Adrenomedullin In Type 2 Diabetics

Diabetes Mellitus is a common disease with major global public health consequences. The pathophysiology of type II diabetes, the most common type of diabetes is unclear, but appears to be multi-factorial. DM is characterized by longstanding complications induding retinopathy, nephropathy and neuropathy all of which are closely related to vascular damage Human adrenomedullin (AM) is an identified 52-amino acid peptide that was originally isolated from an extract of pheochromocytoma tissue. Objective: To study the possible relation between plasma adrenomedullin level to pathogenesis, metabolic control and vascular complications in type 2 diabetics. Subjects and methods: This study included a total number of 85 subjects divided into 4 groups: Control group (GI): This group included 11 healthy volunteers (7 females and 4 males). Their ages ranged between 36- 55 years with mean value  SD of (44.2  6.8) years. Group II (GII): Newly diagnosed type 2 D. M (without apparent complications). This group included 20 patients with newly diagnosed type 2D.M (7 males and 13 females). Their ages had ranged between 36- 48 years with a mean value  SD of (40.7  3.6) years. Group III (GIII): Old standing type 2 D.M with microvascular complications This group included 30 patients with type 2 D.M. (16 males and 14 females), their ages ranged between 41- 63 years with a mean value  SD of (5.8 6) years. The duration of their diabetes ranged 4-19 years with mean value DS of (10.64.1) years. Group III: were further subdivided into: IIIA: Included 7 patients with retinopathy. IIIB: 7 patients with neuropathy. IIIC: 6 patients with nephropathy. IIID: Mixed group included 6 patients with retinopathy plus neuropathy and 4 patients with nephropathy, retinopathy plus neuropathy. Group IV (GIV): old standing type 2 D. M: with macrovascular complication: This group included 24 patients with type 2 D.M (14 males and 10 females) with age ranged between 40-61 years with a mean value  SD of (49.7  6.3) years. The duration of their diabetes ranged 3-15 years with mean value SD of (7.6 3.7). This group was further subdivided into: IVA: included 7 patients with CAD (5 MI and 2 unstable angina). IVB: included 4 patients with CVD. IVC: included 4 patients with PAD, 2 of them had diabetic foot ulcer. IVD: Mixed group included 5 patients with MI plus CVD and 4 patients with MI plus PAD. Results: FBG, PPG, HBA1c, S.creatinine, Blood pressure were higher in cases than control. Plasma addrenomedullin levels were higher in all diabetic patient compared with control and were higher in microvacular complications group than other groups. Among micrvascular complications group, patient with diabetic nephropathy had the highest median level of serum adrenomedullin followed by patients with diabetic retinopathy and nephropathy. There was strong positive correlation of AM with metabolic control parameters of diabetes (FBG, PPG and HBA1c). Among all diabetic groups. Conclusion: Plasma adrenomedullin levels are higher in diabetics than healthy subjects. Plasma adrenomedullin levels are higher with poorly controlled diabetics. Elevated plasma adrenomedullin dependant on the presence of vascular complication. The relation of AM with pathogenesis of type 2 diabetes not decoumnted. Elevated AM level may serve a protective role in diabetic angiopathy by dilating the vessels and lessening ischaemia in organs affected by diabetic angiopathy.