| Background: Antioxidant potential decreases while plasma lipid peroxidation
products increase in type1 diabetes mellitus. The vascular endothelium is a
major target of oxidative stress (OS). Reactive oxygen species signal events
leading to impairment of endothelial function and promotion of leukocyte
adhesion to the vascular endothelium.. Objective: To explore the relation
between OS and adhesion molecules in type1 diabetes and correlate it with the
state of metabolic control, disease duration and microvascular complications
(MVCs). Design: Thirty-eight type 1 diabetics were included: 22 patients with
disease duration less than 5 years and 16 patients with duration of 5 years or
more. Thirty healthy age and sex matched subjects served as controls. They
were assessed clinically. Laboratory investigations included, random blood
sugar (RBS), glycated hemoglobin (HbA1c), fasting lipid profile and
measurement of serum malondialdehyde (MDA) as a marker of lipid
peroxidation and serum soluble P-selectin as a marker of endothelial/platelet
activation. Results: Serum MDA and P-selectin were significantly elevated in
type 1 diabetics compared to controls with the highest level in diabetics with
disease duration of 5 years or more (p < 0.0001). Both MDA and P-selectin
levels were significantly elevated in complicated compared to non complicated
diabetics (P<0.0001) with strong relation to complication severity. Serum MDA
level was positively correlated with serum P-selectin level in diabetics (p
<0.0001). Serum MDA and P-selectin were positively and significantly
correlated with disease duration (p<0.0001 ), RBS (p<0.0001,p=0.001
respectively), HbA1c (p<0.0001), diastolic blood pressure (p=0.03,p=0.005
respectively), total cholesterol (p=0.04,p=0.02, respectively), triglycerides
(p=0.006, p<0.0001 respectively) and low density lipoproteins (p=0.03,p=0.05
respectively) but negatively correlated with high density lipoproteins(p=0.03).
On multiple regression analysis, HbA1c had the strongest effect on both MDA
and P-selectin levels (P<0.0001). Cut off values for serum MDA and Pselectin
equal to 8.035 nmoles/ml and 45.15ng/dl respectively for early
detection of diabetic MVCs were defined. Conclusion: Levels of MAD and
P-selectin are elevated in type1 diabetics with evident relation to disease
duration, metabolic control and severity of MVCs. Hence both of them might
act as good markers to identify diabetics who are more susceptible to
develop vascular disease. |