Type2 diabetes mellitus

Type2 diabetes mellitus

 Background

Type2 diabetes mellitus is one of the most common chronic diseases worldwide affecting nearly 200 million people, and is the fourth or fifth leading cause of death in the developed world. Coronary artery disease (CAD) represents a wide spectrum from angina pectoris, myocardial infarction and sudden death to silent myocardial ischemia. Coronary artery disease has been increased among Type II diabetes mellitus. The plasma fibrinogen plays a vital role in coagulation cascade. Conversely, the increased level of plasma fibrinogen and lipid abnormalities leads to coronary artery disease in type 2 diabetes mellitus. Hence, the present study carried out the correlation of plasma fibrinogen and serum lipid profile in non-diabetic subjects, type2 diabetic without CAD and type2diabeticwith CAD patients.

Materials and Methods

A retrospective study conducted in Sen Sok International University hospital, Phnom Penh, Cambodia, from the period of August 2009 to December 2012. There were 100subjectsincluded in this study were classified in to three groups of which 20healthy controls (group I), 40 subjects (group II) were found to be type 2 diabetic without coronary artery disease and 40 subjects (group III) were type 2 diabetic with coronary artery disease. Coronary artery disease was diagnosed on the basis of typical history of myocardial infarction, angioplasty, and coronary artery bypass grafting and angiographic documentation of stenosis.  Age and gender wise distribution of study subjects were determined. The clinical symptoms were documented and the ECG report was collected from type 2 diabetic with coronary artery disease patients. The plasma samples were collected for the estimation of fibrinogen and glucose levels and the serum samples were obtained for lipid profile estimation using fully automated coagulation and Biochemistry analyzers. The statistical data were analyzed using students “t” test for continuous variable and results were obtained in the form of p (probability) value using statistical software SPSS-16.

Results

The present study observed that there were43% of cases were male and 58% were female subjects in Type II diabetes without CAD group and in Type II diabetes with CAD the male and female subjects were equal percentage (50%).It was found that the age group between 46-55 male and 56-65 female, there were more (22.5% and 15%) cases than other age groups in Type II diabetes without CAD patients. In Type II diabetes with CAD group between 66-75 male and35-45 female age groups, there were higher numbers(20% and 17.5%) of subjects had found than other age groups. It was observed 100% of cases had pressure, heaviness, squeezing and burning, 95% had pain radiation of arms, shoulder and neck and90% of cases had teeth interscapular, epigastric and choking symptoms. The ECG results show ST segment depression among all male and female Type II Diabetes with CAD patients. The mean plasma fibrinogen levels were significantly elevated in Type 2diabetic with CAD and Type 2 diabetic without CAD patients than non-diabetic (p<0.0001). Likewise plasma fibrinogen level was significantly increased in group III than group II subjects. The increased glucose (p<0.0001), serum total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL cholesterol (p<0.0001), VLDL cholesterol (p<0.0001) and low HDL cholesterol (p<0.0001) levels were observed in group II and Group III than group I. The difference between group II and group III were significant (p<0.0001) in the parameters including glucose, serum total cholesterol, triglycerides, VLDL and HDL cholesterol. There was no significant difference of LDL cholesterol levels (P = 0.0029) observed between group II and group III patients. 

Conclusion

            In conclusion the overall female Type II diabetes mellitus subjects are higher number than male subjects. The male and female patients were equally affected by coronary artery disease during Type II diabetes mellitus. The higher number of CAD cases observed age between 66-75 in male and 35-45 in female patients. The ST segment depression was observed among Type II diabetes mellitus with CAD patients. There was a significant elevation of plasma fibrinogen and serum cholesterol, triglyceride, LDL and VLDL cholesterol and lower HDL cholesterol levels were observed among Type II diabetes mellitus with CAD patients than without CAD and control subjects. Plasma fibrinogen was positively correlated with serum lipid profile in type2 diabetes with coronary artery disease patients than without CAD in our study. Hence, the plasma fibrinogen and serum lipid profile are better markers for coronary artery disease in type 2 diabetes mellitus.

Key words: Fibrinogen, lipid profile, Type 2 diabetes, Coronary artery disease