الفهرس 
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Abstract
The global prevalence of diabetes mellitus is rapidly increasing as a result of population
ageing, urbanization and associated lifestyle changes. The number of people with diabetes
mellitus worldwide has more than doubled over the past three decades. Type 2 diabetes mellitus
(T2DM) represents 90% of total cases of diabetes. The number of people globally with diabetes
mellitus is projected to rise to 439 million by 2030, which represents 7.7% of the total adult
population of the world aged from 20–79 year. Genetic and epigenetic predispositions have an
important role in the T2DM epidemic. Many studies showed the potential effect on global
diabetes surveillance of the use of other parameters HbA1c, HOMA –IR and genetic
polymorphisms rather than glucose values as an alternative diagnostic and prognostic
approaches.
The present study investigates:-
The presence of three polymorphisms and the activity of some neuorotansmitter controlling
enzymes and insulin resistance in type 2 diabetes mellitus.
The three genes polymorphisms are:
Angiotensinconverting enzyme gene (rs4646994) polymorphism
Calpain 10 gene SNP-19 polymorphism
Glutathione S-transferase gene(GSTT1) polymorphism
The neuorotansmitter controlling enzymes are:
1- Plasma cholinesterase (pChE) which hydrolyses acetyl choline an important neurotransmitter
which relaxes blood vessels.
2- Monoamine oxidase A ( MAO-A) which hydrolyses monoamines such as serotonin another
important neurotransmitter which affects the psychological state and has a vasoconstrictor
effect.
The aim of this study is to investigate the relations between polymorphism of angiotensin
converting enzyme (ACE), Calpain 10 (CAPN10) and glutathione S-transferase (GST) and
the activity of some neuorotansmitter controlling enzymes, cholinesterase (pChE) and
monoamine oxidase (MAO) in plasma and their association with insulin resistance in type 2
diabetes mellitus.
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The study included the determination of:
A- Body mass index, lipid profile, fasting blood glucose, insulin, HOMA-IR and complete blood
count.
B- Plasma cholinesterase, monoamine oxidase in plasma.
C- Angiotensin converting enzyme gene polymorphism (rs4646994), Calpain 10 gene SNP-19
polymorphism, Glutathione S-transferase gene(GSTT1) polymorphism.
The present study was conducted on 72 essential type 2 diabetic patients (36 patients receiving
insulin and the other 36 receiving oral hypoglycemic agent) they were recruited from the
outpatient clinic of the Internal Medicine Department in the Medical Research Institute,
Alexandria University. And Control subjects: comprising 36 healthy, age-matched subjects as
the case subjects. .
The results indicated that: .
1- GST polymorphism (GSTT1 null genotype) incidence was increased in type 2 diabetic
patients compared to control group.
2- Angiotensin converting enzyme gene polymorphism (rs4646994) insertion /inserion genotype
and insertion allele incidences were significantly increased in type 2 diabetic patients
compared to control group.
3- Calpain 10 gene SNP-19 polymorphism incidence has no significant difference between type
2 diabetic patients and control group.
4- There was a significant increase in the activity of plasma cholinesterase in type 2 diabetic
patients compared to control group.
5- There was a significant increase in the activity of plasma monoamine oxidase in type 2
diabetic patients compared to control group.
6- There was a significant increase in FBG, fasting insulin and HOMA –IR in type 2 diabetic
Patients compared to control group.
7- There was a significant increase in HbA1c in type 2 diabetic patients compared to control
group.
8- There was a significant increase in TG in type 2 diabetic patients compared to control group.
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9- There was a significant increase in BMI in type 2 diabetic patients compared to control group.
10- HOMA –IR, FBG, insulin, HbA1c and TG were significantly increased in T2DM patients
receiving insulin subgroup Ib compared to T2DM patients receiving oral hypoglycemic agents
subgroup Ia and they were increased in the two groups compared to the control group.