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   Table of Contents - Current issue
May-August 2017
Volume 3 | Issue 2
Page Nos. 39-82

Online since Tuesday, October 17, 2017

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The role of genetic polymorphism of β3-adrenergic receptor in the susceptibility to diabetes and its related disorders: a case–control study on Egyptian population p. 39
Neveen S.E.D Hemimi, Mona M Abdelsalam, Lamis M Tawfik, Marwa M Khalil
Background The β3-adrenergic receptor (β3-AR) is mainly expressed in adipose tissue and plays an important role in lipid metabolism and metabolic rate by mediating lipolysis and thermogenesis. It has been suggested that the Trp64Arg (T→C) polymorphism in the β3-AR gene affects fat accumulation and/or impairment of lipid and carbohydrate metabolism. Objective The aim of this study was to investigate whether common polymorphism (Trp64Arg) of β3-AR gene has a role in the apparent susceptibility to type 2 diabetes mellitus (DM) and its related disorders in the Egyptian population. Patients and methods One hundred and thirty five healthy controls and 123 individuals with type 2 DM were enrolled in the study. The β3-AR Trp64Arg polymorphism was identified using restriction fragment length polymorphism PCR of peripheral blood DNA samples. Analysis of data was performed using SPSS program 11. Results Allele frequency for C was 23.2% in the diabetic group compared with 12.2% in the control group. The carriers of XC genotype (TC and CC) were at high risk of developing type 2 DM (odds ratio=2.8; 95% confidence interval=1.6–4.9) when compared with the carrier of TT genotype. Furthermore, they were at much higher risk of developing its related disorders such as central obesity, dyslipidemia, and hypertension (odds ratio=2.8; 1.8, 1.5, 2.2, and 2.7 for BMI, waist–hip ratio, triglycerides, high-density lipoprotein, and hypertension, respectively). Conclusion The prevalence of Arg64 allele of the Trp64Arg polymorphism in the β3-AR gene is a risk factor for type 2 DM and its related disorders in the Egyptian population.
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Serum zinc level and its relation to insulin resistance and lipid profile in childhood and adolescent obesity p. 46
Manal M Abdel Gawad, Omneya M Omar, Reham A Abo Elwafa, Ebtsam M Mohamed
Background Obesity is considered to be a worldwide health problem. Obese individuals are at a high risk of developing dyslipidemia, hypertension, impaired glucose tolerance, insulin resistance, and consequent increase of the risk of metabolic and cardiovascular diseases. In obesity, elevated insulin resistance is observed, which may be associated with disturbances in zinc status in the body. The few studies concerning the status of zinc and its relationship with insulin resistance in obese children and adolescents have brought inconclusive results. Aims The aims of this work were to study the level of serum zinc in obese children and adolescents and to evaluate its potential relation to obesity, insulin resistance, and lipid profile. Patients and methods Thirty obese children and adolescents and 30 healthy controls aged 5–19 years were recruited for the study. Lipid profile, serum zinc, fasting plasma glucose, and fasting insulin were measured. Insulin resistance was calculated according to the homeostatic model of assessment for insulin resistance and quantitative insulin-sensitivity check index. Results Obese individuals had significantly higher serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, fasting blood insulin, and homeostatic model of assessment for insulin resistance, whereas high-density lipoprotein cholesterol and quantitative insulin-sensitivity check index were significantly lower in obese children than in healthy controls (all P<0.05). The serum concentration of zinc was significantly lower in obese individuals compared with control. There was a positive significant correlation between serum zinc level and high-density lipoprotein (r=0.511, P<0.05). Conclusion Obese children and adolescents have a poorer zinc status than children and adolescents of normal weight, which may affect lipid profile.
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Assessment of vitamin D status in different samples of an elderly Egyptian population p. 53
Salah Shelbaya, Salwa Seddik, Abeer Ahmed, Nagwa Roshdy, Magdy Abbas
Introduction Vitamin D is one of the important hormones involved in Ca homeostasis. It is also essential for the prevention of osteoporosis and fractures. Vitamin D is important for maintaining many physiologic functions, such as optimal balance, muscle strength, and innate immunity. Vitamin D deficiency is associated with an increased risk for several types of cancer, as well as autoimmune and cardiovascular disorders. As the influence of diet on vitamin D status is minimal and most circulating vitamin D is derived from exposure to sunlight, elderly populations are greatly affected; they have marked limitations that hinder their exposure to sunlight as well as their feeding and nutritional habits. Objectives of the study The aim of this study was to assess vitamin D status in Egyptian geriatric, homebound, nursing home residents, and ambulatory elderly individuals. Patients and methods This study was carried out on 90 elderly male and female individuals divided into three groups: the first group included 30 homebound elderly individuals, the second group included 30 elderly individuals living in nursing homes, and the third group included 30 community-dwelling ambulatory elderly individuals. Results There were high statistically significant difference in the vitamin D levels between the groups studied, being the highest in group III, 158 (18–240) nmol/l, and the lowest in group II, 16 (4–194) nmol/l. Statistically significant differences were found in sun exposure, with good exposure in 60% of the individuals in group III. There were also statistically significant differences in the intake of vitamin D in diet, with good intake in 64.30% of the individuals in group III. Also, we found the highest waist circumference in group II (98.68±20.73 cm). Vitamin D showed a significant positive correlation with serum calcium in group II (ρ=0.199) and a positive correlation with aspartate transaminase (AST) in group III (ρ=0.418). Conclusion Elderly Egyptian individuals in nursing houses are at risk of developing vitamin D deficiency because of lack of exposure to sunlight, dietary problems, and or central obesity.
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Study of the association of serum level of nesfatin-1 and diabetic kidney disease in patients with type 2 diabetes p. 59
Talaat Abd-Elaaty, Mohamed M Rezk, Hend H Abdel Moneium, Yasmine S Naga, Sara S Ghoniem
Background Nesfatin-1 is a newly found anorectic neuropeptide with potent metabolic regulatory effects, whose peripheral levels are shown to be elevated in diabetes. It is a newly discovered hypothalamic neuropeptide that regulates appetite. Its discovery has generated great interest in the scientific community because of its implication in energy and glucose homeostasis. Nesfatin-1 is an amino-acid peptide originating from the cleavage of nucleobindin2. It has a molecular weight of 9.8 kDa and the half-life of nucleobindin2 mRNA is ∼6 h. Interestingly, nesfatin-1 is also expressed in pancreatic β-cells, where it is localized with insulin in secretion vesicles. The structure of nesfatin-1 is also tripartite; the segment starting from the N-terminal end and going up to 23 amino acids is called N23, the middle segment covering the amino acids from 23 to 53 is called M30, and the segment from the 53rd to 82nd amino acids toward the carboxyl terminus is called C29. Objective We compared serum nesfatin-1 in patients with type 2 diabetes with evidence of diabetic kidney disease (DKD) [urinary albumin–creatinine ratio (UACR) >300 mg/day or reduced estimated glomerular filtration rate (eGFR) <60 ml/min] with patients newly diagnosed with type 2 diabetes and who had no evidence of DKD (UACR<30 mg/day) and a control group of healthy nondiabetic individuals. Patients and methods Ninety patients attending the outpatient clinics at Alexandria Main University Hospital and Alexandria Police Hospital, Egypt, were enrolled in this cross-sectional study to determine the association of serum level of nesfatin-1 and DKD in patients with type 2 diabetes. They were divided into three groups: group I included 30 type 2 diabetic patients with DKD. Group II included 30 type 2 diabetic patients without DKD. Group III included 30 nondiabetic healthy controls matched for age and sex with group I. Assessment included a thorough assessment of history, complete clinical examination, neurological examination, fundus examination, and laboratory investigations including metabolic profile and plasma nesfatin-1 by enzyme-linked immunosorbent assay. Results The study showed a statistically significant difference between the three studied groups in terms of age (P<0.001), HbA1c and fetal bovine serum (P≤0.001), fasting insulin level (P=0.022), blood urea (P<0.001), serum creatinine (P<0.001), eGFR (P<0.001), and UACR (P<0.001). The difference between the three groups studied was not significant in serum nesfatin-1 (P<0.564). The mean peripheral concentrations of nesfatin-1 were not significantly higher in patients with diabetes who had evidence of DKD compared with newly diagnosed type 2 diabetic patients who had no evidence of DKD (P<0.001). Conclusion Serum nesfatin-1 was not significantly higher in albuminuric type 2 diabetic patients compared with normoalbuminuric patients. Serum nesfatin also did not correlate with eGFR and creatinine in the different groups studied. Serum nesfatin-1 may not be useful as an early marker of DKD instead of albuminuria. More studies are needed to identify the role and the significance of nesfatin in diabetic patients.
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Anti-Mullerian hormone, a marker for metformin therapy efficacy in polycystic ovarian syndrome: a pilot study on an Egyptian population p. 68
Nermin Ahmed Sheriba, Mona M Abdelsalam, Bassem Mourad Mostafa, Madha Mamdouh, Samia Mohamed Eltohamy
Background Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy in adult women, and is emerging as a common cause of menstrual disturbance in the adolescent population. Insulin resistance, which is considered one of its underlying causes, has increased markedly in the past decade, placing more adolescent girls at risk for PCOS and its complications. Anti-Mullerian hormone (AMH) is secreted by the granulose cells of ovarian follicles and correlated with the count of small antral follicles and it is expressed throughout folliculogenesis. Objective This study aimed to evaluate AMH in Egyptian women with PCOS and to determine whether it might serve as a prognostic marker for treatment efficacy with metformin. Patients and methods This study included 30 women with PCOS (group 1) and 30 healthy women without PCOS (group 2). AMH was measured in both groups, and before and after treatment with metformin (2550 mg) for 3 months in group 1. Results AMH levels were higher in PCO groups before (3.54±0.58 ng/ml) and after treatment (2.79±0.39 ng/ml) than the control group (2.14±0.49 ng/ml), with P value less than 0.01. In the PCO group, it was higher before (3.54±0.58 ng/ml) than after treatment (2.79±0.39 ng/ml), with P value less than 0.01. Conclusion AMH is higher in PCO patients and its levels decrease significantly with the insulin sensitizer metformin, and it can be used as a marker for treatment efficacy with metformin.
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Effectiveness and safety of insulin glargine plus glimepiride after 6 months of treatment among patients with type 2 diabetes mellitus who failed premixed insulin: An observational study conducted in Egypt p. 75
Aly Abbassy, Ahmed Saad, Abbas Oraby
Objective This study aimed to evaluate the effectiveness and safety of insulin glargine in combination with glimepiride treatment in daily practice in patients who failed premixed insulin with or without oral antidiabetic (OAD) regimen. Patients and methods This 6-month, prospective, multicenter, observational study conducted in Egypt included adult patients with type 2 diabetes mellitus on premix with or without OAD (glimepiride plus metformin), with glycated hemoglobin (HbA1c) greater than 8.5% and for whom the investigator decided to switch to insulin glargine in addition to glimepiride. Overall, three mandatory visits (baseline, 3 months, and 6 months) and seven phone calls were performed by the investigator for each eligible patient. Patients were assessed according to the value of HbA1c and fasting blood glucose (FBG). Results At the end of this study, the results showed effectiveness of combining insulin glargine plus glimepiride in reducing the mean baseline level of HbA1c% by 1.79 and 2.5% at visit 2 (week 12) and visit 3 (week 24), respectively (P<0.001). The percentage of patients reaching target HbA1c less than 7% in visit 2 (week 12) and visit 3 (week 24) was 5 and 24.3%, respectively. They also showed a significant reduction (P<0.001) in the mean FBG at visit 2 (week 12) and visit 3 (week 24) of 97.44 and 104.4 mg/dl, respectively, whereas the mean percent reductions were 44.37 and 47.54%, respectively. The percentage of patients who reaching FBG less than or equal to 100 mg/dl was 26.7 and 32.2%, in visit 2 (week 12) and visit 3 (week 24), respectively. There was no significant change in mean body weight between baseline and visit 3 (P>0.05). The mean 2-h postprandial blood glucose level was decreased significantly (P<0.001) at visit 2 to 171.93±68.2 mg/dl and at visit 3 to 155.88±56.61 mg/dl. The mean reductions of 2-h postprandial blood glucose at weeks 12 and 24 were 140.8 and 156.8 mg/dl, respectively, and the mean percentage reductions were 45 and 50.1%, respectively. A total of 50 adverse events were reported by 41 patients during the study. The most frequently reported adverse event was hypoglycemia, which included 37 episodes reported by 31 patients, where nocturnal hypoglycemia was represented in 12 episodes, with percentage of 32.4%. Conclusion The results showed that a combination therapy of insulin glargine and glimepiride improved glycemic control in patients with type 2 diabetes mellitus, who failed premixed with or without OAD (glimepiride plus metformin). In addition, safety analysis showed high patient tolerability to glargine and glimepiride regimen.
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