ANGIOTENSIN CONVERTING ENZYME ACTIVITY IN TYPE 2 DIABETES MELLITUS PATIENTS IN UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL, PORT HARCOURT

Abstract

Background: Diabetes mellitus (DM) is a chronic metabolic disorder, in which
poor glycaemic control results in complications such as hypertension and
nephropathy with dyslipidaemia as a risk factor. Hyperglycaemia causes altered
lipid metabolism (dyslipidaemia) with the formation of advanced glycation end
products (AGEs) and protein kinase C (PKC), which accelerate atherosclerosis and
alter gene transcription for contractile protein respectively, with eventual
stiffening of the vascular wall leading to hypertension. The rising prevalence of
diabetes in Nigeria, and Africa requires critical attention in the patient
management. Angiotensin converting enzyme (ACE) regulates blood pressure, and
its increased activity results in vascular complications which are also implicated in
DM. This study measured and compared the serum angiotensin converting
enzyme (ACE) activity in: (1) a group of type 2 diabetics with healthy (control)
subjects, (2) diabetics without hypertension and diabetics with hypertension, and
(3) with biochemical parameters of renal function in type 2 diabetics with
hypertension.
Methods: This was a cross-sectional descriptive study conducted in the University
of Port Harcourt Teaching Hospital using confirmed type 2 diabetic patients (out
patients and in-patients) and apparently healthy subjects. They were evaluated
for ACE activity. SPSS version 20.0 was used for statistical analysis. Bar chart, and
Student’s t-test were used for analysis of the distribution, mean differences and
comparison respectively.
Results: Two hundred and forty (240) subjects comprising 120 type 2 diabetics,
and 120 controls were studied. Fifty eight of which were males representing.
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48.3%, and 62 female diabetics (51.7%) with 66 males (55.0%) and 54 female
controls (45.0%). The Mean (± SD) serum angiotensin converting enzyme (ACE)
activity in control subjects was 23.69(± 0.84) IU/L. The ACE activity was
statistically significant (p ≤ 0.05) and higher in diabetic subjects (particularly
males) than in the control subjects. The ACE activity was not significantly different
with duration, and between diabetics with hypertension and DM subjects without
hypertension (p ≥ 0.05). The parameters of renal function had positive association
with the duration of diabetes >1year and hypertension. There was no association
between ACE activity and the parameters of renal function.

Conclusion: Evaluating the angiotensin converting enzyme (ACE) activity, it was
observed that diabetics, particularly the males had higher activity of the enzyme
than the control subjects. There were no differences in the ACE activity with
duration of diabetes and between hypertensive and non-hypertensive diabetics.
Rather, there was evidence of progression of diabetes on the kidney.
Hypertension also affected renal function.