Abstract
Background: Iron metabolism is involved with the development of diabetes. A few studies have suggested a causal relationship between high iron stores and diabetes. The patho-physiology behind this relationship is largely unknown, however, it is proposed that iron mediated free radical injury is the responsible factor.
Objective: The objective of this study was to study Serum Ferritin levels in Type 2 DM patients and its relation with Glycosylated Hemoglobin (A1C) and the relation of Serum Ferritin with HbA1c level after follow up at 3 months.
Method: In this observational case control study, Adults, aged > 18 years, with T2DM as per the Diagnostic criteria by the American Diabetes Association (ADA) were included. We measured FBG, PPBG, A1C, Serum Ferritin, Serum Creatinine in all the patients.
Result: We enrolled 93 patients with diabetes. Mean serum ferritin of all patients was 354.22 + 22.31 ng/ml and mean A1C % of all patients was 8.41 + 0.41%. Significant correlation was found between serum ferritin and FBG levels. Patients with A1C >8.5% had significantly higher serum ferritin level (435.99 + 53.45 ng/ml) in comparison to those with A1C levels between 7.6 and 8.5% (223.59 + 16.88 ng/ml) as well as than those with <7.5% (207.98 + 6.54 ng/ml). On follow up at 3 month A1C levels changed significantly, but there was no significant change in serum ferritin level.
Conclusion: We found that serum ferritin was significantly high in patients with diabetes both males and females as compared to normal population. Serum ferritin levels correlate significantly with FBG levels but not with PPBG and HbA1C. Patients with A1C>8.5% have significantly higher serum ferritin levels. During a follow-up period of 3 months of treatment, A1C level reduced signifacantly while serum ferritin levels did not fall significantly.
Keywords: Serum Ferritin, T2DM, A1C , T2DM
References
- G. Forouhi, A. H. Harding, M. Allison, M. S. Sandhu, A. Welch, R. Luben, S. Bingham, K. T. Khaw, and N. J. Wareham, 'Elevated Serum Ferritin Levels Predict New-Onset Type 2 Diabetes: Results from the Epic-Norfolk Prospective Study', Diabetologia, 50 (2007), 949-56.
- Fumeron, F. Pean, F. Driss, B. Balkau, J. Tichet, M. Marre, and B. Grandchamp, 'Ferritin and Transferrin Are Both Predictive of the Onset of Hyperglycemia in Men and Women over 3 Years: The Data from an Epidemiological Study on the Insulin Resistance Syndrome (Desir) Study', Diabetes Care, 29 (2006), 2090-4.
- Jiang, J. E. Manson, J. B. Meigs, J. Ma, N. Rifai, and F. B. Hu, 'Body Iron Stores in Relation to Risk of Type 2 Diabetes in Apparently Healthy Women', JAMA, 291 (2004), 711-7.
- Liu, L. Sun, Y. Tan, G. Wang, X. Lin, and L. Cai, 'Role of Iron Deficiency and Overload in the Pathogenesis of Diabetes and Diabetic Complications', Curr Med Chem, 16 (2009), 113-29.
- Dmochowski, D. T. Finegood, W. Francombe, B. Tyler, and B. Zinman, 'Factors Determining Glucose Tolerance in Patients with Thalassemia Major', J ClinEndocrinolMetab, 77 (1993), 478-83.
- F. Olivieri, and G. M. Brittenham, 'Iron-Chelating Therapy and the Treatment of Thalassemia', Blood, 89 (1997), 739-61.
- Abril-Ulloa, G. Flores-Mateo, R. Sola-Alberich, B. Manuel-y-Keenoy, and V. Arija, 'Ferritin Levels and Risk of Metabolic Syndrome: Meta-Analysis of Observational Studies', BMC Public Health, 14 (2014), 483.
- K. Padwal, M. Murshid, P. Nirmale, and R. R. Melinkeri, 'Association of Serum Ferritin Levels with Metabolic Syndrome and Insulin Resistance', J ClinDiagn Res, 9 (2015), BC11-3.
- K. Park, J. H. Ryoo, M. G. Kim, and J. Y. Shin, 'Association of Serum Ferritin and the Development of Metabolic Syndrome in Middle-Aged Korean Men: A 5-Year Follow-up Study', Diabetes Care, 35 (2012), 2521-6.
- Swaminathan, V. A. Fonseca, M. G. Alam, and S. V. Shah, 'The Role of Iron in Diabetes and Its Complications', Diabetes Care, 30 (2007), 1926-33.
- M. Fernandez-Real, A. Lopez-Bermejo, and W. Ricart, 'Cross-Talk between Iron Metabolism and Diabetes', Diabetes, 51 (2002), 2348-54.
- Podmore, K. Meidtner, M. B. Schulze, R. A. Scott, A. Ramond, A. S. Butterworth, E. Di Angelantonio, J. Danesh, L. Arriola, A. Barricarte, H. Boeing, F. Clavel-Chapelon, A. J. Cross, C. C. Dahm, G. Fagherazzi, P. W. Franks, D. Gavrila, S. Grioni, M. J. Gunter, G. Gusto, P. Jakszyn, V. Katzke, T. J. Key, T. Kuhn, A. Mattiello, P. M. Nilsson, A. Olsen, K. Overvad, D. Palli, J. R. Quiros, O. Rolandsson, C. Sacerdote, E. Sanchez-Cantalejo, N. Slimani, I. Sluijs, A. M. Spijkerman, A. Tjonneland, R. Tumino, A. Dl van der, Y. T. van der Schouw, E. J. Feskens, N. G. Forouhi, S. J. Sharp, E. Riboli, C. Langenberg, and N. J. Wareham, 'The Association of Multiple Biomarkers of Iron Metabolism and Type 2 Diabetes: The Epic-Interact Study', Diabetes Care (2016).
- Halle, D. Konig, A. Berg, J. Keul, and M. W. Baumstark, 'Relationship of Serum Ferritin Concentrations with Metabolic Cardiovascular Risk Factors in Men without Evidence for Coronary Artery Disease', Atherosclerosis, 128 (1997), 235-40.
- K. Kunutsor, T. A. Apekey, J. Walley, and K. Kain, 'Ferritin Levels and Risk of Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis of Prospective Evidence', Diabetes Metab Res Rev, 29 (2013), 308-18.
- Alap L. Christy, Poornima A. Manjrekar, Ruby P. Babu, AnupamaHegde, and Rukmini M.S, 'Influence of Iron Deficiency Anemia on Hemoglobin A1c Levels in Diabetic Individuals with Controlled Plasma Glucose Levels', Iranian Biomedical Journal, 18 (2014), 88-93
- Kundu, A. Roy, T. Mandal, U. Bandyopadhyay, E. Ghosh, and D. Ray, 'Relation of Iron Stores to Oxidative Stress in Type 2 Diabetes', Niger J ClinPract, 16 (2013), 100-3
- 'Tests of Glycemia in Diabetes', Diabetes Care, 27 (2004), s91-s93.
- Momeni, M. S. Behradmanesh, S. Kheiri, and F. Abasi, 'Serum Ferritin Has Correlation with Hba1c in Type 2 Diabetic Patients', Adv Biomed Res, 4 (2015), 74.
Corresponding Author
Dr Manoj Kumar Mathur
Associate Professor, Department of Medicine, MLN medical College, Allahabad U.P. India – 211002
Mob – 9839064646, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.