Clinical importance of haptoglobin testing in diabetes

Introduction Diabetes affects nearly 400 million people worldwide and is expected to increase to nearly 600 million people by 2035. Patients with diabetes mellitus are often more susceptible to a host of multi-organ complications that arise as a result of microvascular and macrovascular dysfunction. These complications equate to the leading cause of morbidity and mortality in diabetic patients from accelerated atherosclerotic disease. Clearly, there are a variety of contributing factors leading to both diabetes and cardiovascular disease. Among these contributors, the most powerful are genetics, environment, and lifestyle. All three factors collide in the development of diabetes. At its heart, diabetes and all of its complications arise from biochemical mechanisms that are propagated by high glucose levels. For diabetes and subsequent complications to be averted, early glycemic control is paramount. This raises the concept of metabolic memory. Metabolic memory is a phenomena that suggests that microvascular damage that results from high glucose can be reversed if glucose levels can be controlled early after the initial hyperglycemic event [1,2]. The phenomena further shows that if glycemic control is not achieved for a period of time, vascular injury will still result even if glycemic control is eventually reached. One such example is the description of a study [3] where test subjects with diabetes were exposed to good glycemic control (5 years), poor glycemic control (5 years) and mixed (2.5 years poor control and 2.5 years good control) glycemic control immediately following a hyperglycemic event. What was found is that unless good glycemic control was achieved immediately after the hyperglycemic event retinopathy would develop within 5 years in both the poorly controlled and mixed. Early glycemic control can halt the pathological effects associated with reactive oxidative stress.