DEPARTMENT OF BIOCHEMISTRY
FACULTY OF MEDICINE
UNIVERSITY OF KHARTOUM
Assessment of acute phase protein (plasminogen activating inhibitor) levels and in type 2 Sudanese diabetic patients
A research proposal for master degree of medical biochemistry
By Khalid M.Elhassan Osman Abdelsamad Supervisor Dr. Khalid Hussein
Introduction and literature review: Diabetes mellitus is a metabolic disorder of multiple etiologies. It is characterized by chronic hyperglycemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects of insulin secretion, insulin action or both.(1) Type 2 diabetes (formerly called non-insulin-dependent or adult onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity. The expected number of diabetic patients 438 million by 2030, an increase of 54% compared to predicted figures for 2010(2). Macro vascular diseases such as coronary artery disease are one of complications of both type 1 and type 2 diabetes mellitus. The prevalence of diabetes is increasing, now diabetes also affects adolescents and younger adults, thus promoting the earlier development of long term cardiovascular complications. Diabetes itself accounts for 75 – 90% of the excess coronary artery disease (CAD) risk and enhances the effects of other cardiovascular risk factors. Death from stroke and myocardial infarction (MI) are the leading
Type II diabetes is a chronic medical condition that affects the way the body uses glucose. With diabetes, the body can resist the effect of insulin or fails to produce enough insulin to preserve a glucose level within normal limits. Type II diabetes is becoming much more common than before and the occurrence is growing. Approximately 23.5 million people in the United States are living with type II diabetes (Fesselle, 2010).
Pittas (2003) expressed that, Diabetes Mellitus is a group of metabolic disorders characterized by a chronic hyperglycemia (elevated blood sugar level) condition, resulting from the deficit of insulin secretion, insulin action or both. There are two main types of diabetes mellitus: Type 1 diabetes mellitus, also called insulin dependent diabetes mellitus, and is cause by lack of insulin secretion by beta cells of the pancreas; Type 2 diabetes mellitus, also called insulin dependent diabetes mellitus, is caused by decreased sensitivity of target tissues to insulin. In both types of diabetes mellitus, metabolism of all the food is altered. The effect of lack if insulin or insulin resistance of glucose metabolism is to prevent the efficient uptake and utilization of glucose by most cells of the body, except those of the brain. As a result of this, blood glucose concentration increases, cell utilization of glucose falls increasingly lower and utilization of fats and proteins
Diabetes Mellitus is the metabolic disorder characterized by high levels of blood glucose that is caused by deficiency of production of insulin, action of insulin, or may be both of them. The uncontrollable output of hepatic glucose and reduced uptake of glucose by the skeletal muscle with reduced synthesis of glycogen lead to hyperglycaemia. Diabetes is a complicated disease; it can affect mostly every organ of our body and causes devastating consequences.
By 2020 estimates show that approximately 250 million people worldwide will be affected by type 2 diabetes mellitus (Shulman, 2000). Type 2 diabetes also known as adult-onset or non-insulin-dependent diabetes
to be the main cause of chronic diabetic complications, in particular at a microvascular level (Moussa 2008).
Type 2 diabetes, often referred to as noninsulin-dependent diabetes, is a chronic condition that is often brought on by an individual’s lifestyle. Such as obesity, poor eating habits and not exercising. With this condition the body either resist insulin effect or doesn’t produce enough insulin (Buttaro, Trybulski, Bailey, & Sandberg-Cook, 2013).
Diabetes is defined as a disease that an individual’s body ability to either produce or respond to the hormone insulin is impaired. The most common form of diabetes is type 2 diabetes. Type 2 is also known as “adult onset” but younger individuals could still be at risk for developing the disease because of the increase in obesity in childhood. When one does have type 2 diabetes, it means that ones’ body does not use insulin properly or the body does not produce enough insulin to maintain a normal glucose level. Researchers have yet to discover why this happens.
Diabetes is very common in elderly age. The pathophysiology of this disease is different in the elderly; as a result the therapeutic approach towards it should be different (Meneilly, 2009). Type 2 diabetes is caused by a sequence of genetic factors related to impaired insulin secretion and insulin resistance. The main environmental factors which affects this type of diseases such as overweight or obesity, lack of exercise, stress, high-fat diet, family history, high alcohol consumption, high cholesterol and blood pressure, race or ethnic background, certain medications and as well as aging. These factors show that diabetes is a multifactorial disease which involves multiple genes and environmental factors. There are few reasons why the incidence
Smelter et al. (2010) defines diabetes mellitus (DM) as a chronic metabolic disorder of glucose metabolism characterized by hyperglycemia. DM is etiologically divided into types 1 and 2 referring to inadequate insulin secretion and reduced insulin-driven glucose uptake in muscle cells respectively. However, the term “Non-insulin dependent diabetes mellitus” to refer to type 2 DM is no longer used because some degree of beta-cell failure leading to reduced insulin secretion eventually develop leading to need for insulin therapy. Importantly, type 2 DM accounts for 90%-95% of all diabetes cases and a significant proportion of affected persons are not yet diagnosed due to poor screening. Smelter et al. (2010) highlight polyuria, polydipsia, and polyphagia as the cardinal manifestations of diabetes mellitus. However, delayed diagnosis leads to numerous long-term microvascular, macrovascular, and neurologic complications such as diabetic foot, coronary artery disease, and peripheral neuropathy respectively. In fact, complications are associated with a high morbidity and mortality; type 2 DM is the third leading cause of mortality in U.S (Smelter et al., 2010). Conversely, acute complications such as hyperglycemic hyperosmolar coma and diabetic ketoacidosis also claim many lives.
Diabetes Mellitus affects 29.1 million in the United States of America alone. Complications due to diabetes mellitus are a significant measure of costs of healthcare and estimated to be 249 billion dollars annually, (Center for Disease Control and Prevention, 2014). Health problems secondary to diabetes mellitus include cardiovascular diseases, hospitalization for diabetic ketoacidosis, end-stage renal disease, lower extremity conditions especially
(3) Diabetes mellitus is a serious metabolic disease that results in hyperglycemia as a result of ineffective or total inaction of insulin secretion. This condition is most often the result of a defective pancreas that can lead to damage to the heart, kidneys and blood vessels.
Diabetes Mellitus is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. It is a disease which is caused by the insufficient insulin secretion or decrease in the peripheral effects of insulin. It is a serious problem in terms of morbidity and mortality. The hyperglycemia is associated with long term damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels. It’s associated with many complications which includes blindness of the eyes and amputations of the extremities. It is also associated with neuropathy, retinopathy, and cardiovascular diseases which lead to mortalities.
Diabetes mellitus is a chronic disease that occurs in millions of Americans. It occurs when the body cannot secrete insulin or when the insulin secreted is not effectively utilized. This disease can be silent in the beginning stages yet deadly once the organs suffer severe damage along with the nerves and blood vessels. Type one and type two diabetes are comparable but have many differences which will be discussed.
Type-2 diabetes occurs when the body cannot properly use the insulin that is released in the body or does not make enough insulin. It more often develops in adults. Type 2 diabetes may be managed through physical activity and meal planning or may also require medications and/ or insulin to control the blood glucose in body.
Type II diabetes is a serious problem that has been increasing over the years. The CDC predicts that by the year 2050 one in every three US adults could have diabetes. Type II diabetes, happens when the body gradually loses its ability to use or produce insulin, this is the leading cause of cases of diabetes. A person with diabetes has a lot of risk factors that come with this disease. Patients with diabetes have a two to four time greater chance of having a stroke and also having a heart disease related death. Diabetes is the leading cause of new blindness and non traumatic amputations.