The Relationship of Oxidative and Metabolic Parameters With Hemoglobin A1c in Type 2 Diabetes Mellitus

Abstract

Objectives: It has been shown that patients with Diabetes Mellitus (DM) have increased oxidative stress and impaired antioxidant defense system which appears to be a contributory factor for initiation and progression of complications in diabetes. In this study, we aimed to demonstrate the relationship of oxidative and metabolic parameters with Hemoglobin A1c in type 2 diabetes mellitus. Materials and Methods: One hundred and fourteen male and female patients with new onset type 2 diabetes mellitus (DM) without complications were recruited for this study. Besides their systolic and diastolic blood pressures, Body Mass Index (BMI) and age, serum levels of fasting blood sugar, Hemoglobin A1c (HbA1c), LDL, HDL, triglyceride (TG), H2O2, antioxidant capacity (AOC), glutathione (GSH) and malondialdehyde (MDA) were determined in these patients. The median HbA1c value of the subjects was determined and the oxidative and metabolic parameters of the ones who were below the median value were compared with the oxidative and metabolic parameters of the ones who were above the median value. Parametric values were statistically analyzed by student-t test. Results: There wasn’t any statistically significant difference in terms of age and sex between the groups. The subjects who had HbA1c levels below the median value (7,58) showed lower systolic and diastolic blood pressure compared to ones who had HbA1c levels above the median value. This result was statistically significant (p<0.05). The subjects who had HbA1c levels below the median value (7,58) also showed lower serum triglyceride levels compared to ones who had HbA1c levels above the median value. This result was also statistically significant (p<0.05). The subjects who had HbA1c levels below the median value (7,58) had lower LDL, H2O2 and MDA levels, and higher HDL and GSH levels but these results were not found to be statistically significant. Conclusion: In type 2 DM patients, as HbA1 level increases, oxidative stress increases, metabolic parameters increase and GSH decreases. Therefore, improvement in lifestyle to reduce HbA1c is very important in diabetic patients

Keywords

• Oxidative Stress,Hemoglobin A1c,Diabetes Mellitus

Tip 2 Diabetes Mellitus’lu Hastalarda Oksidatif ve Metabolik Parametrelerin HemoglobinA1c ile İlişkisi

Abstract

Amaç: Bugüne kadar yapılan çalışmalar, tip 2 diabetes mellitus (DM)’lu hastalarda artmış oksidatif stres ve bozulmuş antioksidan savunma sisteminin diyabete bağlı komplikasyonların başlaması ve ilerlemesinde rol oynadığını ortaya koymuşlardır. Çalışmamızda tip 2 diabetes mellitus’lu hastalarda oksidatif stres belirteçleri, antioksidan ve metabolik parametrelerin Hemoglobin A1c (HbA1c) değerleri ile ilişkisini ortaya koymaya çalıştık. Materyal ve Metot: Yeni tanı almış komplikasyonsuz Diabetes Mellitus Tip 2 olan 114 hastanın; sistolik ve diyastolik kan basıncı, beden kütle indeksi (BKİ), yaş özelliklerinin yanı sıra açlık kan şekeri, HbA1c, LDL, HDL, trigliserid (TG), hidrojen Peroksit (H2O2), antioksidan kapasite (AOK), glutatyon (GSH) ve malondialdehid (MDA) seviyelerine bakıldı. Bu hastaların ortanca HbA1c değeri hesaplanıp ortalamanın altında ve üstünde kalan hastalarda oksidatif ve metabolik parametreler karşılaştırıldı. Parametrik değerlerin istatistiksel analizinde student-t testi kullanıldı. Bulgular: Deneklerimizin yaş ve cinsiyet dağılımı tamamen eşit idi. Hemoglobin A1c ortanca değeri (7,58) altında kalan deneklerimizin sistolik kan basıncı Hemoglobin A1c değerleri daha yüksek olanlara kıyasla anlamlı olarak daha düşük bulundu (p<0,05). Yine Hemoglobin A1c ortanca değerin altında kalan deneklerimizde serum trigliserid değerleri, HbA1c değerleri daha yüksek olanlara kıyasla anlamlı olarak daha düşük bulundu (p<0,05). HbA1c değerleri ortanca değerin altında kalan hastalarda serum LDL, MDA ve H2O2 değerleri daha düşük bulundu ancak her iki grup arasındaki fark istatistiksel olarak anlamlı değildi. HbA1c değerleri ortanca değerin altında kalan hastalarda serum HDL ve GSH değerleri daha yüksek bulundu ancak her iki grup arasındaki fark istatistiksel olarak anlamlı değildi. Sonuç: Tip 2 DM’li hastalarda HbA1c değeri arttıkça oksidatif stres artmakta, metabolik parametreler yükselmekte ve GSH düşmektedir. Bu nedenle, DM hastalarında HbA1c azaltabilecek sağlıklı yaşam tarzı değişiklikleri büyük önem taşımaktadır.

Keywords

• Oksidatif stres,Hemoglobin A1c,Diabetes Mellitus

References

1. D'Souza JM, D'Souza RP, Vijin VF, Shetty A, Arunachalam C, Pai VR, Shetty R, Faarisa A. High predictive ability of glycated hemoglobin on comparison with oxidative stress markers in assessment of chronic vascular complications in type 2 diabetes mellitus. Scand J Clin Lab Invest 2016;76(1):51-7.
2. Vlassopoulos A, Lean ME, Combet E. Oxidative stress, protein glycation and nutrition--interactions relevant to health and disease throughout the lifecycle. Proc Nutr Soc. 2014 Aug;73(3):430-8.
3. Kutan Fenercioglu A, Saler T, Genç E, Sabuncu H, Altuntaş Y. The effects of polyphenol containing antioxidants on oxidative stress and lipid peroxidation in type 2 diabetes mellitus without complications. Journal of Endocrinological Investigation, 2010;33:118-124.
4. Aouacheri O, Saka S, Krim M, Messaadia A, Maidi I. The investigation of the oxidative stress-related parameters in type 2 diabetes mellitus. Can J Diabetes 2015;39(1):44- 9.
5. Gillani SW, Azeem E, Siddiqui A, Mian RI, Poh V, Sulaiman SA, Baig MR. Oxidative Stress Correlates (OSC) in diabetes mellitus patients. Curr Diabetes Review 2016;12(3):279-84.
6. Fatani SH, Babakr AT, NourEldin EM, Almarzouki AA. Lipid peroxidation is associated with poor control of type-2 diabetes mellitus. Diabetes Metab Syndr 2016;10(2):64-7.
7. Miranda M, Muriach M, Almansa I, Arnal E, Messeguer A, Diaz-Llopis M, et al. CR-6 protects glutathione peroxidase activity in experimental diabetes. Free Radic Biol and Med 2007;43:1494–8.
8. Atli T, Keven K, Avci A, Kutlay S, Turkcapar N, Varli M. Oxidative stress and antioxidant status in elderly diabetes mellitus and glucose intolerance patients. Arch Gerontol Geriatr 2004;39:269–75.

9. Griesmacher A, Kindhauser M, Andert SE, Schreiner W, Toma C, Knoebl P et al. Enhanced serum levels of thiobarbituric-acid-reactive-substances in diabetes mellitus. Am J Med 1995;98:469-75.
10. Marfella R, Nappo F, Angelis L, Paolisso G, Tagliamonte MR, Giugliano D. Hemodynamic effects of acute hyperglycemia in type 2 diabetic patients. Diabetes Care 2000;23:658–63.
11. Ugochukwu NH, Figgers CL. Attenuation of plasma dyslipidemia and oxidative damage by dietary caloric restriction in streptozotocin-induced diabetic rats. Chem Biol Interact 2007;169: 32-41.
12. Henning SM, Zhang JZ, McKee RW, Swendseid ME, Jacob RA. Glutathione blood levels and other oxidant defense indices in men fed diets low in vitamin C. J Nutr 1991;121:1969-75.
13. Seeram NP, Aviram M, Zhang Y, et al. Comparison of antioxidant potency of commonly consumed polyphenol-rich beverages in the United States. J Agric Food Chem 2008;56:1415-22.
14. Kaur R, Arora S, Singh B. Antioxidant activity of the phenol rich fractions of leaves of Chukrasia tabularis A. Juss. Bioresour Technol 2008;99:7692-8.
15. Ignarro LJ, Byrns RE, Sumi D, Nigris FD, Napoli C. Pomegranate juice protects nitric oxide against oxidative destruction and enhances the biological actions of nitric oxide. Nitric Oxide 2006;15:93-102.
16. de Nigris F, Balestrieri ML, Williams-Ignarro S, et al. The influence of pomegranate fruit extract in comparison to regular pomegranate juice and seed oil on nitric oxide and arterial functionin obese Zucker rats. Nitric Oxide 2007;17:50-5.
17. Polychronopoulos E, Zeimbekis A, Kastorini CM, et al. Effects of black and green tea consumption on blood glucose levels in nonobese elderly men and women from Mediterranean Islands (MEDIS epidemiological study). Eur J Nutr 2008;47:10-6.
18. Büyükbalci A, El SN. Determination of in vitro antidiabetic effects, antioxidan activities and phenol contents of some herbal teas. Plant Foods Hum Nutr 2008;63:27-33.
19. Wayner DD, Burton GW, Ingold KU. The antioxidant efficiency of vitamin C is concentration-dependent. Biochim Biophys Acta 1986;884:119-23.
20. Coskun O, Ocakci A, Bayraktaroglu T, Kanter M. Exercise training prevents and protects streptozotocin-induced oxidative stress and beta-cell damage in rat pancreas. Tohoku J Exp Med 2004;203:145-54.
21. Marfella R, Nappo F, Angelis L, Paolisso G, Tagliamonte MR, Giugliano D. Hemodynamic effects of acute hyperglycemia in type 2 diabetic patients. Diabetes Care 2000;23:658-63.
22. Marchioli R. Antioxidant vitamins and prevention of cardiovascular disease: laboratory, epidemiological and clinical trial data. Pharmacol Res 1999;40:227-38.