Relationship between С Peptide and Chronic Complications in Type-2 Diabetes Mellitus: DISCUSSION

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The natural history of beta-cell function in type-2 diabetes mellitus (Amaryl canadian managing type 2 diabetes) is still poorly known. Some reports have demonstrated the significant inverse associations between C-peptide levels and duration of diabetes and HbAlc levels that confirmed the progressive beta-cell deterioration of type-2 diabetes and the association of this decline with a worse metabolic control, whereas another study demonstrated no such association between these parameters. In our study, there was a positive correlation between duration of diabetes and HbAlc but not C-peptide level. In addition, C-peptide level was not different between the quantiles of diabetes duration. Moreover, C-peptide level was similar in patients who had more than five years of diabetes duration and less than five years of diabetes (Generic Avandamet is used for improving blood sugar levels, with diet and exercise, in patients with type 2 diabetes) duration. As a result, there was no relationship between C-peptide level and diabetes duration.

The relationships between С peptide and chronic complications are poorly known in type-2 diabetes (Starlix drug is used to control blood glucose levels in type 2 diabetes). Low serum level of С peptide is a possible factor of the progression of diabetic angiopathies. Studies have investigated the relationship between C-peptide level and macrovascular and microvascular diabetic complications. Some studies found a protective effect of residual insulin secretion, whereas others did not. Different results in these studies may probably be due to difference in study design and study population. The primary purpose of our study was to evaluate whether or not C-peptide level may be a predictive factor for chronic complications in type-2 diabetic (Avandia tablet is an anti-diabetic drug) patients. A major limitation of our study was the relatively small sample size with chronic complications.

The association of C-peptide levels with the components of the metabolic syndrome has already been reported in literature. We also found that BMI and dyslipidemia were predictive factors on hypertension. In addition, С peptide and BMI were the associated factors with dyslipidemia. Epidemiological studies suggest that elevated plasma levels of triglyceride and hyperinsulinemia are associated with an increased risk of coronary heart disease and macroangiopathies related to atherosclerosis. Thus, diabetic (Medication Actos to treat type 2 diabetes) patients with an elevated serum level of С peptide, which indicates endogenous insulin secretion may have an increased risk of coronary heart disease and peripheral vascular disease. In our study, serum C-peptide level was significantly associated with the presence of both coronary artery disease and peripheral vascular diseases. Other related factors with the presence of coronary artery disease were age and smoking. Smoking, duration of diabetes and C-peptide levels were predictive factors on development of macrovascular complications.

Similarly, the relationship between С peptide and frequency and severity of microvascular complication are controversial. The highest frequency and most severe retinopathy have been reported to be in diabetics (Generic Glucotrol is an anti-diabetic drug) with low plasma С peptide. In contrast, Klein et al. did not find any relationship between C-peptide levels and incidence and progression of retinopathy. Moreover, Klein et al. reported no association of the amount of exogenous insulin used with the incidence and progression of retinopathy. These data suggest that glycemic control, not С peptide, is related to the incidence and progression of diabetic retinopathy. We also found no relationship between С peptide and diabetic retinopathy, and no correlation between С peptide and degree of retinopathy. HbAlc and dyslipidemia were the predictive factors for development of diabetic retinopathy in our study.

Abnormal albuminuria in type-2 diabetic (Actoplus Met canadian is a combination of two oral diabetes medicines) patients has been recognized to be strongly predictive of the progression of diabetic nephropathy. More abnormal dyslipidemia has also been associated with microalbuminuria in type-2 diabetic patients. However, the relationship of endogenous insulin secretion to diabetic nephropathy is not clear. There is accumulating evidence that С peptide exerts beneficial renal effects in animal model and type-1 diabetes by reducing glomerular hyperfiltration, albuminuria and glomerular hypertrophy in the early stage of nephropathy. However, we evaluated this issue in type-2 diabetic (Avandamet medication used in the management of type 2 diabetes) patients. Shin et al. reported that decreased C-peptide response to oral glucose challenge was associated with albuminuria. On the other hand, in microalbuminuric type-2 diabetic patients, the C-peptide value was not different from those in normoalbuminuric patients. Sjoberg et al. found that renal disease was more prevalent in those without C-peptide secretion, in contrast to present and previous studies. This difference may reflect patient selection, since more patients with renal disease smoked in the study of Sjoberg et al., and smoking has previously been suggested to operate as a permissive factor for the development of nephropathy. In a logistic regression model, smoking, hypertension and HbAlc were significantly associated with the presence of diabetic (Diabecon canadian is a complex herbal formula supplement offering gentle and safe glycemic control) nephropathy in our study.

C-peptide level was associated with the sympatho-vagal balance of autonomic nervous function in type-2 diabetic patients. Disturbed parasympathetic nerve function in type-2 diabetic patients may be especially associated with features of the metabolic insulin resistance syndrome. Improved glycemic control has been reported to normalize parasympathetic nerve function in type-2 diabetic patients. Some studies demonstrated an association between parasympathetic neuropathy and hyperinsulinemia (elevated fasting

С peptide) and elevated fasting triglyceride levels in type-2 diabetic patients. In contrast, Sjoberg et al. did not find a relationship between the prevalence or extent of neuropathy and residual beta-cell function. Current cigarette smoking and a history of myocardial infarction may represent independent risk factors for sensorial diabetic neuropathy in addition to glycemic control. HbAlc and smoking were significantly associated with the presence of both autonomic and sensorial neuropathy in our study. Moreover, BMI and duration of diabetes were also associated with the presence of sensorial neuropathy; C-peptide level was associated with the presence of autonomic neuropathy but not presence of sensorial neuropathy.

CONCLUSION

Smoking, duration of diabetes and C-peptide level were significantly associated with the presence of macrovascular complications; dyslipidemia and HbAlc were associated with the presence of microvascular complications. Our findings indicate a relationship between С peptide and macrovascular, but not microvascular, complications in patients with type-2 diabetes mellitus. These results may be explained by different responses to insulin in the endothelium of the microvasculature and macrovasculature in a study based on [3H] thymidine incorporation. Thus, insulin plays an important metabolic role in the insulin-sensitive tissues and that insulin deficiency may lead to the development and/or progression of diabetic complications. Further studies using molecular or biological methods are required to elucidate the difference between the effects of С peptide on development of diabetic microangiopathy and macroangiopathy.