Insulin Resistance, a Co-factor to Dysglycemia, Predicting Peripheral Neuropathy in Type 2 Diabetic Patients in an Egyptian Population: A Non-Randomized Retrospective Study

Introduction: Insulin Resistance (IR) a major component of the metabolic syndrome -is directly related to macro-vascular complications in type 2 diabetic patients irrespective of the glycemic level (2). However, the impact of IR on micro-vascular complications such as Diabetic Neuropathy (DN) is not yet fully established. So once more, the IR dilemma rises again but this time from a new prospective. Material & Methods: We recruited 120 type 2 diabetic patients diagnosed for a period of less than 3 years, age range (35-65y) 64 females – non-smokers, with no evidence of peripheral arterial disease confirmed clinically and by duplex study. All 120 patients were subject to Clinical Examination, Ezscan / Sudoscan tests & Laboratory investigations – all on a one-day medical service. Laboratory tests included: Glycemic profile (FBG, 2hPPBG & HbA1c). HbA1c was performed both by High-Performance Liquid Chromatography (HPLC) and by capillary blood sample using the Clover system (Boronate Affinity Chromatography, Infopia). 2) Urea, creatinine & microalbuminuria. 3) Lipid profile & Triglyceride. 4) Complete Blood Count & ESR. 5) Liver enzymes ALT & AST. 6) Fasting & PP C-Peptide. 7) C-reactive protein (CRP hs) & Interlukin 6 (IL-6) serum levels, as inflammatory markers. Insulin Resistance was diagnosed by the Ezscan and confirmed by the Homeostatic model assessment (HOMA-2 ir calculator, university of Oxford, 2004) with a cut-off point of >2.5 ( for present or absent IR). The results of the Ezscan were categorized as follow: <40% is considered absent IR (HOMA <2.5), from 41-60% is considered mild IR (HOMA 2.6-3), from 61-80% is considered moderate IR (HOMA 3.1-4) and >80% is considered severe IR (HOMA >4). Diabetic Neuropathy (DN) was estimated by the Sudoscan using the micro-Seimens unit (uS) and the results were categorized as follow: (1) Mild DN (green zone, >60 uS). (2) Moderate DN (yellow zone, 40-59 uS). (3) Severe DN (red zone, < 40 uS). Results: The results of the Sudoscan & Ezscan tests led to the paradigm of 4 groups: Group A (30 patients, 25%) without evidence of DN and absent IR with an average HbA1c of 8.5% Group B (42 patients, 35%) with mild DN and mild IR (average 52 %) and average HbA1c of 8.7% Group C (30 patients, 25%) with moderate DN and moderate IR (average 70 %) and average HbA1c of 7.9% Group D (18 patients, 15%) with severe DN and severe IR (average 88 %) and average HbA1c of 8.2%. These results were statistically significant (P<0.001) concerning the positive correlation between IR & DN irrespective of HbA1c level a as glycemic marker. A weaker positive correlation could be detected between the level of glycemia (HbA1c) and DN. Conclusion: DN is a common incident in most type 2 diabetic patients, it occurs earlier than we expect in the process of the disease. Our study confirms the strong correlation between IR & DN in type 2 diabetic patients irrespective of the severity of symptoms or the glycemic level. It also confirms the accuracy and simplicity of both the Ezscan & Sudoscan as non-invasive and accurate diagnostic tools for IR & DN respectively. [Ashraf A. El-Sheikh, Nora A. El-Sheikh, Manal M. Badawi, Magda H. Mahran andMaha M. Abdelfattah. Insulin Resistance, a Co-factor to Dysglycemia, PredictingPeripheral Neuropathy in Type 2 Diabetic Patients in an Egyptian Population: A Non-Randomized Retrospective Study. Life Sci J 2015;12(4s):15-22]. (ISSN:1097-8135). http://www.lifesciencesite. com. 3