Archives of General Internal Medicine

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Serum Osteocalcin Level in Type 2 Diabetes and its Relation to the Severity of Coronary Heart Disease, Insulin Resistance and High Sensitive-CRP.

Introduction: Among macrovascular diabetes complications, CAD has been associated with diabetes in numerous studies beginning with the Framingham study. More recent studies have shown that the risk of myocardial infarction (MI) in people with diabetes is equivalent to the risk in non-diabetic patients with a history of previous MI. Osteocalcin is the most abundant noncollagenic protein of the bone matrix. It has have been reported to be inversely associated with measures of insulin resistance Recent cross sectional and prospective studies suggest it to be an established surrogate of atherosclerosis and related cardiovascular risk. Aim of the work: The objective of the study was to investigate the link between serum osteocalcin and hs-CRP in the different degrees of severity of atherosclerotic CAD in patients with and without T2DM. Patients and method: This cross-sectional study was, conducted on 160 male subjects divided into four groups: Group A: 40 CAD patients with T2DM. Group B: 40 CAD patients without T2DM. Group C: 40 T2DM patients without CAD. Group D: 40 healthy control subjects matched for age, sex and socioeconomic status. They were subjected to: complete history taking, thorough clinical examination, Lab investigations (routine, serum insulin, osteocalcin, hs-CRP), ECG, Groups A and B subjected to Cardiac catheterization and coronary angiography. Angiographic analysis was done using the SYNTAX score (SS). Results: there was a statistically significant decrease in serum osteocalcin level in diabetic than non-diabetic subjects; also there was a statistically significant negative correlation between serum osteocalcin and fasting plasma glucose and HbA1c. While there was no difference in serum osteocalcin level between CAD and non CAD subjects and no difference between 3 syntax group of severity of CAD patients. Hs-CRP was statistically significantly higher in CAD than non CAD patients, smokers than non-smokers, syntax group 3 than group 2, and there was a statistically significant positive correlation with the duration of CAD. There was no difference in serum hs-CRP level between diabetic and non-diabetic subjects. Conclusion: Serum osteocalcin level may be considered as an indicator to the severity of glycemic control. While serum hs-CRP level is demonstrated to be an indicator to the degree of atherosclerosis and smoking as both represent a state of chronic inflammation.

Author(s): Nagwa Amr Lacine, Magy Abd El-Monem Shalash, Eman Youssef Moursy, Mohamed Ahmed Sadaka, Gihane Ibrahim Khalil, Asmaa kamal Eldine Elshobaky