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Abstract
Diabetes Mellitus :-is a syndrome of disturbed energy homeostasis caused by deficiency of insulin or of its action and resulting in abnormal metabolism of carbohydrate, protein and fat. Diabetes is characterized by long-term complications including nephropathy, retinopathy and neuropathy, all of which are closely related to vascular damage. (Martinez, et al., 1996)
Well controlled diabetes prevents the occurrence of microvascular complications. (DCCT research group, 1993)
Microangiopathy is widely considered a chronic inflammatory disease and Diabetes Mellitus is an important risk factor for occurrence. Inflammatory activity in individuals with Type I Diabetes Mellitus may be due to hyperglycemia and formation of glycation end product. (Stamler et al., 1993)
Progressive vascular disease is characteristic of Diabetes Mellitus. Microvascular complications of Diabetes Mellitus have complex pathogenesis involving dysfunction and damage to vascular endothelial cells. Vascular endothelial cells are sensitive to stimulatory factors such as hyperglycemia , oxidative stress and advanced glycation endproduct .Association between inflammatory activity and endothelial dysfunction thought to play important role to develop Microvacular complications of Type I Diabetes Mellitus. (Sernau T et al.,1995)
It is well known that type I Diabetes Mellitus is a T-cell dependant autoimmune disease result in selective destruction of beta cell of Largerhans with subsequent programmed cell death i.e. Apoptosis. Tumor necrosis factor-alpha (TNF-?) is involved in apoptotic pathways that are implicated in beta cell destruction. (Ratter et al,.1999)
The Aim of the Work :-
To estimate tumor necrosis factor-alpha (TNF-?) in type I diabetes mellitus patients with and without microvacuolar complications and to evaluate if it has any relation to glycemic control .
Methods:-
Fifty (50) type I diabetic patients and twenty –five (25) healthy individuals as controls .
The participant will be divided into 3 groups :
- Group ? :25 healthy individuals of comparable age and sex as control group
- Group ?:25 patients with type I Diabetes Mellitus with duration of disease less than 5 years
- Group ?: 25 patients with type |I Diabetes Mellitus with duration of disease more than 5 years
All patients and controls will be subjected to laying stress on duration of Diabetes, history of any symptoms suggestive of complication, method of intake of insulin and full clinical examination including BP and fundus examination will be done.
And the following parameters will be evaluated :
• lipid profile including TG, cholesterol , HDL&LDL
• glycosylated Hemoglobin.
• Serum creatinine & BUN
• Micro Albuminuria
• Plasma Tumor necrosis factor alfa by ELISA.