الفهرس 
IncretinsOnly 14 pages are availabe for public view
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Abstract
Incretins are hormones produced by the intestinal mucosa in response to oral intake of nutrients that enhance glucose-stimulated insulin secretion and lower blood glucose levels.. GLP-1 is of particular interest for its glucose-lowering effects, as well as its ability to slow gastric emptying and suppress secretion of glucagon.
Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications.
Peripheral Arterial Disease is mainly caused by atherosclerosis and associated thrombosis within the lower limb arteries leading to end organ ischemia. Other causes include vasculitis and in situ thrombosis related to hypercoagulable states.
The effects of GLP-1 on increasing insulin secretion and decreasing glucose, so the improvement in endothelial function could be by indirect mechanisms.
GLP-1 exerts their effects on blood vessels within diverse vascular beds. The vascular actions of GLP-1 in normal or diseased blood vessels may be direct or indirect. Sites of GLP 1 receptor expressed in blood vessels, immune cells, platelets, and hematopoietic cells.
The aim of this study was to explain the relationship between glucagon like peptide-1 and peripheral vascular disease in type 2 diabetic patients.
Our study was conducted in the period from 1st of January to 1st of June 2017. Our subjects were collected from the diabetes clinic of El Demerdash Hospital.
The study included eighty (80) patients divided into 40 type 2 diabetic patients without peripheral vascular disease (control) (group 1) and 40 type 2 diabetic patients with peripheral vascular disease (cases) (group 2).
All members of the study were subjected to: Full medical history, clinical examination, laboratory investigations including: FBS (mg/dl), PBS(mg/dl), GLP-1 (pg/ml), HbA1C (%), Arterial Doppler examination of both lower limbs and calculation of ankle peak systolic velocity (cm/sec).
The results were statistically analyzed and we observed the following:
• GLP-1 showed statistically significant lower concentrations in diabetic
patients with peripheral vascular disease when compared to controls (p value < 0.001).
• Diabetic patients with peripheral vascular disease show statistically significant higher BMI than control with P-value 0.002.
• Diabetic patients with peripheral vascular disease show no statistically significant when compared to controls as regard systolic and diastolic blood pressure, Fasting and post prandial blood glucose.
• Diabetic patients with peripheral vascular disease show statistically significant difference higher HbA1c levels than control with P-value 0.005 (P-value <0.05).
• GLP 1 correlated positively with APSV with high statistically significant difference; P-value< 0.001.
• GLP 1 correlated negatively with BMI, FBS, 2h PPBS and HbA1C; with statistically significant difference; P-value (0.031, 0.015, 0.033 and 0.010 respectively)
• GLP 1 correlated negatively with age, SBP and DBP but of no statistical difference; P-value (0.232, 0.654 and 0.335 respectively).
• On doing multivariable regression analysis, HbA1C and APSV were the only independent factors of GLP-1 secretion
Conclusion
• GLP-1 levels are lower in Diabetic patients with peripheral vascular disease than controls.
• GLP-1 levels showed significantly lower levels with increasing degree of obesity, FBS, PPBS and HbA1c and negatively significant correlated with APSV so we conclude that GLP1 agonist may have a protective role against PVD.