ASSOCIATION OF ANGIOTENSIN CONVERTING ENZYME GENE POLYMORPHISMS WITH RISK OF DIABETIC 2 AND ITS COMPLICATION AMONG PATIENTS VISITING BAHIRDAR FELEGEHIWOT REFERRAL HOSPITAL NORTH WEST, ETHIOPIA.

Abstract

Type 2 diabetes affect large population and able to develop micro and macrovascular complicati ons. There are many non- genetic and genetic factors or both are associated for the occurrence of type 2 diabetes mellitus (T2DM) and diabetic complications. Genes of the renin angiotensin syst em angiotensin converting enzyme insertion/deletion gene polymorphism has been associated wi th the risk of type 2 diabetes and its complications. The aim of the present study was to investigate the association of angiotensin converting enzyme gene polymorphism, risk of type 2 diabetes and its complications. A total of 222 subjects (111 T2DM and 111 healthy controls) were collected from Bahir Dar Felegehiwot referral hospital and Bahir Dar town, respectively by using non-probability purposive sampling techniques. Patients with T2DM were selected using non probability purposive sampling technique. Minidray fully automated analyzer was used for biochemical tests such as glucose, total cholesterol, triglycerol, urea and creatinine to assess the associated risk factors. The ACE I/D genotypes were identified by Polymerase chain reaction (PCR) using appropriate primers and PCR reaction conditions. The present study revealed that the frequency of DD genotype and D allele were higher in type 2 diabetes mellitus compared to healthy controls (DD, 64.2% Vs 35.6% P < 0 .001) and ( D, 79.3% Vs 59.9% P < 0.001). DD genotype showed three fold increase risk towards T2DM as compared to II Genotype (OR: 2.984, CI: 1.332 - 6.689, P < 0.02). The D allele carriers had five times high risk of getting diabetic as compared to I allele. (OR, D 2.178; CI: 1.168 – 3.232 P < 0.001 Vs I OR, 0.459; CI: 0.309 – 0.681 P < 0.001). To determine whether ACE gene polymorphism was associated with diabetic complication, patients with type 2 diabetes were divided into diabetic hypertension, diabetic retinopathy and diabetic nephropathy. The frequency of ACE DD genotype and D allele in patients with diabetic hypertension were significantly higher than T2DM patients (41.6% and 60.4% Vs 19.5% and 37.8% P < 0.01). The frequency of ACE DD genotype and D allele in patients with diabetic retinopathy were also higher than T2DM patients (28.6% and 44.1% Vs 19.5% and 37.8%). The frequency of ACE genotype in patients with diabetic nephropathy did not show significant association. This might be due to small sample size that lack statistical power. This study indicated that the frequency of ACE DD genotype and D allele were markedly higher in patients with type 2 diabetes. This genotype and allele were significantly associated with diabetic hypertension and diabetic retinopathy patients. Keywords: ACE gene polymorphism; diabetes complications; diabetic hypertension; diabetic retinopathy; diabetic nephropathy