Study of measuring Serum OPG in diabetic patients with peripheral arterial disease

Abstract

Diabetes Mellitus (DM) is now a recognized pandemic and treatment costs of DM and its complications are a major burden on healthcare systems throughout the world. Diabetic vasculopathy (DV) is one of the most important consequence of chronic hyperglycemia, in patients with DM. Peripheral arterial disease (PAD) is a major risk factor for lower-extremity amputation, especially in patients with diabetes Pathogenesis of DV seems to precipitate from a complex interaction between the blood milieu and the vasculature, and mediated by several biochemical modulators. Osteoprotegerin (OPG) is a secretory basic glycoprotein member of the tumor necrosis factor receptor super family and acts as an inhibitor of bone resorption, it plays a critical role in the pathogenesis of atherosclerosis. Hence in our study we aimed to detect relation of osteoprotegerin levels to peripheral arterial disease in type 2 diabetic patients. The study was conducted on 90 diabetic patients who were classified into a group of 40 diabetic patients with peripheral arterial disease compared to age and sex matched randomly selected diabetic patients without peripheral arterial disease or other macro-vascular complication. All patients of this study were submitted to detailed history [including smoking history, history of cerebro-vascular and cardiovascular disease], clinical examination including foot examination for peripheral arterial disease using ABI [ankle brachial index] was done, Cardiovascular risk assessment using ASCVD Risk Estimator was estimated, FBS, PPBS, HbA1c%, eGFR using CKD-EPI creatinine 2009 equation, lipid profile, fundus examination and serum OPG was estimated using ELISA technique. Our results denoting • Significant higher diastolic blood pressure in diabetic patients with PAD (p= 0.008) • Significantly lower eGFR in diabetic patient without PAD (p= 0.023) • Significantly higher serum OPG in diabetic patients with PAD (p < 0.001) • Upon conducting correlation study only ASCVD showed significantly positively correlated with OPG in patient with PAD (p< 0.001) • Upon conducting logistic regression analysis to detect predictors for PAD LDL, OPG, smoking, ASCVD and systolic blood pressure were independent factors that increase the likelihood of being a case