Biochemical Parameters Variations in Type–II Diabetes Mellitus: Special Reference in Rewa Region

Dr. Suresh Kumar Sutrakar¹, Dr. Drutpal Singh Baghel²

¹Assistant Professor, Department of Pathology, Shyam Shah Medical College and Associated. S.G.M. Hospital Rewa (M.P.), India-486001

²Assistant Professor and Head, Department of Biochemistry, Shyam Shah Medical College and Associated. S.G.M. Hospital, Rewa (M.P.)

*Corresponding Author E-mail: sutrakar.skumar35@gmail.com

ABSTRACT:

Non-insulin dependent diabetes mellitus (NIDDM) Type –II occurs at any age, but is more common between 40–80 years of age and also has a strong genetic component. India tops the world diabetes list with 31.7 million diabetic patients and this is likely to rise to 79.4 million by the year 2030. Over ninety percent of these have Type –II diabetes mellitus (T2DM). Type –II diabetes mellitus is closely related to life style factors, including diet, physical activities, alcohol and smoking, as well as obesity and a family history of diabetes. Lipotoxicity also has been implicated as an acquired cause of impaired beta-cell function, as individuals progress from impaired glucose tolerance to overt Type –II diabetes mellitus. The clinical materials for present study comprised 59 patients are attended in outdoor department or admitted in the department of medicine ward and 50 ages matched healthy individual control groups. Clinical investigations performed for serum glucose, Cholesterol, HDL–cholesterol, LDL–cholesterol, and triglycerides. Obtained data were analyzed statistically by using student “t” test.

KEYWORDS: Non-insulin dependent diabetes mellitus (NIDDM) type- II, Sugar, Lipid profile.

INTRODUCTION:

Diabetes mellitus is one of the commonest endocrine disorders encountered in clinical practices. Non-insulin dependent diabetes mellitus (NIDDM) Type –II occurs at any age, but is more common between 40–80 years of age and also has a strong genetic component.⁽¹⁾ The majority of diabetes (~90%) is Type –II diabetes (T2D) caused by a combination of impaired insulin secretion from pancreatic beta cells and insulin resistance of the peripheral target tissues, especially muscle and liver. ⁽²⁾

The incidence and prevalence of Type –II diabetes mellitus (T2DM) among Aboriginal peoples in Canada is not only disproportionately higher, but also increasing rapidly.⁽³⁾ The need to determine population-based risk factors of T2DM is, therefore, urgent and necessary.⁽⁴⁾ India tops the world diabetes list with 31.7 million diabetic patients and this is likely to rise to 79.4 million by the year 2030.⁽⁵⁾ Over ninety percent of these have Type –II diabetes mellitus (T2DM).⁽⁶⁾

Diabetes is due to failure in the formation of Insulin or liberation or action. Since insulin is produced by the β-cells of the islets of Langerhans, any receding in the number of functioning cell will decrease the amount of insulin that can be synthesized.⁽⁷⁾ Diabetes mellitus is a modifiable risk factor for a first ischaemic stroke. Risk factors for stroke in diabetic patients include elevated blood pressure, smoking, age, male sex, atrial fibrillation and hyperglycemia.⁽⁸⁾ Type –II diabetes mellitus is closely related to life style factors, including diet, physical activities, alcohol and smoking, as well as obesity and a family history of diabetes.⁽⁹⁾

Peripheral neuropathy is a major factor in the occurrence of foot ulcers in patients with diabetes. Type –II diabetes and peripheral neuropathy are common causes of foot ulceration, gangrene, and amputation and are serious problems in Iran.⁽¹⁰⁾ Lipotoxicity also has been implicated as an acquired cause of impaired beta-cell function, as individuals progress from impaired glucose tolerance to overt Type –II diabetes mellitus.^(11,12)  In ours study, we monitoring serum sugar, lipid profile, and their biochemical changes with better management may better treat Type –II diabetic mellitus.

MATERIAL AND METHODS:

Study of type–II diabetes mellitus are attended in outpatient department or admitted in the Department of Medicine ward of S. G. M. & G. M. Hospital, Rewa (M. P.) from date of the Dean Permission and Institutional Ethics Committee approval number IEC 036 Date 13–08–2013. The clinical materials for present study comprised 59 patients are attended in outdoor department or admitted in the department of medicine ward and 50 ages matched healthy individual control groups.

Blood samples were collected from the patients under all aseptic condition. 3 ml of venous fasting blood samples were collected from each subject by using disposable syringe. This blood used for separation of serum. Serum used for estimation of glucose and lipid profile. Blood samples taken in plain vial were incubated at 37˚C for 45 minutes in winter or 20 minutes in hot climate. After incubation, clot was removed and remaining sample was taken in centrifuge test tube. This sample centrifuged at 3000 rpm for 10 to 20 minutes. Supernatant collected in clean and dry serum test tube for analysis of serum glucose and lipid profile.

Clinical investigations performed for various parameters by using their methodology. S  erum glucose, Cholesterol, HDL–cholesterol, LDL–cholesterol, and triglycerides were estimated by GOD-POD⁽¹³⁾, C Libermann et al, 1885⁽¹⁴⁾, Phosphotungstic acid method⁽¹⁵⁾, Friedewald equation)⁽¹⁶⁾ and GPO–PAP, Herbert K, 1984⁽¹⁷⁾ methods respectively. Obtained data were analyzed statistically by using student “t” test.

OBSERVATIONS:

Table: 1. Population percentage of normal healthy controls and type–II Diabetes mellitus patients.     

S. No.	Age Range	Normal Healthy control groups					type–II Diabetes mellitus patients
		Total N.C.	Male	%	Female	%	Total N.C.	Male	%	Female	%
1.	30 – 50	26	14	53.85	12	46.15	30	16	53.33	14	46.67
2.	51 – 70	24	13	54.16	11	45.83	29	14	48.27	15	51.72
Total		50	27	54.00	23	46.00	59	30	50.85	29	49.15

Table: 2. Smoking percentage of normal healthy controls and type–II Diabetes mellitus patients.

S. No.	Age Range	Normal Healthy control groups					type–II Diabetes mellitus patients
		Total N.C.	Male	%	Female	%	Total N.C.	Male	%	Female	%
1.	30 – 50	26	02	07.69	00	00	17	8	47.05	3	17.64
2.	51 – 70	24	04	16.66	01	04.16	21	12	57.14	5	41.66
Total		50	06	12.00	01	02.00	38	20	52.63	8	21.05

Table: 3. Alcoholics percentage of normal healthy controls and type–II Diabetes mellitus patients.

S. No.	Age Range	Normal Healthy control groups					type–II  Diabetes mellitus patients
		Total N.C.	Male	%	Female	%	Total N.C.	Male	%	Female	%
1.	30 – 50	26	03	11.53	02	07.69	15	9	60.00	4	26.66
2.	51 – 70	24	06	25.00	01	04.16	23	15	65.21	7	30.43
Total		50	9	18.00	03	06.00	38	23	60.52	11	28.94

Note: N C; Number of cases.

Results: There are table 1 to 3 showing; population prevalence, smoking, alcohol addiction percent in normal healthy controls and type–II Diabetes mellitus patients respectively.

Table: 4. Significant (Mean ± S.D.) biochemical parameters values between normal male healthy controls and male type–II Diabetes mellitus patients (age: 30 – 50^year).

S. No.	Biochemical parameters		N M H C (♂)		Male–DM2		t–test	P–Value
			N C	Mean ± S.D.	N C	Mean ± S.D.
1	Glucose (F) (mg / dl)		14	85.36 ±10.06	16	211.47 ±29.25	15.29	<0.0001
2	Glucose (PP) (mg / dl)			131.07 ±3.71		158.13 ±9.16	10.28	<0.0001
3	Cholesterol ( mg / dl)			181.36±21.38		303.93 ±20.40	15.80	<0.0001
4	HDL–Cholesterol ( mg / dl)			25.67 ±0.62		45.71 ±5.64	13.70	<0.0001
5	LDL–Cholesterol ( mg / dl)			93.71±25.35		168.13±4.39	11.20	<0.0001
6	Triglyceride ( mg / dl)			91.57±19.44		170.67±4.50	15.34	<0.0001
7	Blood pressure (mmHg)	SBP		124.36±1.91		144.40±4.22	16.26	<0.0001
		DBP		84.50±2.10		100.67±2.69	17.93	<0.0001
8	Body Mass Index (Kg / m^2)			25.71±4.95		41.53±2.95	10.53	<0.0001

Table: 5. Significant (Mean ± S.D.) biochemical parameters values between normal male healthy controls and male type–II Diabetes mellitus patients (age: 51 – 70 ^year).

S. No.	Biochemical parameters		N M H C (♂)		Male–DM2		t–test	P–Value
			N C	Mean ± S.D.	N C	Mean ± S.D.
1	Glucose (F) (mg / dl)		13	76.31±7.19	14	215.15±31.92	15.29	<0.0001
2	Glucose (PP) (mg / dl)			131.54±4.12		163.15±9.60	10.91	<0.0001
3	Cholesterol ( mg / dl)			181.54±20.35		304.64±18.42	16.50	<0.0001
4	HDL–Cholesterol ( mg / dl)			52.69±3.40		24.38±1.19	28.32	<0.0001
5	LDL–Cholesterol ( mg / dl)			103.38±22.63		171.38±6.01	10.62	<0.0001
6	Triglyceride ( mg / dl)			100.62±29.99		172.23±4.68	8.50	<0.0001
7	Blood pressure (mmHg)	SBP		125.54±1.66		145.38±1.89	28.37	<0.0001
		DBP		83.69±1.60		99.69±3.54	14.83	<0.0001
8	Body Mass Index (Kg / m^2)			25.54±4.35		40.15±1.34	11.57	<0.0001

Table: 6. Significant (Mean ± S.D.) biochemical parameters values between normal female healthy controls and female type–II Diabetes mellitus patients (age: 30 – 50 ^year).

S. No.	Biochemical parameters		N F H C (♀)		Female–DM2		t–test	P–Value
			N C	Mean ± S.D.	N C	Mean ± S.D.
1	Glucose (F) (mg / dl)		12	79.67±8.50	14	218.23±28.12	16.36	<0.0001
2	Glucose (PP) (mg / dl)			130.17±5.80		163.33±9.57	10.36	<0.0001
3	Cholesterol ( mg / dl)			168.58±14.69		312.38±23.41	18.20	<0.0001
4	HDL–Cholesterol ( mg / dl)			43.50±5.85		24.69 ±0.63	11.53	<0.0001
5	LDL–Cholesterol ( mg / dl)			104.83±22.57		167.92±4.44	9.88	<0.0001
6	Triglyceride ( mg / dl)			99.50±28.13		168.77±5.09	8.73	<0.0001
7	Blood pressure (mmHg)	SBP		122.67±2.15		142.77±3.96	15.57	<0.0001
		DBP		83.17±1.59		98.62±2.63	17.58	<0.0001
8	Body Mass Index (Kg / m^2)			27.08±4.89		39.92±1.66	8.94	<0.0001

Table: 7. Significant (Mean ± S.D.) biochemical parameters values between normal female healthy controls and female type–II Diabetes mellitus patients (age: 51 – 70 ^year). 

S. No.	Biochemical parameters		N F H C (♀)		Female–DM2		t–test	P–Value
			N C	Mean ± S.D.	N C	Mean ± S.D.
1	Glucose (F) (mg / dl)		11	83.27±9.67	15	213.29±29.26	14.09	<0.0001
2	Glucose (PP) (mg / dl)			129.82±5.69		165.86±10.41	10.30	<0.0001
3	Cholesterol ( mg / dl)			181.18±19.81		306.21±20.86	15.20	<0.0001
4	HDL–Cholesterol ( mg / dl)			46.91±6.38		26.14±0.95	12.08	<0.0001
5	LDL–Cholesterol ( mg / dl)			95.55±23.14		165.79±4.37	11.16	<0.0001
6	Triglyceride ( mg / dl)			87.36±20.54		168.43±5.60	14.18	<0.0001
7	Blood pressure (mmHg)	SBP		124.00±2.00		143.86±3.96	15.14	<0.0001
		DBP		84.18±1.89		100.57±2.87	16.31	<0.0001
8	Body Mass Index (Kg / m^2)			27.82±4.62		40.57±1.55	9.69	<0.0001

Note: N C; Number of cases.

Results: There are table 4 to 7 showing; extremely significant (P<0.0001) values between normal healthy controls and type–II diabetes mellitus patients (male and female) respectively

DISCUSSION AND CONCLUSION:

Diabetes mellitus is a multifactorial, polygenic metabolic disorder which can affect nearly every organ system in the body. According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken.⁽¹⁸⁾ India, the world’s second most populous country, now has more people with type–II diabetes (more than 50 million) than any other nation.  The problem has been well documented in a battery of recent papers.^(19–24) The female diabetics showed 60.25% and males had 45.57% and 65.59% decreases respectively.⁽²⁵⁾ Similar prevalence results were found in our study     (Table: 1).     

First of all, an association between longer disease duration and inadequate glycaemic control has been found in our study, which is in accordance with many previous studies.^{(26, 27)} The fact that the longer someone had been diagnosed with diabetes, the harder it was to maintain glycaemic control highlighted the inevitable progressive β-cell failure.⁽²⁸⁾ The increase in triglycerides may be due to insulin resistance and relative insulin deficiency which results in faulty glucose utilization, and causes hyperglycemia and mobilization of fatty acids from peripheral adipose tissue. The excess fatty acids are both mobilized for energy purpose and accumulated in the liver, which are converted to triglycerides. This phenomenon might be more evident for the Chinese population characterized by the carbohydrate-rich food. It has been demonstrated that the high plasma level of free fatty acids was related with excessive accumulation of fat in pancreatic β-cells⁽²⁹⁾, and it leads to constellation  of islet derangements, including the decrease in β-cell GLUT-2 expression, enhancement of nitric oxide formation, impairment of β-cell function and apoptosis of a substantial subgroup of β-cells. These mechanistic studies can explain, at least in part, the association between hypertriglyceridaemia and inadequate glycaemic control.⁽³⁰⁾ Controlling blood pressure is also critical in diabetic patients.  Hypertension increases the risk of cardiovascular disease and retinopathy in type II diabetics.^{(31 - 37)} Lowering of  blood pressure benefit type 2 diabetics.^{(38 - 40)} In our study, we were found increased cholesterol, LDL-C, and triglyceride. Reduced level of HDL-C was found in both male and female age between 30 -50 and 51 – 70yr (Table: 4–7) and similar results were found other respected workers.^{(41, 42)}

Diabetes mellitus is a chronic medical disorder known to be common among poor, ethnic minority populations. Primary care physicianrs who treat these patients are obliged to recognize and minimize, if possible, risk factors for the disease and its complications. Recently, some investigators have described substance use, particularly alcohol and tobacco use, as a possible risk factor related to the development of type–II diabetes in some patients.⁽⁴³⁾ Tsumura and colleagues⁽⁴⁴⁾ observed a large cohort of Japanese men (6,362) and found that heavy alcohol use among lean men was associated with an increased risk of type 2 diabetes. Likewise, Holbrook et al⁽⁴⁵⁾ examined 524 adult diabetic patients and found that alcohol intake was a risk factor for the development of non-insulin-dependent diabetes mellitus in men, but not women. Lindeg   ard and Langman⁽⁴⁶⁾ also found a positive correlation between alcoholism and the prevalence of diabetes. Kawakami et al⁽⁴⁷⁾ also found that individuals who smoked 16 to 25 cigarettes per day had a 3.27 times higher risk of developing type – II diabetes compared with those who never smoked. Furthermore, Rimm et al⁽⁴⁸⁾ documented an in-creased relative risk of  1.9 for developing diabetes among smokers in a cohort study of more than 41,000 male health professionals observed for a 6-year period. We were also observed prevalence of alcohol addiction and smoking habitual in male diabetic patients (Table: 2–3). The common approach to the management of hyper-triglyceridaemia in the setting of T2DM is to pursue aggressive lowering of plasma glucose prior to the initiation of any triglyceride-lowering drugs.^{(49, 50)} In our study, the majority of patients had never received any lipid-lowering strategies, despite the fact that early initiation of lipid-lowering therapy may get additional benefits in both glycaemic control and reduced CHD risk and similar explained by others.⁽⁵¹⁾  Joshi R (2003) reported that peculiar metabolic features of Asian Indians characterized by a propensity to excess visceral adiposity, dyslipidaemia with low HDL cholesterol, elevated serum triglycerides and increased small, dense LDL cholesterol, and an increased ethnic (possibly  genetic) susceptibility to diabetes and premature coronary artery disease.⁽⁵²⁾ Therefore it can be concluded that patients with type–II diabetes mellitus improved glycemic control and in addition to the expected lowering of plasma lipid concentrations.

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Received on 30.08.2014         Modified on 09.09.2014

Accepted on 25.09.2014         © AJRC All right reserved

Asian J. Research Chem. 7(10): October- 2014;  Page  877-881