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18
VOLUME 9 NUMBER 1 • MARCH 2012
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
to our results to test the hypothesis of a linear relation between
the studied variables within the same group. A
p
-value < 0.05 was
considered statistically significant.
Results
The mean age of all females participating in this study was
comparable. The duration of diabetes mellitus in the females suffering
from vascular complications was significantly higher than those not
suffering from vascular complications, indicating that the process of
development of vascular complications in diabetes is determined by
the duration of exposure to uncontrolled hyperglycaemia.
The types of vascular complications in the diabetic females
were mostly microvascular complications, namely nephropathy
(90%), retinopathy (63%) and neuropathy (57%), followed by
macrovascular complications, namely cardiovascular disease (47%),
peripheral vascular disease (27%) and cerebrovascular disease
(13%). The carotid intima–media thickness (CIMT), which monitors
the degree of atherosclerosis, was significantly higher in the group
presenting with vascular complications when compared to both the
control group and those without vascular complications (Table 1).
The mean value of the albumin-to-creatinine ratio (ACR) in
the diabetic females with vascular complications was significantly
higher than the mean ACR values in both the diabetic females
without vascular complications and the control group (Table 2).
Plasma glucose, reflecting momentary changes in glycaemic
status and whole blood glycated haemoglobin (HbA
1c
), reflecting
long-term monitoring of glycaemic control, were significantly
higher in both groups of diabetic females compared to the control
group, and even more elevated in those with vascular complications
compared to those without complications. Urea and creatinine,
although showing some significant differences between the groups,
were within the reported safe reference intervals.
The lipid profile in the three groups demonstrated significantly
higher mean values of total cholesterol, low-density lipoprotein
cholesterol and triglycerides, and lower mean values of high-
density lipoprotein cholesterol in the diabetic group with vascular
complications compared to the control group. There was no
statistically significant difference in lipid profile between the two
groups of diabetic patients (Table 2).
Markers of oxidative stress measured in this study, namely
thiobarbituric acid-reactive substances, showed significantly higher
mean values in both patient groups compared to the control group,
as well as a significantly higher mean value in the group presenting
with vascular complications compared to those without vascular
complications (Table 2).
Soluble RAGE in the diabetic group without vascular
complications showed a significantly lower mean value compared
to the diabetic group with vascular complications and the control
group. No significant difference was noted between the control
group and the patients with vascular complications (Table 2). On
the other hand, soluble TNF-
α
mean values in the patients with
vascular complications were significantly higher compared to the
Table 2.
Biochemical and calculated parameters in whole blood, plasma and urine of patients in the studied groups.
Analytes
Control group (I)
Diabetic group
p
-value
Without vascular
complications (II)
With vascular
complications (III)
P1
P2
P3
Random urine sample
Albumin (mg/l)
9.97 ± 2.04
11.4 ± 3.81
341.9 ± 271.5
NS
< 0.001 < 0.001
Creatinine (gm/l)
1.27 ± 0.21
1.09 ± 0.33
1.53 ± 0.75
NS
NS
0.019
ACR (mg/gm)
7.99 ± 1.74
11.13 ± 4.16
237.07 ± 186.8
NS
< 0.001 < 0.001
Fasting whole venous blood sample
HbA
1c
(%)
4.92 ± 0.43
7.72 ± 1.64
9.66 ± 1.97
< 0.001 < 0.001 < 0.001
Fasting plasma sample
Heparin plasma
Glucose (mmol/l)
4.95 ± 0.33
8.58 ± 1.98
13.48 ± 3.41
< 0.001 < 0.001 < 0.001
Urea (mmol/l)
3.33 ± 0.83
5.81 ± 1.33
6.31 ± 3.49
NS
0.011
0.014
Creatinine (μmol/l)
71.60 ± 7.96
88.4 ± 14.14
95.47 ± 34.48
NS
0.004
NS
Total cholesterol (mmol/l)
4.40 ± 0.34
4.92 ± 0.67
5.39 ± 0.98
NS
< 0.001
NS
HDL–C (mmol/l)
1.42 ± 0.21
1.11 ± 0.21
1.06 ± 0.23
0.001
< 0.001
NS
LDL–C (mmol/l)
2.56 ± 0.28
3.21 ± 0.54
3.57 ± 0.80
0.009
< 0.001
NS
Triglycerides (mmol/l)
0.95 ± 0.25
1.34 ± 0.51
1.60 ± 0.87
NS
0.003
NS
EDTA plasma
TBARS (μmol/l)
1.69 ± 0.52
2.95 ± 1.89
5.73 ± 1.32
0.014
< 0.001 < 0.001
Fasting serum sample
sRAGE (pg/ml)
1261 ± 496
691 ± 537
1279 ± 758
0.025
NS
0.009
TNF-
α
(pg/ml)
8.45 ± 4.66
11.08 ± 6.64
23.15 ± 23.32
NS
0.009
0.035
p
< 0.05 was considered statistically significant,
p
< 0.001 was considered highly significant, NS: not statistically significant.
P1: statistical difference between control group and diabetic group without vascular complications.
P2: statistical difference between control group and diabetic group with vascular complications.
P3: statistical difference between diabetic patients with and without vascular complications.
ACR: albumin-to-creatinine ratio, HbA
1c
: glycated haemoglobin, A
1c
fraction, HDL-C: high-density lipoprotein cholesterol, LDL-C: low-density lipoprotein cholesterol,
sRAGE: soluble from of receptor for advanced glycation end products, TBARS: thiobarbituric acid-reactive substances, TNF-
α
: tumour necrosis factor-alpha.