الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is characterized by chronic hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.
The International Diabetes Federation (IDF) MENA region reported that globally, 425 million people have been estimated to have diabetes, among which more than 39 million reside in the MENA region; by 2045, this number is anticipated to escalate to 67 million. Without interventions to halt the increase in diabetes, there will be at least 629 million people living with diabetes by 2045.
Diabetes is a chronic, progressive metabolic disorder which causes both microvascular and macrovascular complications through a myriad of pathophysiological mechanisms. The most common complication is atherosclerosis of cardiovascular and cerebrovascular beds, which has imparted a significant socioeconomic burden to an individual and health sector. Patients with both type-1 and type-2 DM are at high risk for several cardiovascular disorders as coronary heart disease, cardiomyopathy, congestive heart failure; cerebrovascular and peripheral arterial disease. Often diabetes is accompanied by other vascular risk factors as hypertension, obesity and dyslipidemia, which result in accelerated atherosclerosis and premature death.
Carotid intima-media thickness (IMT) is a surrogate marker of early atherosclerosis. It is strongly associated with primary and recurrent stroke. There is an increased risk of stroke in diabetic patients with increasing carotid IMT.
Measuring carotid intima media thickness (c-IMT) of the common carotid artery by B-mode ultrasonography was found to be suitable to monitor early stages of atherosclerosis. Moreover, c-IMT has been reported to be an indicator of CVD. On the other hand, increased c-IMT has been observed in patients with T2DM or metabolic syndrome. Asymptomatic hyperglycemic subjects were shown to have significantly higher c-IMT than healthy control subjects. Therefore, c-IMT has been used as a marker of atherosclerosis progression in patients with T2DM.
Different manifestations of peripheral arterial diseases in diabetics include peripheral arterial disease of lower extremities (PAD), carotid artery disease, aortic aneurysm, renovascular hypertension, abdominal angina, and ischemia of the upper extremities. Atherosclerosis is associated with more proximal PAD localized to aortoiliofemoral segment, where as diabetic vasculopathy involves below the knee arterial segment as popliteal, anterior tibial, peroneal and posterior tibial arteries. DM is accepted as a CVD equivalent. The prevalence of PAD in diabetic patients ranges from 10% to 20.9%.