الفهرس 
DIABETES MELLITUSOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is a group of metabolic disorders of
carbohydrate metabolism, producing hyperglycemia. The chronic
hyperglycemia of diabetes is associated with long-term damage,
dysfunction and failure of various organs. Type II diabetes is the
most prevalent form of diabetes worldwide and account for 90%
of cases globally.
The metabolic syndrome is a constellation of several
metabolic derangements that is often associated with cardiovascular
morbidity and mortality. It is characterized by the
presence of central obesity, glucose intolerance, hypertension,
dyslipidemia, prothrombotic state and proinflammatory state.
Low grade inflammation has been associated with central
obesity, cardiometabolic and type II DM. Adipokines have diverse
autocrine, paracrine and endocrine actions and have been
implicated in the pathogenesis of MS and cardiovascular diseases.
The concept that heightened inflammation is important in the
pathogenesis of type II DM is supported by evidence that
inflammation in islets, adipose tissue, liver and muscles may
provoke insulin resistance and β-cell dysfunction and may
therefore antedate the diagnosis of diabetes.
Chemerin is an adipokine secreted mainly from adipose
tissue. It contributes to the pathophysiology of insulin resistance
by its reversible bindingto the extracellular domain of insulin
receptor-tyrosine kinasein peripheral tissues and decreasing the
rate of autophosphorylationand subsequent downstream intracellular
signaling cascades.
SUMMARY AND CONCLUSION
151
Other adipokines associated with MS and insulin resistance
include the circulating inflammatory markers TNF-α and IL-6,
where the effect of these adipokines on MS and type II DM seems
to stem from the influence of a combination of adipokines rather
than from the effect of a single adipokine.
The present study was conducted to evaluate the level of
some inflammatory chemokines such as chemerin, TNF-α and IL-
6 and detect their implication in diagnosis, prognosis and severity
of MS and type II DM as well as their role in obesity. This work
was conducted on a total of 56 male subjects aged (32-60) years,
40 patients; 20 non-diabetic metabolic syndrome patients and 20
non-metabolic syndrome patients with overt type II diabetes
mellitus, their results were compared with those of 16 healthy
controls.
On assessment of the different studied parameters, the
clinical characteristics revealed that WC showed a highly
significant elevation in MS group and Type II DM group when
compared to control group. Also, SBP was significantly increased
in MS group compared to both Type II DM group and control
group.
Blood parameters results revealed that the FBS and PPBS
showed a highly significant elevation in Type II DM group when
compared to both MS group and control group. In addition,
HOMA-IR was significantly increased in Type II DM group when
compared to control group. Moreover, HbA1C and fasting insulin
were significantly increased in Type II DM group when compared
to control group. Also, serum TG showed a highly significant
SUMMARY AND CONCLUSION
152
elevation in MS group when compared to both Type II DM group
and control group. A significant increase was shown in serum
total cholesterol and HDL-C in MS group when compared to both
Type II DM group and control group. Serum LDL-C was
significantly increased in MS group compared to Type II DM
group. Furthermore, CAD-risk showed a highly significant
decrease in group2 (MS group) when compared to both Type II
DM group and control group.
Moreover, the results revealed that serum TNF-α was
significantly increased in MS group and Type II DM group when
compared to control group. In addition, serum chemerin and IL-6
were significantly increased in MS group when compared to Type
II DM group and control group.
The correlation of the present study between serum chemerin
level and other studied parameters revealed that there was a
significant negative correlation between serum chemerin level and
both HDL-C and CAD-risk. Moreover, a significant positive
correlation was found between serum chemerin levels and each of
SBP, DBS, LDL-C, TG, total cholesterol and WC.
Furthermore, we evaluated the diagnostic performance of
serum chemerin in the metabolic syndrome to find that the best
cutoff was 125 ng/ml, with an 80% diagnostic sensitivity and a
100% diagnostic specificity. Area under curve was calculated
through a ROC curve and found to be 1.00.
Moreover, we evaluated the diagnostic performance of
serum chemerin in type II DM to find that the best cutoff was 71
ng/ml, with an 90% diagnostic sensitivity and a 56.25%
diagnostic specificity. Area under curve was calculated through a
ROC curve and found to be 0.739.
Also, the diagnostic performance of serum TNF-α in both
metabolic syndrome and type II DM was evaluated, to find that
the best cutoff for both diseases was 15.4 pg/ml with an 100%
diagnostic sensitivity and a 100% diagnostic specificity. Area
under curve was calculated through a ROC curve and found to be
1.00.
In addition, we evaluated the diagnostic performance of
serum IL-6 in the metabolic syndrome to find that the best cutoff
was 3.2 pg/ml, with an 75% diagnostic sensitivity and a 56%
diagnostic specificity. Area under curve was calculated through a
ROC curve and found to be 0.697.
Furthermore, we evaluated the diagnostic performance of
serum IL-6 in type II DM to find that the best cutoff was 3.2
pg/ml, with an 75% diagnostic sensitivity and a 56% diagnostic
specificity. Area under curve was calculated through a ROC curve
and found to be 0.697.
In conclusion, high serum TNF-α and chemerin levels were
strongly associated with MS disorders and Type II DM and
assessment of their levels could be beneficial in diagnosis, early
detection and prevention of these pathological states and their
unfavorable consequences especially the cardiovascular complications
and atherosclerosis. Hence, this study introduces serum
TNF-α and serum chemerin as a novel markers for diagnosis of
the metabolic syndrome to be added to the panel of laboratory
parameters of this metabolic abnormali