الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY ype two diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with disturbance of carbohydrate, fat and protein metabolism which take place as a result of either insulin resistance and/or insulin deficiency. It accounts for 90–95% of all diabetes. This medical condition required a chronic monitoring and treatment throughout patient life; the treatment will involve several aspects like self-care measures, lifestyle changes and in some cases medications. High blood sugar when remain for long time will mainly cause macrovascular and microvascular complications. DSPN is a symmetrical, length dependent sensorimotor polyneuropathy attributable to metabolic and microvessel alterations as a result of chronic hyperglycemia exposure (diabetes). It affects Sensory nerves, which enable people to feel pain, temperature, and other sensations and Motor nerves, which control the muscles and give them their strength and tone. It is the most common form of the diabetic neuropathies. All patients with type 2 diabetes should be assessed annually for DSPN using the medical history and simple clinical tests. Apelin is a peptide produced and secreted by white adipose tissue, discovered in 1998 by tatemoto and other co-workers. It is synthesized as preproapelin, a protein containing 77 aminoacids which is then cleaved to shorter active fragments. As an adipokine, apelin plays a role in the regulation of many biological T Summary 120 functions, including body energy homeostasis and glucose metabolism, water balance, and immunity. Apelin levels were found to be higher in diabetic patients than healthy controls. When diabetic patients were evaluated, apelin levels of DPN group were found to be significantly higher than DM patients without DPN. It is supposed that elevated apelin levels may indicate the metabolic state causing diabetic complications. Apelin might reflect endothelial dysfunction, microangiopathic changes and inflammation mechanisms in diabetic patients which all play some role in DSPN pathogenesis. apelin might be used as markers of DSPN. This study was conducted on 80 subjects,60 with type 2 DM, Their age ranged from 40 to70 years old and BMI ranged from 28 to38 Kg/m2 from the outpatient clinic of Dar El-Shefa hospital and 20 healthy subjects with age, sex & BMI matched taking as control from November 2016 to march 2017. Subjects were be divided in to three groups diabetic patients with neuropathy, diabetic patients without neuropathy and non diabetic control. All patients were subjected to full history taking, full clinical examination, Hb A1C, fasting plasma glucose, lipid profile [total cholesterol, HDL, LDL, TG], nerve conduction study, plasma apelin level and fasting insulin [to calculate HOMA-IR]. All patients with neuropathy due to other causes other than diabetes, renal or hepatic disease, coronary heart disease, retinopathy, any end organ failure, thyroid disease, any Summary 121 current infection and hypertensive patient on ARBS or ACEI treatment were excluded from the study. Our results show that apelin levels were increased in diabetic patients when compared with healthy control subjects. Further, when the apelin levels were evaluated with regard to the presence of neuropathy, diabetic patients with neuropathy had significantly higher apelin levels than the control subjects. So apelin level seems to be beneficial biomarker in early detection of type-2 diabetes, insulin resistance, glucose intolerance and diabetic complications (neuropathy, nephropathy and retinopathy). Also it seems to have a beneficial role in follow up and treatment of diabetic neuropathy regarding to its anti inflammatory, anti oxidant and anti insulin resistance effects |