Relation between early stages of diabetic retinopathy and early stages of diabetic kidney disease in patients with type 2 diabetes in Egypt

Background. Diabetes mellitus is a pandemic disease. Type 2 diabetes (T2DM) is the most common type. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are disabling chronic complications. The relation between both is not yet well-established in T2DM. Egypt is considered one of the top ten countries re- garding the prevalence of diabetes that makes diabetes and its complications a major health problem. This encouraged us to conduct this research.  Materials and methods. The study included 79 patients with T2DM divided into two groups according to the presence of retinopathy. Both groups were subdivided according to urinary albumin to creatinine ratio (UACR) into normoalbuminuric and albuminuric subgroups. Retinopathy group was further subdivided according to severity of retinopathy into mild, moderate and severe non-proliferative DR (NPDR). Statistical analysis was done and relation between the severity of retinopathy and UACR was studied.  Results. Patients with retinopathy had significantly higher diabetes duration and UACR than non retinopathy group. Also in subgroups of normoalbuminuria and albuminuria, retinopathy group was significantly higher regarding the same parameters. On subdividing the retinopathy group according to severity, severe NPDR group had significantly higher UACR. The severity of DR was significantly positively correlated with UACR.  Conclusions. The present study identified a significantly positive correlation between early stages of DR and UACR in patients with T2DM in Egypt. Not all cases of DR had DKD especially in early stages and also not all cases of DKD are associated with the presence of DR in T2DM.   Background. Diabetes mellitus is a pandemic disease. Type 2 diabetes (T2DM) is the most common type. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are disabling chronic complications. The relation between both is not yet well-established in T2DM. Egypt is considered one of the top ten countries re- garding the prevalence of diabetes that makes diabetes and its complications a major health problem. This encouraged us to conduct this research.  Materials and methods. The study included 79 patients with T2DM divided into two groups according to the presence of retinopathy. Both groups were subdivided according to urinary albumin to creatinine ratio (UACR) into normoalbuminuric and albuminuric subgroups. Retinopathy group was further subdivided according to severity of retinopathy into mild, moderate and severe non-proliferative DR (NPDR). Statistical analysis was done and relation between the severity of retinopathy and UACR was studied.  Results. Patients with retinopathy had significantly higher diabetes duration and UACR than non retinopathy group. Also in subgroups of normoalbuminuria and albuminuria, retinopathy group was significantly higher regarding the same parameters. On subdividing the retinopathy group according to severity, severe NPDR group had significantly higher UACR. The severity of DR was significantly positively correlated with UACR.  Conclusions. The present study identified a significantly positive correlation between early stages of DR and UACR in patients with T2DM in Egypt. Not all cases of DR had DKD especially in early stages and also not all cases of DKD are associated with the presence of DR in T2DM. 

Study of the Relationship between Serum Asprosin, Endothelial Dysfunction and Insulin Resistance

Background: Until now, the relationship between asprosin and soluble E-selectin (sE-selectin) as well as the role of asprosin in diabetes are still unclear. This work aimed to assess the relationship between fasting serum asprosin and markers of endothelial dysfunction and metabolic parameters, namely, sE-selectin, fasting insulin, fasting plasma glucose (FPG), HOmeostatic Model Assesment – Insulin Resistance (HOMA-IR), fasting lipid profile, and glycated hemoglobin (HbA1c) among people with different spectra of glycemia including normal subjects, impaired glucose tolerance (IGR), and subjects with type 2 diabetes mellitus (T2DM). Methods: Ninety subjects were recruited and divided according to the American Diabetes Association (ADA) diagnostic criteria into three groups; subjects with type 2 diabetes mellitus (n = 30), subjects with impaired glucose resistance (n = 30), and control subjects (n = 30). All groups were subjected to thorough history taking, physical examination, and laboratory investigation, involving fasting asprosin, sE-selectin, and HOMA-IR. Results: The univariate analysis showed a significant positive correlation between asprosin and glycemic parameters, insulin resistance, obesity parameters, and endothelial dysfunction in the three groups. However, multivariate analysis showed that triglycerides and sE-selectin are the most independent factors affecting asprosin. Univariate analysis for parameters affecting sE-selectin showed that asprosin is significantly correlated with sE-selectin, and multivariate analysis revealed that asprosin was the most independent factor affecting sE-selectin. Conclusions: Our study showed a significant positive correlation between asprosin, glucose dysregulation, insulin resistance, and endothelial dysfunction

Zależność między wczesnymi stadiami retinopatii cukrzycowej a wczesnymi stadiami cukrzycowej choroby nerek u chorych na cukrzycę typu 2 w Egipcie

Wstęp. Cukrzyca jest chorobą uważaną za pandemię. Najczęstszą postać stanowi cukrzyca typu 2 (T2DM). Retinopatia cukrzycowa (DR) i cukrzycowa choroba nerek (DKD) to przewlekłe powikłania cukrzycy, prowadzące do niepełnosprawności. Dotychczas nie ustalono dokładnie, jakie relacje występują między tymi powikłaniami w T2DM. Egipt jest jednym z dziesięciu państw o największej częstości występowania cukrzycy, co sprawia, że choroba ta i jej powikłania stanowią poważny problem zdrowotny. To skłoniło autorów do przeprowadzenia niniejszego badania.  Metody. Do badania włączono 79 chorych na T2DM, których podzielono na dwie grupy w zależności od obecności retinopatii. Obie grupy podzielono dodatkowo w zależności od wartości współczynnika albumina/ /kreatynina (UACR) na podgrupę z normoalbuminurią i podgrupę z albuminurią. W grupie z retinopatią wydzielono dodatkowo w odniesieniu do ciężkości retinopatii trzy podgrupy: z łagodną, umiarkowaną i ciężką nieproliferacyjną DR (NPDR). Wykonano analizy statystyczne i oceniono zależności między ciężkością retinopatii a UACR.  Wyniki. U chorych z retinopatią czas trwania cukrzycy był istotnie dłuższy, a wskaźnik UACR istotnie wyższy niż w grupie bez retinopatii. Także w podgrupach z normoalbuminurią i albuminurią u osób z retinopatią stwierdzono wyższe wartości tych parametrów. Po podzieleniu grupy chorych z retinopatią ze względu na jej ciężkość stwierdzono, że w podgrupie z ciężką NPDR wskaźnik UACR był istotnie wyższy. Stwierdzono istotną dodatnią korelację między ciężkością DR a UACR.  Wnioski. W przedstawionym badaniu wykazano istotną dodatnią korelację między wczesnymi stadiami DR i UACR u chorych na T2DM w Egipcie. Nie u wszystkich chorych z DR występowała DKD, zwłaszcza we wczesnych stadiach. Z kolei nie wszystkie przypadki DKD były związane z obecnością DR w przebiegu T2DM.