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Summary and conclusionInsulin resistance describes a condition that is characterised by decrease tissue sensitivity to the action of insulin, leading to a compensatory increase in insulin secretion. Most people with insulin resistance are able to secrete enough insulin to maintain non diabetic glucose levels, some of these people will go on to develop overt type 2 diabetes . The metabolic syndrome is a cluster of closely associated and interdependent abnormalities, including insulin resistance, compensatory hyperinsulinemia, hyperuricemia, and predisposes individuals to type 2 diabetes, hypertension and coronary heart disease.Iron is both essential mineral nutrient . Age and sex -related increase in iron stores have been implicated in pathogenisis of several common diseases including atherosclerosis and diabetes.This study was planned to study firstly any change in serum ferritin level in some groups of patients with insulin resistance, (namely frank type 2 diabetics, obese first degree relatives of type 2 D M and patients with end stage renal disease (ESRD). Secondly to find out any relation between serum ferritin level and each of the state , degree of insulin resistance and to the presence of complication in these groups. Thirdly, to find out any relation between serum ferritin level and degree of atherosclerosis associated with insulin resistance states. lastly to test effect of retrograde parenteral iron administration in some patients ( anemia in CRF)on iron storage and the insulin resistance .The present study included a total number of 80 volunteer subjects, they were divided into the following groups;Group I:included 20 healty volunteers(10male and 10 female).Group II: included a total number of 60 highly susceptible insulin resistant subjects as follow :A)GroupIIA: included 20 obese subjects(10 hypertensive and 10 normotensive).B) Group II B: included 20 type2 diabetics subjects (10 with complication and 10 without complication).C) GroupIIC:included20 chronic renal failure subjects(10patients receivced iv iron therapy and 10 patients didnot receivce iv iron therapy).All subjects of the study were subjected to the following;Full history and thorough clinical examination, Complete blood picture , liver function tests , kidney function tests ,E.S.R, C- reactive protein ,fasting and two hours post prandial blood glucose, resting 12 leads electrocardiographic tracing,pelviabdominal ultrasonogrphy,measurment of fasting insulin by radioimmunoassay (?U/mL),measurement of insulin resistance(HOMA%) .In addition to anthropometric measurements(BMI, WHR, Waist circumference) , measurment of lipid profile, glycosylated hemoglobin, serum ferritin level and ultrasonographic measurement of carotid intima- media thickness (CA-IMT).The following results were obtained :? Significant increase in serum ferritin in insulin resistant subjects as a whole as compared to healthy control group I and significant positive correlation between serum ferritin versus each of fasting insulin and homa% in all insulin resistant subjects.? Significant increase in serum ferritin in the diabetics subgroup as compared to both obese and chronic renal failure subgroups and significant positive correlation between serum ferritin versus each of fasting insulin and homa% in each of diabetics , obese and chronic renal failure (CRF) subgroups separatly.? Significant increase in serum ferritin, serum glucose,HbA1c, fasting serum insulin and homa% in (IR)complicated diabetics as compared to non complicated subgroups.? Significant increase in serum ferritin,serum insulin and homa% in(IR) obese hypertensive as compared to normotensive, and significant positive correlation between serum ferritin versus mean arterial pressure and waist circumference in the all obese subgroup.? Significant increase in serum ferritin, serum insulin and homa% in(IR) CRF received iron as compared to CRF did not receive iron .? Significant increase in carotid artery intimal median thickness (CAIMT) in in insulin resistant subjects as a whole as compared to control group I, also in the diabetics subgroup as compared to both obese and chronic renal failure subgroups and significant positive correlation between CAIMT versus each of serum ferritin, fasting insulin and homa% in all insulin resistant subjects? Significant positive correlation between serum ferritin versus serum cholesterol, triglyceride and LDL-C in all insulin resistant subjects, but no significant correlation versus HDL-C in this group.Conclusion:It can be concluded that serum ferritin was elevated in insulin resistant states , this elevated serum ferritin may play a role in the pathogenesis of insulin resistance and the elevated serum ferritin may be considered a component of insulin resistance syndrome. The degree of both insulin resistance and atherosclerosis were proportional with serum ferritin . Elevated iron storage can be linked to complication and control of type 2 diabetes. ,also it may be implicated in the development of hypertesion and atherogenesis .Recommendations:1- Iron and insulin resistance interrelation ship should be tested in large-scale clinical trials, searching for the level of serum iron storage parameters (for age and sex) beyond it,toxicity of iron occures.2- Study usefulness and cost-effectiveness of therapeutic measures that decrease iron toxicity and in treating diabetes complications3- Study role of mild and sever chronic infection related changes in serum ferritin and its refliction on insulin resistance.4-Parenteral iron should be guided by serum iron storage parameters and not by the company schadule.
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