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Category: Volume 06 Issue 10 October 2018
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Title: To Study the Association of Free Insulin Levels, Obesity Markers & Lipid Profile Parameters in Newly Diagnosed Patients of Type 2 Diabetes Mellitus in Tertiary Care Centre of Kumaon Region

Authors: Seema Gupta, Basant Joshi, Taukeer Ahmad, Sangeeta Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v6i10.229

Abstract

Diabetes Mellitus is the commonest metabolic abnormality in the world. Type 2 diabetes the commonest form of diabetes constitutes nearly 90% of diabetic population in any country. Type 2 diabetes mellitus is characterized by impaired insulin secretion, insulin resistance, excessive hepatic glucose production, and abnormal fat metabolism. Obesity, particularly visceral or central (as evidenced by the hip-waist ratio), is very common in type 2 diabetes mellitus. Obesity is always associated with increase in plasma triglycerides. Dyslipidemia includes hypertriglyceridemia, reduced HDL cholesterol, and increased numbers of small, dense LDL particles. The present was therefore planned to study the correlation between markers of obesity, lipid profile & insulin resistance in newly diagnosed patients of type 2 Diabetes mellitus.

Materials & Methods: 100 newly diagnosed patients of Type 2 DM were taken as cases. Healthy age & sex matched 100 subjects were included in control group.

Results: In this study 37 patients of DM were overweight and 19 were obese. All the female patients showed waist hip ratio (WHR) >0.85 and 33 males out of 43 had WHR >0.90. Mean waist circumference in diabetic cases were significantly raised when compared with healthy controls. The mean level of Triglyceride & VLDLc in diabetic cases was found to be significantly raised when compared with normal subjects. The mean level of ApoB was found to be significantly elevated in diabetics as compared with controls. in this study the levels of HbA1c & serum free insulin were also significantly raised in diabetic cases as compared to normal subjects.

Conclusion: This study showed that newly diagnosed diabetic patients have high incidence of obesity, insulin resistance and dyslipidemias, which predisposed them to metabolic syndrome.  Significantly high levels of HbA1c in newly diagnosed DM suggests its utility as the predictor of future risk for metabolic syndrome.  

Keywords: diabetes mellitus, dyslipidemias, obesity, insulin resistance.

References

  1. IC Health. National Cardiovascular Disease Database. Available from: http: //www. whoindia. org/LinkFiles/NMH_Resources_National_CVD_database-Final_Report. pdf, accessed on February 10, 2008.
  2. International Diabetes Federation (IDF). (2007). Diabetes alas. Belgium: International Diabetes Federation.
  3. Wild, S., Roglic, G., Green, A., et al. (2004). Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care, 27, 1047-1053.
  4. World Health Organization. (2006). Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: Report of a World Health Organization and International Diabetes Federation. Geneva, Switzerland.
  5. American Association of Diabetes Educators. (2006). Art and science of diabetes self-management education: A desk reference for health care professionals. Chicago, Illinois.
  6. American Association of Clinical Endocrinologists. (2007). Medical guidelines for clinical practice for the management of diabetes mellitus. Endocrine Practice, 13.
  7. Kaprio J, Tuomilehto J, Koskenvuo M, Romanov K, Reunanen A, Eriksson J, Stengård J, Kesäniemi YA (1992); Concordance for Type 1 (insulin dependent) and Type 2 (non-insulin-dependent) diabetes mellitus in population based cohort of twins in Finland. Diabetologia, 35:1060-1067.
  8. Alvin C. Powers, Harrison’s Principles of Internal Medicine, 2008, volume II, 17th edition, Page no. 2280-2281.
  9. David E. Laaksonen, Hanna-Maaria Lakka et al, Insulin resistance in metabolic syndrome Am J Epidemiol 2002; 156: 1070-1077.
  10. Kahn R, Buse J, Ferrannini E, Stern Ml. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2005;28:2289 –2304.
  11. Marsh JB. Lipoprotein metabolism in obesity and diabetes: insights from stable isotope kinetic studies in humans. Nutr Rev. 2003; 61:363–375.
  12. McNamara J, Campos H, Ordovas J, Peterson J, Wilson P, Schaefer E. Effect of gender, age, and lipid status on low density lipoprotein subfraction distribution. Results of the Framingham Offspring Study. Arteriosclerosis. 1987; 7:483–490.
  13. Su Q, Tsai J, Xu E, Qiu W, Bereczki E, Santha M, Adeli K (2009). "Apolipoprotein B100 acts as a molecular link between lipid-induced endoplasmic reticulum stress and hepatic insulin resistance". Hepatology50(1): 77–84. doi: 1002/hep. 22960. PMID 19434737.
  14. American Diabetes Association. (2008). Clinical practice recommenda-tion: Standards of medical care. Diabetes Care, 31. (Suppl. 1), S14.
  15. Alshkri MM, Elmehdawi RR. Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi-Libya: A pilot study. Libyan J Med 2008; AOP: 080715: [Online], available from: www. ljm. org. ly. (accessed on 12 june 2008).
  16. World Health Organization Western Pacific Region International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Heath Communications Australia Pty Limited; 2000.
  17. MA Shekhar, HM Somashekhar, BS Vishwanath. Study of incidence of obesity in newly diagnosed type 2 diabetics using anthropometric measurements Int J Diab Dev Countries 2005;25: 102-04
  18. Gupta R, Rastogi S, Panwar RB, Soangra MR, Gupta VP, Gupta KD. Major coronary risk factors and coronary heart disease epidemic in India. South Asian J PrevCardiol2003;7:11-40.
  19. Valluri Satya Prasad, et al, “The Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus”. Journal of Evidence based Medicine and Healthcare; Volume 2, 2015; Page:2500-2507.
  20. Huges et al, Premature coronary artery disease in North India: An Angiography study of 1971 patientes. Indian Heart. 2011;57;311-318.
  21. Lee YJ, Tsai JC. ACE gene insertion/deletion polymorphism associated with 1998 World Health Organization definition of metabolic syndrome in a Chinese type 2 diabetic patients. Diabetes Care 2002;25:1002–8.
  22. Faraj M, Messier L, Bastard JP, et al. Apolipoprotein B: a predictor of inflammatory status in postmenopausal overweight and obese women. Diabetologia 2006;49:1637-46.
  23. Williams K, Sniderman AD, Sattar N, D’Agostino R Jr, Wagenknecht LE, Haffner SM. Comparisons of the associations of apolipoprotein B and low-density lipoprotein cholesterol with other cardiovascular risk factors in the Insulin Resistance Atherosclerosis Study (IRAS]. Circulation 2003;108:2312-16.
  24. Kathiresan S, Otvos JD, Sullivan LM, et al. Increased small low-density lipoprotein particle number: a prominent feature of the metabolic syndrome in the Framingham Heart Study. Circulation 2006;113:20-29.
  25. Lim JS, Lee DH, Park JY, Jin SH, Jacobs DR (2011). "Reliability of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B measurement". Journal of Clinical Lipidology5 (4): 264–272. doi: 1016/j. jacl. 2011. 05. 004. PMID 17478563.
  26. Ryoo JH, Park SK. Association of apolipoprotein B and in­cidence of metabolic syndrome in Korean men: a 5-years’ follow-up study. Atherosclerosis 2013;226:496-501.
  27. Yokota C, Ikebuchi M, Suzuki M, Norioka M, Ikeda K, Shinozaki K, Harano Y. Insulin resistance rather than hy­perinsulinemia more closely associated with essential hy­pertension. ClinExpHypertens1995;17:523-36.
  28. David E. Laaksonen, Hanna-Maaria Lakka et al, Insulin resistance in metabolic syndrome Am J Epidemiol 2002; 156: 1070-1077.
  29. Osei K, Rhinesmith S, Gaillard T, Schuster D. Is glycosylated hemoglobin A1c a surrogate for metabolic syndrome in nondiabetic, first-degree relatives of African-American patients with type 2 diabetes? J ClinEndocrinolMetab2003; 88: 4596–4601.
  30. Jasmin S, Venesa Abdie-Nekie et al, Study Of HbA1c As A Reliable Indicator For Metabolic Syndrome In Non Diabetic Patients 2008.

Corresponding Author

Sangeeta Singh

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