STUDY OF SOLUBLE VASCULAR CELL ADHESION MOLECULE-1 IN TYPE 2 DIABETES MELLITUS WITH CERTAIN MICROVASCULAR COMPLICATIONS

SUMMARY AND CONCLUSIONThis work was carried out in the Internal Medicine, Clinical Pathology, Rheumatology and Ophthalmology Departments of Zagazig University Hospital in the period from May 2002 to August 2004.The work was designed to study the soluble vascular cell adhesion molecule-1 in type 2 diabetes mellitus with certain microvascular complications.The study was carried out on 3 groups of subjects: 1) Group (I) consisted of 10 apparently healthy subjects, their age ranged from 46 to 66 years with mean ageSD of 536.6 years, 2) Group (II) consisted of 20 patients with type 2 DM without microvascular complications, their age ranged from 47 to 71 years with the mean ageSD of 567.5 years and 3) Group (III) consisted of 40 patients with type 2 DM with microvascular complications, their age ranged from 46 to 73 years with the mean age  SD of 588.2 years.All subjects were subjected to:1- Thorough clinical examination.2- Laboratory investigations:- Complete blood picture.- Erythrocyte sedimentation rate (ESR).- Blood urea and serum creatinine.- Creatinine clearance.- Liver function tests.- Fasting and postprandial blood sugar.- HbA1C.- Serum total cholesterol and serum triglyceride.- Simple mid stream urine analysis- 24 hour urinary protein.3- Resting 12 leads ECG.4- Radiological examination:- Pelviabdominal ultrasound.- Chest X ray.5- Specific investigations:- Fundus examination with coloured fundus photography.- Nerve conduction velocity.- Serum sVCAM-1 level.The results were statistically analysed and the following findings has been obtained:- HbA1C: Was significantly higher in diabetics compared to controls and significantly higher in diabetic patients with microvascular complications compared to diabetic patients without microvascular complications.- Creatinine clearance: There was no significant difference between the three groups of the study.- Serum triglyceride: Was significantly higher in diabetics compared to control group and significantly higher in diabetic patients with microvascular complications compared to diabetic patients without microvascular complications.- Serum cholesterol: There was no significant difference between the three groups of the study.- Serum sVCAM-1:a- Was significantly higher in diabetic patients compared to control group and significantly higher in diabetics with microvascular complications than those without microvascular complications.b- Was significantly higher in diabetics with 3 microvascular complications compared to diabetics with 2 or l microvascular complications and significantly higher in diabetics with 2 microvascular complications compared to diabetics with 1 microvascular complication.c- Was significantly higher in diabetics with neuropathy compared to diabetics without neuropathy.d- Was significantly higher in diabetics with retinopathy compared to diabetics without retinopathy and significantly higher in diabetics with proliferative retinopathy than those with non proliferative retinopathy.e- Was significantly higher in diabetics with albuminuria than those without albuminuria and significantly higher in diabetics with macroalbuminuria compared to diabetics with microalbuminuria.f- Had highly significant positive correlation with number of microvascular complications, known diabetes duration and serum triglyceride level.It can be concluded that sVCAM-1 level is significantly high in type 2 diabetics especially those with microvascular complications compared to diabetics without microvascular complications. Moreover sVCAM-1 increase with progression of microvascular disease. This conclusion may be attributed to endothelial dysfunction and may suggest a possible role of sVCAM-1 in the pathogenesis of initiation and/or progression of microvascular complications and could be used as a marker of early and preclinical diabetic microvascular complications and/or its progression.Further studies are recommended to find out the role of anti VCAM.1 therapy in prevention or control of microvascular complications of diabetes. Also, more efforts and further clinical trials to develop specific antagonists for adhesion molecules are recommended as it holds great promise in both diagnostic and therapeutic implications in various diabetic microvascular complications.