LIPID ASSOCIATED OXIDATIVE

STRESS IN DIABETES MELLITUS

PATIENTS WITH
RETINOPATHY

PS/MLB/14/0121
PS/MLB/15/0001
PS/MLB/15/0004
PS/MLB/15/0081 1
 CONTENT
 INTRODUCTION

 PROBLEM STATEMENT

 AIM AND SPECIFIC OBJECTIVES

 JUSTIFICATION

 METHODOLOGY

 DATA ANALYSIS

 BUDGET AND TIMELINE

 REFERENCES

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 INTRODUCTION
• Diabetes retinopathy(DR) is a microvascular complication of diabetes mellitus. It is
a disease that affects blood vessels in the retina and characterized by gradual and
progressive changes in the vasculature of the retina caused by chronic
hyperglycemia.

• DR currently affects almost 100 million people worldwide and is becoming an

ever-increasing health burden (Leashe,2016) According to report of the 27th
annual general and scientific meeting of the ophthalmological society of Ghana in
October 2017,out of the 28 million Ghanaians, 270 000 is estimated to have
diabetes and 93 000 have diabetes retinopathy.

• It is therefore worthwhile researching in this area to understand the complication

and how to prevent or slow it progression in cases where the complication has
already established itself.

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 PROBLEM STATEMENT
• Oxidative stress and dyslipidemia have been implicated in the pathogenesis of many
complications of diabetes mellitus (Esra et al., 2012)

• More and more recent publications have described the effects of oxidized lipids in atherosclerosis
and associated risk factors (Sampat, 2012), with very few studies investigating serum Ox-LDL
association with diabetes retinopathy (Ganjifrockwala et al.,2016).There is scanty data in Sub-
Saharan Africa to confirm the findings of this few studies.

• The association between conventional lipid profile and diabetes retinopathy has shown to be
insensitive. This insensitivity has been hypothesized to be due to inability of conventional lipid
profile to reliably identify subclass of lipids or lipoproteins that may have a pathogenic role
(Modjtahedi et al., 2016)

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 PROBLEM STATEMENT
CONT’D
• Lipoprotein (A) has been shown to be atherogenic (Yung et al., 2016) but few
studies that have investigated its association with diabetes retinopathy have
shown inconsistent results. This necessitate that more studies be done to
establish this association.

• Also there has not been any study that has investigated the relationship between
Ox-LDL and Lipoprotein(A) and how they both contribute or are associated with
diabetes retinopathy in the same study subjects.

• This study therefore seeks to determine the association that exist between OX-
LDL, lipoprotein(A) and diabetes retinopathy in type 2 diabetes mellitus patients

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AIM
The aim of this study is to assess dyslipidemia and oxidative stress, and its

association with diabetes retinopathy.

SPECIFIC OBJECTIVES
• To determine conventional lipid profile and lipoprotein (A) levels using chemistry
analyzer and ELISA respectively.
• To measure serum Total antioxidant capacity (TAC) and -LDL using the ABTS
method and ELISA respectively.
• To assess the clinical features of diabetes retinopathy.

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 METHODOLOGY
Study site and Study design and
sampling method Sampling method
 Diagnosis and classification of
 This will be a case control diabetes retinopathy will be
 The study will be study involving 90 based on ophthalmoscopy results
conducted in cape coast participants who will be
at the Diabetes and recruited by the
Ophthalmology units of  Questionnaires will be
convenience sampling
administered to participants to
the Cape Coast Teaching method obtain some information
Hospital . important in this study. Some of
 This study will involve the information that will be
non-diabetes patients captured include age, duration of
and type 2 diabetes diabetes, blood pressure etc.
patients with retinopathy
and those without
retinopathy.

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 METHODOLOGY CONT’D

30 diabetes 30 diabetes
30 Non-diabetes participants
participants with
participants without
retinopathy
retinopathy

5ml of venous
blood sample after
12 hours overnight
fasting

Measurement of
1. lipid profile 2. TAC
3. serum OX-LDL
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4.Lipoprotein(A)
 DATA ANALYSIS
• Results will be reported as mean ± standard deviation (SD)

• Statistical analysis will be performed using one-way analysis of variance (ANOVA). If the overall P-
value is found to be statistically significant (P < 0.05), further comparisons among groups will be
made according to the post hoc Tukey’s procedure multiple comparison test, and linear
regression analysis.

• All statistical analyses will be performed using GraphPad Prism 7 and IBM SPSS version 25. All
Graphs will be sketched using SPSS version 25.

EXPECTED OUTCOME
Serum OX-LDL and lipoprotein (A) will be higher in the type 2 diabetes group with retinopathy than
in the type 2 diabetes group without retinopathy and the non-diabetes group.
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 BUDGET AND TIMELINE
Timeline Budget
ACTIVITY TIME Item Quantity Unit cost Total/GH₵
5th November 2018
Proposal defense Sample tubes 2 packs 75 150.00
Seeking ethical approval 10th Nov- 10th
December,2018 3805.00
Reagent kits
Procurement of Materials 10th December 2018 to Syringe
or Equipment 11th January 2019 2 boxes 50 100.00
Recruitment and 15th -22nd January 2019 cotton
interaction with interest 1 25 25.00
groups 70% alcohol 500ml 10 10.00
Sample Collection and 4th March – 6th April 2019 Phlebotomy plaster 2 boxes 5 10.00
analysis
Data compilation & 20th April – 6th May 2019 Transportation 700.00
analysis
User facility fee 300.00
Write up & submission of 10th May -June
project report
Miscellaneous 120.00
Total 5310.00
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 REFERENCES
• 1. Lyons, T.J, Li, W., Wells-Knecht, M.C, et al (1994) Toxicity of mildly modified
low-density lipoproteins to cultured retinal capillary endothelial cells and pericytes.
Diabetes 43:1090-1095.
• 2. Eldin, E., Nour, M., Almarzouki, A., Assiri, A. M., & Elsheikh, O. M. (2014).
Oxidized low density lipoprotein and total antioxidant capacity in type-2 diabetic and
impaired glucose tolerance Saudi men, 6(1), 1–10. https://doi.org/10.1186/1758-5996-
6-94
• 3. Ergun, U. G. O., Oztuzun, S., & Seydaoglu, G. (2004). Lipoprotein (A) levels in
type 2 diabetic patients with diabetic retinopathy. The Medical Journal of Malaysia,
59(3), 406–410.
• 4. Fu, D., Yu, J. Y., Wu, M., Du, M., Chen, Y., Abdelsamie, S. A., … Lyons, T. J.
(2014). Immune complex formation in human diabetic retina enhances toxicity of
oxidized LDL towards retinal capillary pericytes. Journal of Lipid Research, 55(5),
860–869. https://doi.org/10.1194/jlr.M045401
• 5. Ganjifrockwala, F., Joseph, J., & George, G. (2016). Serum Oxidized LDL Levels
in Type 2 Diabetic Patients with Retinopathy in Mthatha Region of the Eastern Cape
Province of South Africa, 2016.

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