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IS SERUM FERRITIN LEVEL DIFFERENT BETWEEN HEALTHY INDIVIDUALS AND NEWLY DIAGNOSED PATIENTS WITH TYPE 2 DIABETES MELLITUS?: A CASE-CONTROL STUDY

Year 2021, , 102 - 106, 27.04.2021
https://doi.org/10.20492/aeahtd.826939

Abstract

Introduction: This study aims to evaluate whether serum ferritin levels differ between recently diagnosed patients with type 2 diabetes mellitus (DM) and healthy controls, and to assess the relationship between serum ferritin level, insulin resistance and metabolic control in patients with type 2 DM.
Material and methods: This study included 40 patients with recently diagnosed type 2 DM and 40 healthy controls. The Homeostasis Model Assessment of insulin resistance (HOMA-IR) score was used for evaluation of insulin resistance. HOMA-IR scores ≥2.7 were accepted as insulin resistance. The patient and control groups were compared in terms of age, gender, BMI, serum ferritin, insulin, HbA1c, and HOMA-IR scores. If ferritin levels correlated with other parameters was assessed in the patient group. Furthermore, patients with good (HbA1c<7%) and poor glycemic control (HbA1c≥7%) were compared regarding serum ferritin level.
Results: Ninety percent (n=36) of the patient group and 27.5% (n=11) of the controls had HOMA-IR scores ≥2.7. Serum ferritin levels were significantly higher in the patient group (153.57±150.01 vs 62.83±53.18; p=0.003). There were significant positive correlations between serum ferritin and fasting plasma glucose levels (r=0.419 p=0.007), HbA1c (r=0.410, p=0.009) and HOMA-IR score (r=0.320, p=0.044) in the patient group. Mean serum ferritin level of patients with poor metabolic control (201.20±170.67) was significantly higher than ones with good metabolic control (91.92±71.39) among patients with type 2 DM (p=0.047).
Conclusion: Serum ferritin levels were found to be higher in patients with type 2 DM than controls and there was positive correlation between serum ferritin levels and insulin resistance.

Supporting Institution

none

Project Number

none

Thanks

Dr İsmihan SUNAR for her precious support

References

  • 1. Classification and Diagnosis of Diabetes. Diabetes Care 2017; 40: S11-s24.
  • 2. Engelgau MM, Geiss LS, Saaddine JB et al. The evolving diabetes burden in the United States. Ann Intern Med 2004; 140: 945-950.
  • 3. Yang W, Lu J, Weng J et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090-1101.
  • 4. Mokdad AH, Ford ES, Bowman BA et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Jama 2003; 289: 76-79.
  • 5. Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 2005; 365: 1333-1346.
  • 6. Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med 1996; 125: 221-232.
  • 7. Harris MI, Flegal KM, Cowie CC et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998; 21: 518-524.
  • 8. Haffner SM, Miettinen H, Gaskill SP, et al. Decreased insulin secretion and increased insulin resistance are independently related to the 7-year risk of NIDDM in Mexican-Americans. Diabetes 1995; 44: 1386-1391.
  • 9. Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest 2006; 116: 1793-1801.
  • 10. Vandanmagsar B, Youm YH, Ravussin A et al. The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance. Nat Med 2011; 17: 179-188.
  • 11. Duncan BB, Schmidt MI, Pankow JS et al. Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes 2003; 52: 1799-1805.
  • 12. Pradhan AD, Manson JE, Rifai N et al. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. Jama 2001; 286: 327-334.
  • 13. Vozarova B, Weyer C, Lindsay RS et al. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002; 51: 455-461.
  • 14. de Rekeneire N, Peila R, Ding J et al. Diabetes, hyperglycemia, and inflammation in older individuals: the health, aging and body composition study. Diabetes Care 2006; 29: 1902-1908.
  • 15. Merkel PA, Simonson DC, Amiel SA et al. Insulin resistance and hyperinsulinemia in patients with thalassemia major treated by hypertransfusion. N Engl J Med 1988; 318: 809-814.
  • 16. Jehn M, Clark JM, Guallar E. Serum ferritin and risk of the metabolic syndrome in U.S. adults. Diabetes Care 2004; 27: 2422-2428.
  • 17. Iwasaki T, Nakajima A, Yoneda M et al. Serum ferritin is associated with visceral fat area and subcutaneous fat area. Diabetes Care 2005; 28: 2486-2491.
  • 18. Emerit J, Beaumont C, Trivin F. Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother 2001; 55: 333-339.
  • 19. Ford ES, Cogswell ME. Diabetes and serum ferritin concentration among U.S. adults. Diabetes Care 1999; 22: 1978-1983.
  • 20. Chen J, Wildman RP, Hamm LL et al. Association between inflammation and insulin resistance in U.S. nondiabetic adults: results from the Third National Health and Nutrition Examination Survey. Diabetes Care 2004; 27: 2960-2965.
  • 21. Williams R, Smith PM, Spicer EJ et al. Venesection therapy in idiopathic haemochromatosis. An analysis of 40 treated and 18 untreated patients. Q J Med 1969; 38: 1-16.
  • 22. Dymock IW, Cassar J, Pyke DA et al. Observations on the pathogenesis, complications and treatment of diabetes in 115 cases of haemochromatosis. Am J Med 1972; 52: 203-210.
  • 23. Ascaso JF, Pardo S, Real JT et al. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care 2003; 26: 3320-3325.
  • 24. Tang Q, Li X, Song P, Xu L. Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future. Drug Discov Ther 2015; 9: 380-385.
  • 25. Touitou Y, Proust J, Carayon A et al. Plasma ferritin in old age. Influence of biological and pathological factors in a large elderly population. Clin Chim Acta 1985; 149: 37-45.
  • 26. Woo J, Mak YT, Law LK, et al. Plasma ferritin in an elderly population living in the community. J Med 1989; 20: 123-134.
  • 27. Dinneen SF, O'Mahony MS, O'Brien T et al. Serum ferritin in newly diagnosed and poorly controlled diabetes mellitus. Ir J Med Sci 1992; 161: 636-638.
  • 28. Hernandez C, Lecube A, Carrera A, et al. Soluble transferrin receptors and ferritin in Type 2 diabetic patients. Diabet Med 2005; 22: 97-101.
  • 29. Kim NH, Oh JH, Choi KM et al. Serum ferritin in healthy subjects and type 2 diabetic patients. Yonsei Med J 2000; 41: 387-392.
  • 30. Chen KW, Boyko EJ, Bergstrom RW et al. Earlier appearance of impaired insulin secretion than of visceral adiposity in the pathogenesis of NIDDM. 5-Year follow-up of initially nondiabetic Japanese-American men. Diabetes Care 1995; 18: 747-753.
  • 31. Weyer C, Bogardus C, Mott DM, et al. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest 1999; 104: 787-794.
  • 32. Chen L, Li Y, Zhang F et al. Association of serum ferritin levels with metabolic syndrome and insulin resistance in a Chinese population. J Diabetes Complications 2017; 31: 364-368.
  • 33. Fernandez-Real JM, Ricart-Engel W et al. Serum ferritin as a component of the insulin resistance syndrome. Diabetes Care 1998; 21: 62-68.
  • 34. Facchini FS. Effect of phlebotomy on plasma glucose and insulin concentrations. Diabetes Care 1998; 21: 2190.
  • 35. Hua NW, Stoohs RA, Facchini FS. Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians. Br J Nutr 2001; 86: 515-519.
  • 36. Ascherio A, Rimm EB, Giovannucci E et al. Blood donations and risk of coronary heart disease in men. Circulation 2001; 103: 52-57.

SERUM FERRİTİN DÜZEYİ SAĞLIKLI BİREYLERLE YENİ TANI TİP 2 DİYABET HASTALARINDA FARKLI MIDIR?: VAKA KONTROL ÇALIŞMASI

Year 2021, , 102 - 106, 27.04.2021
https://doi.org/10.20492/aeahtd.826939

Abstract

Giriş: Bu çalışmanın amacı yeni tanı tip 2 DM hastaları ile sağlıklı bireyler arasında serum ferritin düzeyi açısından fark olup olmadığını değerlendirmek, ayrıca tip 2 DM hastalarında serum ferritin düzeyinin insülin direnci ve metabolik kontrol ile ilişkisini araştırmaktır.
Materyal ve metod: Çalışmaya 40 yeni tanı tip 2 DM hastası ile 40 sağlıklı kişiden oluşan kontrol grubu dahil edildi. İnsülin direncini değerlendirmek için Homeostasis Model Assessment of insülin resistance (HOMA-IR) skoru kullanıldı. HOMA-IR skorunun ≥2,7 olması insulin direnci olarak kabul edildi. Hasta ve kontrol grubunu oluşturan bireyler yaş, cinsiyet dağılımı, VKİ, serum ferritin düzeyi, insülin düzeyi ve HOMA-IR skoru açısından karşılaştırıldı. Hasta grubundaki bireylerin ferritin düzeyi ile diğer parametreler arasındaki ilişki incelendi. Ayrica iyi metabolik kontrollü (HbA1c<%7) ve kötü metabolik kontrollü (HbA1c≥%7) hastaların serum ferritin düzeyleri karşılaştırıldı.
Bulgular: Hasta grubunun %90’ında (n=36), kontrol grubunun %27,5’inde (n=11) HOMA-IR skoru ≥2,7 olarak tespit edildi. Hasta grubunun ferritin düzeyi kontrol grubuna göre anlamlı olarak yüksek saptandı (153,57±150,01’e 62,83±53,18; p=0,003). Hasta grubunda ferritin düzeyi ile açlık kan şekeri (r=0.419 p=0.007), HbA1c (r=0.410, p=0.009) ve HOMA-IR skoru (r=0.320, p=0.044) arasında pozitif bir korelasyon tespit edildi. Tip 2 DM hastalarında kötü metabolik kontrollü hastaların ortalama ferritin düzeyleri (201,20±170,67) iyi metabolik kontrollü hastaların ortalama ferritin düzeylerine (91,92±71,39) göre anlamlı olarak daha yüksek saptandı (p=0,047).
Sonuç: Tip 2 DM hastalarında serum ferritin düzeyi sağlıklı bireylere göre yüksek saptanmış olup serum ferritin düzeyi ile insülin direnci arasında pozitif bir ilişki bulunmuştur.

Project Number

none

References

  • 1. Classification and Diagnosis of Diabetes. Diabetes Care 2017; 40: S11-s24.
  • 2. Engelgau MM, Geiss LS, Saaddine JB et al. The evolving diabetes burden in the United States. Ann Intern Med 2004; 140: 945-950.
  • 3. Yang W, Lu J, Weng J et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090-1101.
  • 4. Mokdad AH, Ford ES, Bowman BA et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Jama 2003; 289: 76-79.
  • 5. Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 2005; 365: 1333-1346.
  • 6. Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med 1996; 125: 221-232.
  • 7. Harris MI, Flegal KM, Cowie CC et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998; 21: 518-524.
  • 8. Haffner SM, Miettinen H, Gaskill SP, et al. Decreased insulin secretion and increased insulin resistance are independently related to the 7-year risk of NIDDM in Mexican-Americans. Diabetes 1995; 44: 1386-1391.
  • 9. Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest 2006; 116: 1793-1801.
  • 10. Vandanmagsar B, Youm YH, Ravussin A et al. The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance. Nat Med 2011; 17: 179-188.
  • 11. Duncan BB, Schmidt MI, Pankow JS et al. Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes 2003; 52: 1799-1805.
  • 12. Pradhan AD, Manson JE, Rifai N et al. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. Jama 2001; 286: 327-334.
  • 13. Vozarova B, Weyer C, Lindsay RS et al. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002; 51: 455-461.
  • 14. de Rekeneire N, Peila R, Ding J et al. Diabetes, hyperglycemia, and inflammation in older individuals: the health, aging and body composition study. Diabetes Care 2006; 29: 1902-1908.
  • 15. Merkel PA, Simonson DC, Amiel SA et al. Insulin resistance and hyperinsulinemia in patients with thalassemia major treated by hypertransfusion. N Engl J Med 1988; 318: 809-814.
  • 16. Jehn M, Clark JM, Guallar E. Serum ferritin and risk of the metabolic syndrome in U.S. adults. Diabetes Care 2004; 27: 2422-2428.
  • 17. Iwasaki T, Nakajima A, Yoneda M et al. Serum ferritin is associated with visceral fat area and subcutaneous fat area. Diabetes Care 2005; 28: 2486-2491.
  • 18. Emerit J, Beaumont C, Trivin F. Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother 2001; 55: 333-339.
  • 19. Ford ES, Cogswell ME. Diabetes and serum ferritin concentration among U.S. adults. Diabetes Care 1999; 22: 1978-1983.
  • 20. Chen J, Wildman RP, Hamm LL et al. Association between inflammation and insulin resistance in U.S. nondiabetic adults: results from the Third National Health and Nutrition Examination Survey. Diabetes Care 2004; 27: 2960-2965.
  • 21. Williams R, Smith PM, Spicer EJ et al. Venesection therapy in idiopathic haemochromatosis. An analysis of 40 treated and 18 untreated patients. Q J Med 1969; 38: 1-16.
  • 22. Dymock IW, Cassar J, Pyke DA et al. Observations on the pathogenesis, complications and treatment of diabetes in 115 cases of haemochromatosis. Am J Med 1972; 52: 203-210.
  • 23. Ascaso JF, Pardo S, Real JT et al. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care 2003; 26: 3320-3325.
  • 24. Tang Q, Li X, Song P, Xu L. Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future. Drug Discov Ther 2015; 9: 380-385.
  • 25. Touitou Y, Proust J, Carayon A et al. Plasma ferritin in old age. Influence of biological and pathological factors in a large elderly population. Clin Chim Acta 1985; 149: 37-45.
  • 26. Woo J, Mak YT, Law LK, et al. Plasma ferritin in an elderly population living in the community. J Med 1989; 20: 123-134.
  • 27. Dinneen SF, O'Mahony MS, O'Brien T et al. Serum ferritin in newly diagnosed and poorly controlled diabetes mellitus. Ir J Med Sci 1992; 161: 636-638.
  • 28. Hernandez C, Lecube A, Carrera A, et al. Soluble transferrin receptors and ferritin in Type 2 diabetic patients. Diabet Med 2005; 22: 97-101.
  • 29. Kim NH, Oh JH, Choi KM et al. Serum ferritin in healthy subjects and type 2 diabetic patients. Yonsei Med J 2000; 41: 387-392.
  • 30. Chen KW, Boyko EJ, Bergstrom RW et al. Earlier appearance of impaired insulin secretion than of visceral adiposity in the pathogenesis of NIDDM. 5-Year follow-up of initially nondiabetic Japanese-American men. Diabetes Care 1995; 18: 747-753.
  • 31. Weyer C, Bogardus C, Mott DM, et al. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest 1999; 104: 787-794.
  • 32. Chen L, Li Y, Zhang F et al. Association of serum ferritin levels with metabolic syndrome and insulin resistance in a Chinese population. J Diabetes Complications 2017; 31: 364-368.
  • 33. Fernandez-Real JM, Ricart-Engel W et al. Serum ferritin as a component of the insulin resistance syndrome. Diabetes Care 1998; 21: 62-68.
  • 34. Facchini FS. Effect of phlebotomy on plasma glucose and insulin concentrations. Diabetes Care 1998; 21: 2190.
  • 35. Hua NW, Stoohs RA, Facchini FS. Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians. Br J Nutr 2001; 86: 515-519.
  • 36. Ascherio A, Rimm EB, Giovannucci E et al. Blood donations and risk of coronary heart disease in men. Circulation 2001; 103: 52-57.
There are 36 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original research article
Authors

Veli Sunar 0000-0003-4672-4621

Project Number none
Publication Date April 27, 2021
Submission Date November 16, 2020
Published in Issue Year 2021

Cite

AMA Sunar V. IS SERUM FERRITIN LEVEL DIFFERENT BETWEEN HEALTHY INDIVIDUALS AND NEWLY DIAGNOSED PATIENTS WITH TYPE 2 DIABETES MELLITUS?: A CASE-CONTROL STUDY. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. April 2021;54(1):102-106. doi:10.20492/aeahtd.826939