The Glycocalyx Bedside Evaluation Plays A Central Role in Diagnosing Type 2 Diabetes Mellitus and in its Primary Prevention

The normal endothelial glycocalyx is composed by glycosaminoglycans (GAGs), proteoglycans and glycoproteins fully integrated into a functional layer attached to the vascular endothelial luminal surface. The shredding of the glycocalyx appears as an essential initial step in the pathophysiology of atherosclerosis and microangiopathic complications of T2DM: the degradation of the glycocalyx enables an abnormal protein filtration at glomerular level and a progressively worsening disorder of the endothelium. These abnormalities underlie both the appearance and progression of the diabetic micro-angiopathy (DMA).11 A number of early microvascular changes with loss of the glycocalyx, before clinically apparent vascular complications, were observed in a population of children affected by type 1 diabetes mellitus.12 These results disclose the glycocalyx as a possible monitoring measurement for earlier detection of DMA and may provide a basis for new diagnostic and therapeutic strategies aiming at protection or restoration of the glycocalyx. This reinforces the importance, starting from the first decade of life, of a proper and timely assessment of the glycocalyx and the microvascular compartment. In the present paper we explore a pathophysiology of T2DM resumed in five-stages suggested by a clinical diagnosis, based on the Auscultatory Percussion (AP) of organs and viscera,13-16 and termed Quantum Biophysical Semeiotics (QBS). This novel technique allows an early assessment of the clinical and preclinical stages of T2DM. Our research is based on a case series observational study run by the senior Author, between 1982 and 2012. The inclusion criteria were the patient’s age (< 40 y.o.), an already established clinical T2DM diagnosis and the absence of the clinical signs of the DMA. The exclusion criteria were the patient’s age (> 40 y.o.) and the presence of already well known complications related to the DMA. A total of 250 patients were recruited and evaluated using the QBS diagnostic method based on the spatial (cm) and temporal (sec) reflexes’ parameters which can be observed during the AP. The following outcome measures were adopted: (1) to establish the variations over time (mean follow-up 10 years) of the parameters appreciated during Overview Mitochondria dysfunctions,1-2 blood-brain barrier impairments,3-5 endothelial6-8 and glycocalyx evaluations9-11 are novel insights into the pathogenesis and early diagnosis of type 2 diabetes mellitus (T2DM). T2DM is characterised by a localised endothelial cell dysfunction that underlies the development of both the microand macrovascular complications of the disease. Various theoretical models and experimental approaches provide data about changes to the structure and functions of the glycocalyx under various types of inflammatory conditions.8 These alterations are suggested to promote inflammatory processes in the vessels and to contribute to the pathogenesis of a