The relationship between serum biochemical parameters and glycemic control in diabetes

Yıl 2012, Cilt: 1 Sayı: 2, 51 - 54, 01.05.2012

Kübranur Karatoprak Sema Uysal Zeynep Seçkin Akkılık Müjgan Ercan Fatma Meriç Yılmaz

https://doi.org/10.5505/abantmedj.2012.36854

Öz

OBJECTIVE: We aimed this study to evaluate the relationship between some biochemical parameters and glycemic control in diabetic patients categorized by HbA1c levels.METHODS: This study includes 24 good glycaemic control HbA1c6,5 patients with diabetes mellitus and 29 healthy subjects. Plazma levels of HbA1c measured by HPLC. Serum fasting and post-prandial glucose, creatinin, triglyceride, total cholesterol, HDL cholesterol concentrations analyzed by photometric methods. Urine protein and microalbumin levels studied by turbidimetric method. Serum TSH, sT3, sT4, vitamin B12 and folic acid concentrations measured by electrochemiluminescent assay.RESULTS: Serum triglyceride levels of poorly glycemic control group were higher than healthy subjects p=0,003 . Urine microalbumin/creatinine ratio was increased in patients with poorly glycemic control when compared good glycaemic control group p=0,05 . There was no significant differences between groups and other biochemical parameters. CONCLUSION: The triglyceride and microalbumin levels were associated with glycemic control in diabetic patients. These data suggested that glycemic control may affect development of nephropathy and coronary artery disease in patients with diabetes mellitus.

Anahtar Kelimeler

Glycaemic control, diabetes mellitus, HbA1c, lipid parameters, microalbumin

Diyabette glisemik kontrolün serum biyokimyasal parametreleri ile ilişkisi

Öz

AMAÇ: Bu çalışmanın amacı diyabetes mellitus hastalarını HbA1c düzeylerine göre iyi ve kötü kontrollü diyabet olarak sınıflandırarak glisemik kontrol ile bazı biyokimyasal parametrelerin ilişkisini araştırmaktır.YÖNTEMLER: Çalışmaya 24 iyi kontrollü diyabet HbA1c6,5 hastası ve diyabeti olmayan 29 sağlıklı birey katıldı. HbA1c seviyeleri HPLC yöntemiyle, açlık ve tokluk kan glukozu, kreatinin, trigliserid, total kolesterol ve HDL kolesterol seviyeleri fotometrik, idrar protein ve mikroalbumin düzeyleri türbidimetrik, TSH, sT3, sT4, B12 vitamini ve folik asit seviyeleri elektrokemilüminesans yöntemle ölçüldü.BULGULAR: Kötü kontrollü diyabet hastalarının trigliserid düzeyleri kontrol gurubuna göre anlamlı derecede yüksek bulundu p=0,003 . İdrar mikroalbumin/kreatinin düzeyleri, kötü kontrollü diyabet hastalarında iyi kontrollü diyabet hastalarına göre anlamlı şekilde yüksek bulundu p=0,05 . Diğer parametreler açısından, gruplar arasında anlamlı bir farklılık tespit edilemedi. SONUÇ: Diyabetik hastalarda glisemik kontrol, trigliserid ve mikroalbumin düzeyi ile ilişkili bulunmuştur. Bu veriler, diyabetli hastalarda glisemik kontrolün nefropati ve koroner kalp hastalığı gelişimini etkileyebileceğini düşündürmektedir.

Anahtar Kelimeler

Glisemik kontrol, diyabetes mellitus, HbA1c, lipid profili, mikroalbumin

Kaynakça

• de Zeeuw D, Ramjit D, Zhang Z, Ribeiro AB, Kurokawa K, Lash JP, Chan J, Remuzzi G, Brenner BM, Shahinfar S. Renal risk and renoprotection among ethnic groups with type 2 diabetic nephropathy: a post hoc analysis of RE- NAAL. Kidney Int. 2006; 69: 1675-82.
• Mogensen CE. Microalbuminuria predicts clinical pro- teinuria and early mortality in non-insulin-dependent diabetes. N Eng J Med. 1984; 310: 356-360.
• Rutledge JC, Ng KF, Aung HH, Wilson DW. Role of tri- glyceride-rich lipoproteins in diabetic nephropathy. Nat Rev Nephrol. 2010; 6: 361-370.
• Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemie with macrovascular and microvascular complications type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321: 405-12.
• Khaw KT, Wareham N. Glycated hemoglobin as a marker of cardiovascular risk. Curr opin Lipidol. 2006; 17: 637- 43.
• Selvin E, Ning Y, Steffes MW, Bash LD, Klein R, Wong TY, Astor BC, Sharrett AR, Brancati FL, Coresh J. Glycated hemoglobin and the risk of kidney disease and retinopa- thy in adults with and without diabetes. Diabetes. 2011; 60: 298-305.
• Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal T, Hemmingsen C, Wetterslev J. Intensive glycaemic con- trol for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of ran- domised clinical trials. BMJ. 2011;343:d6898.
• Koenig RJ, Peterson CM, Kilo C, Cerami A, Williamson JR. Hemoglobin A1c as an indicator of the degree of glucose intolerance in diabetes. Diabetes. 1976; 25: 230-232.
• Herman WH, Fajans SS. Hemoglobin A1c for the diagno- sis of diabetes: practical considerations. Pol Arch Med Wewn. 2010; 120: 37-40.
• True MW. Circulating biomarkers of glycemia in diabe- tes management and implications for personalized med- icine. J Diabetes Sci Technol. 2009 1; 3: 743-747.
• American Diabetes Association. Standarts of medical care in diabetes-2009. Diabetes Care. 2009; 32(Suppl 1):S13-61.
• Rodbard HW, Blonde L, Braithwaite SS, Brett EM, Cobin RH, Handelsman Y, Hellman R, Jellinger PS, Jovanovic LG, Levy P, Mechanick JI, Zangeneh F. American Associa- tion of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes melli- tus. AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. Endocr Pract. 2007; 13 Suppl 1: 1-68.
• Niskanen L, Uusitupa M, Sarlund H, Siitonen O, Vouti- lainen E, Penttile I, Pyorala K. Microalbuminuria predicts the development of serum lipoprotein abnormalities fa- vouring atherogenesis in newly diagnosed type 2 (non- insulin-dependent) diabetic patiens. Diabetologia. 1990; 33: 237-43.
• Witte EC, Lambers Heerspink HJ, de Zeeuw D, Bakker SJ, de Jong PE, Gansevoort R. First morning voids are more reliable than spot urine samples to assess microalbumi- nuria. J Am Soc Nephrol. 2009; 20: 436-443.
• Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R. Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pres- sure, and hyperglycemia. Arch Intern Med. 1998 11; 158: 998-1004.
• Zarini GG, Exebio JC, Gundupalli D, Nath S, Huffman FG. Hypertension, poor glycemic control, and microalbumi- nuria in Cuban Americans with type 2 diabetes. Int J Nephrol Renovasc Dis. 2011; 4: 35-40.
• AlAdsani A, Memon A, Suresh A. Pattern and Determi- nants of Dyslipedemia in Type 2 Diabetes Mellitus pa- tients in Kuwait. Acta Diabetol. 2004; 41:1295.
• Naheed T, Khan A, Masood G, Yunus BB, Chaudry MA. Dyslipedemias in type II diabetes mellitus patients in a teaching hospital of Lahore, Pakistan. Pak J Sci. 2003; 19: 2836.
• Thomas RM. Oxidative stress and lipid in diabetes. A role in endothelium vasodilator dysfunction. Vasc Med. 2002; 1: 195–204.
• Ginsberg HN. Identification and treatment of hypertri- glyceridemia as a risk factor for coronary heart disease. Curr Cardiol Rep. 1999; 1: 2337.
• Agbola Abu CF, Ohwovoriole AE, Akinlade KS. The effect of glycaemic control on the prevalence and pattern of dyslipedemia in Nigerian patients with newly diagnosed noninsulin dependent diabetes. West Afr J Med. 2000; 19: 275.