The relation between oxidative stress and adhesion molecules in Egyptian children and adolescents with type 1 diabetes mellitus

Background: Antioxidant potential decreases while plasma lipid peroxidation products increase in type1 diabetes mellitus. The vascular endothelium is a major target of oxidative stress (OS). Reactive oxygen species signal events leading to impairment of endothelial function and promotion of leukocyte adhesion to the vascular endothelium.. Objective: To explore the relation between OS and adhesion molecules in type1 diabetes and correlate it with the state of metabolic control, disease duration and microvascular complications (MVCs). Design: Thirty-eight type 1 diabetics were included: 22 patients with disease duration less than 5 years and 16 patients with duration of 5 years or more. Thirty healthy age and sex matched subjects served as controls. They were assessed clinically. Laboratory investigations included, random blood sugar (RBS), glycated hemoglobin (HbA1c), fasting lipid profile and measurement of serum malondialdehyde (MDA) as a marker of lipid peroxidation and serum soluble P-selectin as a marker of endothelial/platelet activation. Results: Serum MDA and P-selectin were significantly elevated in type 1 diabetics compared to controls with the highest level in diabetics with disease duration of 5 years or more (p <0.0001). Both MDA and P-selectin levels were significantly elevated in complicated compared to non complicated diabetics (P < 0.0001) with strong relation to complication severity. Serum MDA level was positively correlated with serum P-selectin level in diabetics (p 0.0001). Serum MDA and P-selectin were positively and significantly correlated with disease duration (p < 0.0001 ), RBS (p < 0.0001,p=0.001 respectively), HbA1c (p < 0.0001), diastolic blood pressure (p=0.03,p=0.005 respectively), total cholesterol (p=0.04,p=0.02, respectively), triglycerides (p=0.006, p < 0.0001 respectively) and low density lipoproteins (p=0.03,p=0.05 respectively) but negatively correlated with high density lipoproteins(p=0.03). On multiple regression analysis, HbA1c had the strongest effect on both MDA and P-selectin levels (P <0.0001). Cut off values for serum MDA and Pselectin equal to 8.035 nmoles/ml and 45.15ng/dl respectively for early detection of diabetic MVCs were defined. Conclusion: Levels of MAD and P-selectin are elevated in type1 diabetics with evident relation to disease duration, metabolic control and severity of MVCs. Hence both of them might act as good markers to identify diabetics who are more susceptible to develop vascular disease. Keywords: Type1 diabetes, oxidative stress, P-selectin, adhesion molecules, microvascular complications Egypt J Pediatr Allergy Immunol 2009; 7(2): 65-77