherosclerosis, and are independently associated with the carotid intima media thickness (CIMT).
Visfatin may be used as promising predictor for obesity, insulin resistance, glycemic control and atherosclerosis disease.
We recommended
More research is needed to better understand the factors that control synthesis/release of visfatin and to evaluate the role of visfatin in atherosclerosis-related disease. Large studies with homogeneous populations will probably be needed to answer these questions.