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Background: Diabetes mellitus (DM) is a group of metabolic disorders Characterized by chronic hyperglycaemic condition resulting from defects in insulin secretion, insulin action or both. Type2 Diabetes Mellitus (T2DM) is the predominant form of diabetes and represent 90% of all cases of DM. Studies show that vitamin D (VD) has an important role in modifying the risk of T2DM, especially among insulin resistant diabetic patients. Recently a novel association between insulin resistance and vitamin D deficiency has been proposed. Aim: In the current research we investigate the association between hypovitaminosis D and T2DM. Also we will study the effect of vitamin D supplementation on glycemic status, oxidative stress status and inflammatory markers in T2DM patients. Methods and patients: forty T2DM patients with hypovitaminosis D were assessed for glycemic, inflammatory and antioxidants parameters. After 6 months of VD supplementation for the intervention group of patients (n=20), there was significant improvement in VD level, Homeostatic model assessment of insulin resistance (HOMA - IR), Fasting blood glucose (FBG), glycated haemoglobin (HbAIC), serum insulin, interleukin 6 (IL-6), tumor necrosis factor -α (TNF-α), total antioxidant capacity (TAC) and malondialdehyde (MDA). Conclusion: Vitamin D supplementation has a promising effect on the treatment of Type 2 Diabetes as there is a significant improvement in glycemic , inflammatory and oxidative parameters in Type 2 Diabetes mellitus patients

Background Chemerin a novel adipokine is linked to insulin resistance and adiposity which are major characteristics of polycystic ovary syndrome (PCOS). Results Chemerin level was found to be significantly higher in PCOS group than in control group (94.99 ± 12.52 ng/dl vs 73.41 ± 6.95 ng/dl) (P < 0.001) being the highest in obese PCO group, also chemerin positively correlated with BMI, fasting insulin, and HOMA-IR (P < 0.001), Multivariate linear regression analysis for factors affecting chemerin level in both PCO groups showed that the most important factor was fasting insulin (P = 0.042). Conclusion Chemerin correlates with insulin resistance and may be involved in the pathogenesis of insulin resistance in PCOS patients.

Background: Plasma calprotectin is a persistent biomarker of insulin resistance (IR), gastroenteritis, and cardiovascular disease (CVD). We assessed the role of plasma and urinary calprotectin in type 2 diabetes patients with peripheral arterial disease (PAD), to assess whether calprotectin is a risk factor for developing PAD in type 2 diabetes patients. Aim of the work: To study the association of plasma and urinary calprotectin levels with peripheral arterial disease in type 2 diabetic patients Methods: The current study was conducted on 90 subjects. They were subdivided into 3 groups. Group I: 30 type 2 diabetics with PAD, group II: 30 type 2 diabetics without PAD and group III: 30 healthy control subjects of comparable age and sex. They were subjected to history taking, full clinical examination, anthropometric measurement, plasma and urinary calprotectin levels that were measured by ELISA and ankle brachial index. In addition, HbA1c, fasting serum lipid profile, highly sensitive CRP and CBC were measured. Results: plasma calprotectin level was significantly higher in patients with T2DM with lower extremity peripheral arterial disease (LEPAD) compared to the other 2 groups, urinary calprotectin was significantly higher in all type 2 diabetic subjects compared to healthy control group. Age, current smoking status, duration of diabetes, glycated hemoglobin and plasma calprotectin were independent determinant of peripheral arterial disease in T2DM patients Conclusion: Elevated plasma and urinary calprotectin levels in diabetic patients compared to healthy control suggest the possible role of calprotectin in development of atherosclerosis and peripheral arterial disease and the possibility of its use as a biomarker for diabetic vasculopathy.

Background: Diabetes Mellitus (DM) is a major and growing public health problem throughout the world. In developing countries, there is a scarcity in the published data regarding the quality of care of DM, including non-adherence of the patients, poor glycemic control, and the long-term consequences of DM. Aim of Study: The International Diabetes Management Practices Study (IDMPS) was developed to provide standard-ized data about the management of care of patients with diabetes in developing countries. In this report, we presented the results of the seventh wave of IDMPS about the manage-ment of care of DM in Egypt. Patients and Methods: IDMPS is an international, multi-center, observational, cross-sectional study to assess current practices in the management of care of people with DM. The primary outcome in the present study was the proportion of patients achieving glycemic targets (HbA1c) as per recom-mendations of International guidelines (HbA1c

Background PrePubertal children with type 1 diabetes mellitus are shorter than their non- diabetic peers. we aimed to evaluate the role of HbA1c and IGFBP-3 in this phenomenon. Aim of the work: The aim of the study was to evaluate the effect of glycemic control on the growth and IGFBP-3, represented by height, weight, height and weight percentiles for age in a sample of prepubertal Egyptian children with T1DM. Patients and Methods This study was a cross sectional study conducted on 80 pre-pubertal Egyptian children, divided into 25 Males and 25 Females with T1DM and 30 age matched controls (15 Males and 15 Females), the participants were recruited from the Outpatient Clinic of the Pediatric Department of Ain Shams University Hospitals and the National Institute of Diabetes and Endocrinology in Cairo, Egypt during the period from July 2018 to August 2019. Anthropometric measures including height and weight were obtained and used to calculate the height and weight percentiles using the CDC calculators. HbA1c as well as IGFBP-3 levels were tested. Results The mean age (years) of the participants was (9.671±2.24) for male patients, (9.22 ± 2.19) for female patients and (8.39 ± 2.034) for controls. The height found to be lower in the children with T1DM when compared to the disease-free controls with median values of (129.287 ± 13.410) in male patients, (127.727 ±10.155) in female patients and (136.760 ± 13.431) in the controls. the height and weight percentiles (%) were found to be lower in the children with T1DM when compared to the disease-free controls, the height percentile with median values of 14.54 (IQR 27.95) in male patients, 17.93 (IQR 29.20) in female patients and 87.07 (IQR 20.48) in the controls. the weight percentile with median values of 40.68 (IQR 40.83) in male patients, 30.64(IQR 35.59) in female patients and 85.18 (IQR 20.17) in the controls. A negative correlation between HbA1c (%) and serum IGFBP-3 (ng/ml), height and height percentile were found with (0.014, 0.049 and 0.012) as well as a positive correlation between serum IGFBP-3 and height, height and weight percentiles (%), were found with (,0.004, 0.009 and 0.005 respectively). Serum IGFBP-3 levels were also found to be significantly lower in patients (P < 0.001) with a mean value of (198.6 ± 45.335) in male patients and (168.4 ± 44.317) in female patients and (285.333 ± 61.936) in the disease-free controls. Conclusion Serum IGFBP-3 levels (ng/ml) as well as growth are negatively affected in prepubertal children with T1DM in relation to the glycemic control.

Background Diabetic kidney disease (DKD) is considered a major cause of end stage renal disease (ESRD). It has been established that controlling microalbuminuria can delay progression to ESRD. Sodium glucose co transporter 2 inhibitor (SGLT2 i) is a newer antidiabetic drug that has a renoprotective and antiproteinuric effect. Aim of the Study to study the effect of SGLT2 inhibitor on proteinuria in diabetic patients and compare it with classic antiproteinuric drugs. Patients and Methods we conducted a randomized interventional study, involving 60 adult patients with type 2 DM divided into 2 groups: group I were prescribed the classic antiproteinuric drugs in the form of ACE inhibitors or ARBs, aspirin and statins and group II were prescribed an additional dapagliflozin 10 mg/day. Follow up as regard changes in UACR, HbA1C, Blood pressure, body weight and e GFR was done after 6 months of treatment. Results There was statistically significant decline in UACR after 6 months of treatment with dapagliflozin in group II in comparison to group I (p-value < 0.001). There was also statistically significant decline in SBP in both groups with (p-value < 0.010) in group I and (p-value Conclusion There was better reduction in albuminuria when adding dapagliflozin to antiproteinuric drugs, so we recommend starting dapagliflozin early in patients with DKD to delay progreesion to ESRD.

Background PCOS appears to be associated with an increased risk of metabolic aberrations, including insulin resistance and hyperinsulinemia, type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease throughout womens’ lifespan. Obesity is a state of chronic low-grade systemic inflammation. This chronic inflammation is characterized by abnormal cytokine production and activation of inflammatory signaling pathways in adipose tissues, which contributes to insulin resistance and its related diseases such as PCOS and metabolic syndrome. Objective To evaluate Lipocalin-2 level in a sample of Egyptian females with PCOS and study the effect of metformin therapy on Lipocalin-2 level in patients with PCOS. Methods This case control study was conducted on 52 females, collected from the outpatient obstetrics and gynaecology clinics of Ain Shams University Hospitals from June 2018 to March 2019, their age ranged between 17-43 years old. divided into 2 groups: Group (I) 32 women with polycystic ovary syndrome According to the Rotterdam diagnostic criteria of PCOS, and Group (II) 20 healthy women old with normal ovulatory cycle as a control group. All subjects were subjected to full medical history taking, thorough physical examination including BMI and waist circumference. Fasting plasma glucose, Fasting s.insulin, HOMA-IR, lipocalin-2 level were assessed. Results Serum lipocalin-2 levels did not differ between patients with PCOS and BMI-matched healthy controls (P-value 0.193), and there was no significant difference between the 2 studied groups as regard HOMA-IR (p = 0.375). Metformin therapy for 3 months in patients with PCOS in the present study, resulted in significant reduction in lipocalin-2 level (p-value Conclusion PCOS per se is not associated with elevated serum lipocalin-2 levels. Metformin therapy induces a significant reduction in serum lipocalin-2 levels, weight, BMI, waist circumference and HOMA-IR in patients with PCOS. Reduction of BMI was the only significant confounder affecting lipocalin level after metformin therapy. So the reduction in lipocalin level following metformin therapy in patients with PCOS in our study may be due to weight reduction perse.

Background The Prevalence of thyroid nodules is rising nowadays, luckily most of them are benign. The risk of malignancy 5-15%, which necessitates the ultimate need to accurately distinguish benign from malignant nodule to avoid unnecessary thyroidectomy with risk of recurrent laryngeal nerve injury, postoperative hypothyroidism and lifetime thyroid replacement therapy, and other complications related to surgery and anaesthesia. Recent evidence suggests that circulating miRNA might have probable advantage as diagnostic or prognostic markers for numerous cancers. Given their reproducible and constant presence in sera, miRNA profiles have emerged as a non-invasive method to categorise a wide variety of human cancers. Aim of the study To evaluate a possible relationship between the expression level of circulating miRNA-222 and the histological outcome of euthyroid patients undergoing thyroidectomy for thyroid nodules with indeterminate FNAB cytology. Patients and Methods 45 patients of both genders, of age ranging from 19-70 years old visiting endocrine clinic or admitted to the endocrine surgical department with indeterminate thyroid nodules planned for thyroidectomy were included. All pateints were subjected to full medical history taking, general and local clinical examination, laboratory investigations (thyroid function tests), quantitative assay of serum micro RNA-222 expression by quantitative Real-Time polymerase chain reaction (qRT-PCR), ultrasonography imaging of thyroid gland, fine needle aspiration biopsy and cytology of the thyroid nodule, histopathological examination after thyroidectomy. Results The incidence of thyroid nodules was predominant in female gender in benign group and malignant group. Risk of malignancy increases as TI-RADS and Bethesda scores increases. Also, larger nodule in size has a more risk of malignancy (p = 0.034). Expression level of circulating miRNA222 in serum can’t differentiate between healthy, benign and malignant patients where there was no significant difference between them statistically (p = 0.867). Circulating miRNA-222 is a poor predicator for malignant nodules with sensitivity of 50%, specificity of 32.43%, with high negative predictive value (NPV=75%). Conclusion Expression level of circulating miRNA-222 is a poor predictor of malignant nodules in our studied group. The larger the nodule size the more risk of malignancy. Also, as TI-RADS and Bethesda scores increases the more risk of malignancy.

Background Gestational diabetes mellitus (GDM) defined as glucose intolerance with onset or first diagnosis during pregnancy. While GDM usually resolves following delivery, it can have long-lasting health consequences, including increased risk for type 2 diabetes (T2DM) and cardiovascular disease (CVD) in the mother, and future obesity, CVD, T2DM, and/or GDM in the child. This contributes to a vicious intergenerational cycle of obesity and diabetes that impacts the health of the population as a whole. Fibroblast growth factor 21 (FGF21) is a hormone that is expressed predominantly in the liver, but also in other metabolically active tissues such as pancreas, skeletal muscle and adipose tissue. An elevated FGF21 level is also an independent predictor of T2DM. GDM and T2DM are proposed to have similar underlying pathophysiologies, raising the question of whether a similar relationship exists between FGF21 and GDM as it does with T2DM. Objectives assess the role of Fibroblast growth factor 21 (FGF-21) as a prognostic marker for maternal and fetal complications in patients with gestational diabetes mellitus (GDM). Patients and Methods A case control study that was conducted on 50 patients diagnosed with Gestational Diabetes Mellitus and 50 control subjects at Diabetes and Obstetrics outpatient clinic and inpatient ward at Ain Shams university hospitals in the period between December 2018 and July 2019. Patients diagnosed with gestational diabetes mellitus (GDM) at 24-28 weeks of gestation were included in this study. Results FGF 21 levels varied significantly with blood sugar values where higher levels of FGF 21 levels were found in patients with GDM with study results showing that FGF 21 can be used as a diagnostic marker for GDM at levels above 121 pg/ml with sensitivity 84% and specificity 92%. Conclusion FGF 21 can be used as a diagnostic marker for gestational diabetes. Further studies needed for better correlation between FGF 21 levels during pregnancy and maternal outcome.

Background:: Sodium glucose co-transporter 2 inhibitor (SGLT2i) is a new arment in the prevention and treatment of diabetic kidney disease with a potential effect on reducing and preventing Chronic Kidney Disease (CKD) progression. Objective:: To evaluate the effect of SGLT2 inhibitor in comparison to traditional medication in diabetic patients with microalbuminuria. Methods: A total of 60 diabetic patients with microalbuminuria were divided into group I, where 30 patients were treated by traditional medications (RAAS blockers) and group II where 30 patients were treated by Dapagliflozin added to the traditional medications. All patients were followed up for 6 months and their Urine Albumin/Creatinine Ratio (UACR) and eGFR changes were monitered. Results:: UACR significantly declined after 6 months of treatment in group II with a p-value Conclusion:: Dapagliflozin, when added to traditional medications (RAAS Blockers), leads to a significant reduction in microalbuminuria with no significant eGFR changes.

Background: Symbiotic interactions of microorganisms are widespread in nature, and support fundamentally important processes linking health and disease to the bacterial ecology. Intestinal microbiota is the largest source of microbial stimulation that exerts both harmful and beneficial effects on human health. It participates in the development of the postnatal immune system as well as oral tolerance and immunity. The recently explored impact of the microbiota on energy metabolism, gut hormone regulation and the gut-brain axis was judged to be a fascinating topic and of great value in the future, and can have a clinical role in the management of obesity and diabetes. Objective: To assess the impact of the gut microbe, Lactobacillus acidophilus, in patients with type 2 Diabetes Mellitus (controlled and uncontrolled) compared to healthy individuals, as a preliminary approach to future treatment with probiotics, prebiotics or diet modulation. Methods: A case control study was conducted on 30 diabetic patients and 10 control individuals. All patients were subjected to full history, thorough clinical examination, and laboratory measurement of fasting blood sugar, 2 hours post prandial, Glycosylated Hemoglobin (HbA1C), CRP (C-Reactive Protein), Lipid profile, and Identification of stool Lactobacillus acidophilus by PCR (polymerase chain reaction) technique. Results: Significantly lower Stool Lactobacillus acidophilus PCR count among diabetic patients when compared to healthy control individuals. Conclusion: Stool Lactobacillus acidophilus PCR count was lower among type 2 diabetic patients, which may show relationship of lactobacillus with type 2 diabetes mellitus. However, further studies are needed to determine correlation or causation of this relationship.

Background Irisin is a newly discovered myokin secreted by myocytes responsible for transmission of signals from muscles to other body tissues. Irisin improves systemic metabolism by increasing the energy expenditure. Owing to numerous similarities in action between irisin and thyroid hormones it seems imperative to explore these substances’ potential mutual influence on the body. Objective To estimate serum irisin concentration in patients with hypothyroid and hyperthyroid diseases, and to detect the relation of serum irisin in patients with thyroid disorders with creatine kinase (CK), a serum marker of muscle damage. Patients and methods The study comprised 30 hyperthyroid patients (group 1), 30 hypothyroid patients (group 2), and 30 normal persons (group 3). Irisin was measured using enzyme-linked immunosorbent assay. Thyroid-stimulating hormone, triiodothyronine, and free thyroxine levels were measured using chemiluminescent microparticle immunoassay technology. Results Irisin hormone level significantly decreased in hypothyroid patients in comparison with hyperthyroid patients. Irisin hormone level increased in hyperthyroid patients in comparison with normal persons, whereas it decreased in hypothyroid patients in comparison with normal persons. CK level significantly decreased in hyperthyroid patients in comparison with hypothyroid patients. CK level significantly increased in hypothyroid patients in comparison with normal persons, whereas it significantly decreased in hyperthyroid patients in comparison with normal persons. Conclusion Obtained results suggest the influence of thermometabolic state on irisin level.

Background study of chemerin level in polycystic ovarian syndrome (PCO) patients and its relation to insulin resistance (IR). Upon chemerin on adipose tissue and glucose metabolism, serum chemerin has been recently studied in (PCO) women Aim We aimed to study the level of serum chemerin in PCO patients and its relation to insulin resistance. Methods The current study included 45 subjects with PCO syndrome and 45 healthy subjects as a control group. PCO subjects were divided into 27 obese PCO and 18 lean PCO. Control women were divided into 25 obese women and 20 lean women. Measurement of serum chemerin levels, fasting blood glucose (FBG),fasting insulin (FIN), total testosterone and pelvic ultrasonography Results Serum chemerin was significantly higher in the obese PCOS group (99.65 ± 13.72 ng/mL) compared with lean PCOS (87.99 ± 5,64 ng/mL) and the obese (76.82 ± 2.39 ng/mL) and non-obese (69.19 ± 8.40 ng/mL) control groups. In PCOS women, serum chemerin levels were positively correlated with Body mass index (BMI) (r = 0.835, P Conclusion There is an increase in serum chemerin level in PCOS patients with even more significant increase in patients with obese PCOS.

Background Thyroid nodules are extremely common. By age 60, about one-half of all people have a thyroid nodule. Cryoablation is used in a variety of clinical applications, using hollow needles (cryoprobes). Cryoprobes are inserted into or placed adjacent to diseased tissue which is desired to be ablated. Aim of work To evaluate the effect of Cryoablation on the size & function of thyroid noduleWhich may replace the need for surgery or radiotherapy. Patients & methods This is an interventional therapeutic study, conducted in Ain-Shams University hospitals; endocrinology clinic. Our study sample included 80 subjects, age between 20 & 60, having thyroid nodule diagnosed by ultrasound. Subjects were divided into 2 groups: Group 1 included 40 subjects “control group” who were not subjected to cryoablation. Group 2 included 40 subjects “cases” upon which cryoablation was done. Neck ultrasound was done for subjects & they were sampled for their TSH, free T4 & free T3 levels at start and after 3 & 6 months. Results There was high statistical significant difference between group 1 & group 2 regarding nodule size after 6 months. Group 1 showed mean nodule size (0.89 cm ± 0.25 SD) while group 2 showed (0.62 cm ± 0.35 SD),(p-value Conclusions Cryoablation causes nodule size reduction, especially after 2nd session. Cryoablation doesn’t affect thyroid function tests, all through our study.

Objective The aim of the present study is to investigate the association of urinary calprotectin levels with lower extremities peripheral arterial disease (LEPAD) in patients with type 2 diabetes mellitus (T2DM). Background calprotectin is formed by two different calcium- binding proteins; it constitutes about 40% of neutrophils all cytosolic proteins. Calprotectin or its components (S100A8/S100A9) consider as a potential therapeutic target in inflammatory conditions including diabetes mellitus. The ankle-brachial index of less than 0.9 was applied for LEPAD diagnosis. Method we recruited 60 patients with T2DM; half of them had LEPAD and a healthy control group consists of 30 participants. Urinary Calprotectin and high sensitivity CRP (hsCRP) were measured by enzyme-linked immunoassay kit. Results Urinary calprotectin level was statistically significant higher among the three participating groups (p value Conclusion Urinary calprotectin cannot be used as a biomarker for LEPAD in T2DM.

Background: Vitamin D deficiency is seen more frequently in diabetic patients with distal symmetrical polyneuropathy. Unfortunately, there is a shortage of data concerning prediabetic individuals with peripheral neuropathy (PN). Therefore, we aimed to study the association of vitamin D deficiency with PN severity and to determine the effect of vitamin D supplementation on PN in prediabetics. Methods: A case-control study was conducted consisting of 178 prediabetic individuals recruited from the outpatient department of the National Institute of Diabetes and Endocrinology, Cairo, Egypt. All patients were screened for PN using clinical examination and Douleur Neuropathique 4 diagnostic questionnaire (DN4). They were divided into 89 patients with and 89 patients without PN (group A and B). Group A was assessed for neuropathic severity using the Short-Form McGill Pain Questionnaire (SF-MPQ). In addition, 25-hydroxyvitamin D, ionized calcium, phosphorus, parathyroid hormone (PTH), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-hour post 75g glucose (2h-75g glucose) and lipid profile were measured. Prediabetic patients with PN were given vitamin D3 200.000 IU IM monthly for three months. After three months, clinical assessment, DN4, SF-MPQ and all laboratory measures were repeated. Results: Vitamin D level was negatively correlated with neuropathy score and severity (r = -0.65, -0.47, p Conclusion: Vitamin D deficiency is an independent risk factor for PN. Correction of vitamin D deficiency improves glycemic parameters, PN score and severity.

Background: there were over 7.8 million cases of diabetes in Egypt in 2015. The prevalence of diabetic retinopathy in Egypt among adult diabetic patients in 2010 was around 20.5%. 90 percent of all cases of blindness from diabetes can be prevented. Copeptin, a novel biomarker (a surrogate to arginine vasopressin was found to increase with diabetic nephropathy. Objectives: this study aimed to detect the level of copeptin in patients with diabetic retinopathy.Patients and Methods: the study was conducted on individuals attending the diabetes and the ophthalmology outpatient clinics in Ain Shams University Hospitals between February and August 2017. This study included 96 individuals and they were divided into 4 groups. Group I consisted of 24 patients with proliferative diabetic retinopaty (PDR), group II 24 patients with non proliferative diabetic retinopathy (NPDR), group III included 24 diabetic patients with no fundus abnormalities and group IV included 24 healthy non diabetic individuals. The individuals were subjected to full medical history taking, slit lamp biomicroscope fundus examination and the measurement of serum fasting blood sugar, 2 hour post prandial blood sugar, glycated hemoglobin, serum creatinine, serum copeptin and urinary albumin creatinine ratio. History taking included age, gender, type of diabetes, duration of diabetes, antidiabetic medications, any other medical comorbidities and pregnancy for females. Results: the present study showed a statistically significant rise in the level of copeptin in patients with PDR (Group I) and NPDR (Group II) when compared to those with no diabetic retinopathy (Group III) and the control group (Group IV) (P value

Nature is a phenomenal treasure of remedies. Numerous previous studies reported that Nigella sativa NS improved glycemic control, reduced insulin resistance, and improved lipid profile. NS was never investigated before as a monotherapy for newly diagnosed type 2 diabetes mellitus T2DM patients. Our aim was to investigate the potential metabolic benefits of NS monotherapy in newly diagnosed T2DM patients. Prospective, open-label randomized clinical trial at outpatient endocrinology clinic at Ain-Shams University hospital. Eligible patients were randomly assigned to either metformin tablets or NS oil capsules. Both groups received treatment for 3 months. Glycemic index (FBG, 2 h pp, A1C, insulin sensitivity %S, secretory function %B, insulin resistance IR), lipid profile (TC, LDL, HDL, TG), liver and kidney functions (AST, ALT, Sr cr), total antioxidant capacity TAC, weight, waist circumference WC and body mass index BMI were assessed at baseline and at the end of treatment period. A concentration of 1350 mg/day NS in newly diagnosed T2DM patients was inferior to metformin in terms of lowering FBG, 2 h pp, and A1C or increasing %B. However, NS was comparable to metformin in lowering weight, WC, and BMI significantly. NS was comparable to metformin in regards of their effects on fasting insulin, %S, IR, ALT, TC, LDL, HDL, TG, and TAC. Metformin showed significant increase in AST and creatinine which was reserved in NS group. NS administration in newly diagnosed T2DM was tolerable with no side effects as compared to metformin; however, it was inferior to metformin in terms of diabetes management.

Vitamin D is claimed to have an adjuvant effect on glycemic control by dual action on pancreatic β-cells and insulin resistance. The aim of this study was to assess the possible effect of short-term alfacalcidol supply on glycemic control in type 2 diabetic hemodialysis (HD) patients. Twenty type 2 diabetic HD patients (using diet and oral drugs but not insulin) were randomly selected from our dialysis unit as well as 20 non-diabetic HD patients as control. A third group of 12 healthy subjects were studied as well. All three groups were similar in age, sex, and body mass index. Oral alfacalcidol therapy was administrated daily as recommended by Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for 12 weeks guided by monthly serum phosphorus and Cax PO4 product. Corrected total calcium, phosphorus, intact parathyroid hormone, 25-hydroxy vitamin D (25[OH]D), and glucoparameters (fasting blood glucose, glycated hemoglobin [HbA1c%], insulin resistance by homeostatic model assessment, and β-cell function by HOMA-β%) were measured under basal conditions and after 3 months of therapy. 25(OH)D was non-significantly lower in diabetic than non-diabetic HD patients, but significantly lower than healthy subjects at the start of the study. However, vitamin D level increased significantly after 3 months of trial, although the levels did not reach normal values. This vitamin D rise was associated with highly significant improvement in concentrations of fasting blood sugar (FBS), fasting insulin, HbA1c%, and HOMA-β-cell function in diabetic and non-diabetic controls. However, there was a significant rise in insulin resistance after treatment. The percentage of change was evident more in diabetics regarding FBS and 25(OH)D concentration. Adjustment of 25(OH)D level in type 2 diabetic prevalent HD patients may improve, at least with short-term therapy, glycemic control mainly through improving β-cell function.

Diabetic polyneuropathy (DPN) is a complex and multifactorial entity in which various factors besides hyperglycemia play an important role. Symptoms of DPN are sensory, motor or autonomic. Intensive research proved that oxidative stress is the common denominator for the four major destructive pathways of hyperglycemia including increased hexosamine pathway flux, activation of Protein kinase-C (PKC) pathway, increased Advanced Glycated End-products (AGEs) formation, and increased Polyol Pathway flux. National data in Egypt confirms that more than 60% of Egyptian diabetic patients suffer from neuropathy. The most common complications of DPN are Cardiac Autonomic Neuropathy (CAN), diabetic foot and ulcers, neuromuscular disability, and anxiety. In addition, DPN affects the Quality of Life (QoL). According to common clinical practice, the common diagnostic tools are bed-side diagnosis and electrophysiological tests. Early diagnosis is critical to improve the prognosis of DPN and therapeutic intervention in the early phase. In this review, we provide a clear understanding of the pathogenesis, early diagnosis and the good management of DPN. Since the pathogenesis of DPN is multifactorial, its management is based on combination therapy of symptomatic; either pharmacological or non-pharmacological treatments, and pathogenic treatment. Alpha Lipoic Acid (ALA) is a potent anti-oxidant that has several advantages as a pathogenic treatment of DPN. So, in clinical practice, ALA may be prescribed for patients with early neuropathic deficits and symptoms. Patient education has an important role in the managemement of DPN.

Background Chemerin is a novel adipokine, which is suggested to play a role in the development of type 2 diabetes mellitus (T2DM) and its chronic complications. Diabetic retinopathy (DR) is a common complication of diabetes, caused by diabetic microvascular lesions. Objective To investigate the relationship between serum chemerin level and DR in T2DM. Study design Eighty participants were enrolled in the study and were divided into three groups: group I included 40 patients with T2DM complicated with DR, and this group was further subdivided to proliferative diabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR); group II included 20 patients with T2DM not complicated with DR; and group III included 20 apparently healthy patients representing control group. Anthropometric and laboratory measurements including serum chemerin levels were assessed, and values were analyzed to compare the differences among the groups. Results Chemerin level was significantly higher in group I than that in both group II and group III (158.4±25.7 vs. 127.4±20.1 and 116.6±20.3 ng/dl, respectively; P Conclusion Serum chemerin levels were elevated in patients with T2DM with DR than those without DR and were elevated in patients with PDR than NPDR, suggesting that chemerin may be involved in the development of PDR.