الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is one of the most common metabolic disorders characterized by chronic hyperglycemia which causes acute and chronic complications by various pathologic pathways.
It affects almost 6% of the world’s population and it is expected that the number of people with DM will double by 2025 which makes it a great health and economic burden.
Chronic complications of DM are divided into macrovascular complications (ischaemic heart disease, cerebrovascular disease and peripheral vascular disease) and microvascular complications(retinopathy, nephropathy and neuropathy).
Diabetic peripheral arterial disease is the most common cause of non-traumatic lower limb amputation. Of all the late complications of diabetes, foot problems are probably the most preventable. Thus, Joslin, who wrote in 1934 that “diabetic gangrene is not heaven-sent, but earth-born” was correct as the development of foot ulceration mostly results from the way we care for our patients or the way patients care for themselve .
Diabetic nephropathy is the leading cause of end-stage renal disease. About 30-40% of type 1 DM patients and 15-20% of type 2 DM patients develop clinical renal disease.
Recent studies were done on various biomarkers to identify patients with type 2 DM at high risk for macro- and microvascular complications. Most of these biomarkers showed large variations in risk prediction depending on metabolic status and disease severity of the study groups. Recently published data imply, that most novel biomarkers do not improve risk prediction when added to models based on conventional risk scores . Yet, associations of novel biomarkers such as fetuin-A with metabolic markers or complications do help to understand their role in the pathophysiology of vascular disease.
The aim of our study was to evaluate the association of plasma fetuin-A and type 2 diabetes mellitus with and without macrovascular complication (as peripheral arterial disease (PAD)) and microvascular complication (as diabetic nephropathy).,also in PAD without diabetes mellitus to understand Fetuin-A role in the pathophysiology of vascular disease as an inhibitor of vascular calcification and a mediator of insulin resistance.
The study included 75 patients: 20 patients have diabetes with PAD without nephropathy, 15 patients have diabetes with nephropathy (10 microalbuminuria & 5macroalbuminuria) without PAD, 20 patients have diabetes without any complication, 10 patients have PAD without diabetes and 10 healthy control subjects.
Our study showed that there is no statistically significant association between plasma fetuin-A level and all 5 groups, with lowest plasma levels noticed in groups (group B2) (diabetic with macroalbuminuria) and (group D) (PAD).
Limitations of the study:
1. High expense of the study.
2. Difficulty to find diabetic patients with macroalbuminuria.
3. Poor patient cooperation.
4. Small number of patients.