Nusrat Zerin¹*, Sharmin Sultana¹, Farhana Afroz², Mahfuja Rahman¹ and Sabrina Afrin Chowdhury³

¹Lecturer, Department of Biochemistry, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
²Assistant Professor, Department of Biochemistry, Sheikh Hasina National Institute of Burn and Plastic Surgery
³Assistant Professor, Department of Biochemistry, Northern International Medical College, Dhaka, Bangladesh

*Corresponding Author: Nusrat Zerin, Lecturer, Department of Biochemistry, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh. Email: lizu.khan@gmail.com.

Received: July 31, 2023; Published: August 16, 2023

Abstract

Background: Diabetes Mellitus is a leading cause of death and disability world wide. Glycated haemoglobin (HbA1c) is recommended for screening and diagnosis of Type 2 Diabetes Mellitus. Iron is a transitional metal and a potential catalyst in cellular reactions that produces reactive oxygen species. Ferritin is an index of body iron stores and acts as an iron overload marker. Many cross sectional studies suggest a link between body iron excess and insulin metabolism.

Objectives: To evaluate the association of iron status parameters with glycemic status in Type 2 DM.

Methods: A cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College (DMC), Dhaka; from July 2015 to June 2016. According to selection criteria a total 50 diagnosed patients of Type 2 DM attending in the Department of Endocrinology & Metabolism, Dhaka Medical College Hospital were selected as Group A and same number of age and sex matched apparently healthy individuals were selected (from same hospital staff, patient attendants and visitors by personal contact) as Group B. All the study subjects were subjected to detailed clinical history, physical examinations and laboratory biochemical investigations. After an overnight fast venous sample was taken from all subjects. Fasting plasma glucose was estimated enzymatically by glucose oxidase method, Glycated hemoglobin was measured by high performance liquid chromatography and estimation of serum iron, serum ferritin, total iron binding capacity were done by using Automatic Biochemistry Analyzer. Then data was analyzed by using Statistical Package for Social Science (SPSS) 20.0.

Results: Mean serum iron in Group A and Group B were 112.7 μg/dl and 87.6 μg/dl respectively. Mean serum ferritin concentration in Group A and Group B were 199.3 μg/dl and 107.0 μg/dl respectively. There was statistically significant increase in serum iron and serum ferritin concentrations in group A (p < 0.0001) compare to Group B (p < 0.0001). Both serum ferritin and serum iron levels show strong positive correlations with HbA1C ((r = 0.724, p < 0.001, r = 0.724, p < 0.001) and FPG ((r = 0.724, p < 0.001, r = 0.724, p < 0.001). The mean TIBC level was found 184 g/dl in Group A and 318.8 g/dl in Group B. TIBC levels were significantly lower in Group A than Group B and negative correlation was found between TIBC with HbA1c and FPG.

Conclusion: In comparison with healthy individuals, Type 2 DM patients had increased serum ferritin and serum iron levels and decreased TIBC with strong correlations of these parameters with glycemic control of diabetic’s patients. Thus, routine screening for iron status along with Glycemic control in diabetic patients might help preventing complications.

 Keyword: Diabetes Mellitus; Glycated Haemoglobin (HbA1c); Iron Status

References

1. Pearson ER and Crimmon RJ. “Diabetes mellitus”. Davidson's principles and practice of medicine, 22^nd edition, Toronto: Elsevier (2014): 797-836.
2. Kaku K. “Pathophysiology of type 2 diabetes and its treatment policy”. Japan Medical Association Journal 1 (2010): 41-46.
3. Holt G. “Diagnosis, epidemiology and pathogenesis of diabetes mellitus an update for Psychiatrists”. The British Journal of Psychiatry 47 (2004): s55-s63.
4. Gonzalez E., et al. “Trends in the Prevalence and incidence of diabetes in the UK 1996-2005”. Epidemiology 63 (2009): 332-336.
5. WHO (World Health Organization). “The Global Burden of Disease: 2004 Update”. Geneva, World Health Organization (2008).
6. Thakur S., et al. “Role of HbA1C in Diabetes Mellitus”. Journal of Indian Academy of Clinical Medicine (JIACM)1 (2009): 52-54.
7. Chandalia HB and Krisnaswamy PR. “Glycated Hemoglobin”. Current Science12 (2002): 1522-1532.
8. Nitin S. “HbA1c and factors other than diabetes mellitus affecting it”. Singapore Medical Journal 8 (2010): 616-622.
9. Kapoor S and Sharma AK. “Study of serum parameters of iron metabolism in type 2 diabetes mellitus patients”. Journal of Chemical and pharmaceutical Research3 (2015): 1839-1844.
10. Manikandan A., et al. “STUDY OF IRON STATUS IN TYPE 2 DIABETES MELLITUS”. International Journal of Clinical Biochemistry and Reasearch2 (2015): 77-82.
11. Shetty JK., et al. “Relationship between free iron and glycated hemoglobin in uncontrolled type 2 diabetes patients associated with complications”. Indian Journal of Clinical Biochemistry 1 (2008): 67-70.
12. Dulal HP., et al. “Status of iron, oxidant and antioxidants in chronic type 2 Diabetes mellitus patients”. Nepal Medical College Journal1 (2014): 54-57.
13. Kar M and Chakraborti AS. “Effect of glycosylation on iron-mediated free radical reactions of hemoglobin”. Current Science6 (2001): 770-773.
14. Panter SS. “Methods Enzymol” 231.1 (1994): 502-514.
15. Papanikolaou G and Pantopoulos K. “Iron metabolism and toxicity”. Toxicology and Applied Pharmacology2 (2005): 199-211.
16. Swaminathan S., et al. “The role of iron in diabetes and its complication”. Diabetes Care 7 (2007): 1926-1933.
17. Sudhakar B., et al. “Elevated serum ferritin and serum free iron - a novel marker for pre diabetes type 2 in relationship with HbA1C”. Journal of Medical Science and Technology 2 (2014): 61 -66.
18. Torti F and Torti S. “Regulation of ferritin genes and protein”. Blood10 (2002): 3505-3516.
19. Zumin S., et al. “Association between serum ferritin, hemoglobin, iron intake and diabetes in adults in Jiangsu, China”. Diabetes Care8 (2006): 1878-1883.
20. Fumeron F., et al. “Ferritin and transferrin are both predictive of the onset of hyperglycemia in men and women over 3 years”. Diabetes Care9 (2006): 2090-2094.
21. Tomoyuki I., et al. “Serum Ferritin is associated with visceral fat area and subcutaneous fat area”. Diabetes Care10 (2005): 2486-2491.
22. Chen X., et al. “Association of elevated serum ferritin levels and the risk of gestational diabetesmellitus in pregnant women”. Diabetes Care 5 (2006): 1077-1082.
23. Fernandez-Real JM., et al. “Bloodletting in high-ferritin type 2 diabetes”. Effects on Insulin Sensitivity and Cell Function, Diabetes4 (2002): 1000-1004.
24. Barham D and Trinder P. “An improved colour reagent for the determination of blood gluose by the oxidase system”. The Analyst151 (1972): 142-145.
25. Porstmann T and Kiessig ST. “Enzyme immunoassay techniques an overview”. Journal of Immunological Methods, 1-2 (1992): 5-21.
26. Onno W., et al. “Determination of Serum, Iron, Total Iron-Binding Capacity and Percent Transferrin Saturation”. Clinical and Laboratory Standards Institutes 19 (1998): 2-7.
27. Tietz NW. “Textbook of Clinical Chemistry, 3^rd edition”, Philadelphia, PA: WB Saunders (1999): 1701-1703.
28. Lahousen T., et al. “Silent haemoglobin variants and determination of HbA1c with the HPLC Bio-Rad Variant II”. Journal of Clinical Pathology 9 (2002): 699-703.
29. Bozzini C., et al. “Prevalence of body iron excess in the metabolic syndrome”. Diabetes Care8 (2005): 2061-2063.
30. Jiang R., et al. “Body iron stores in relation to risk of type 2 diabetes in apparently healthy women”. Journal of the American Medical Association 6 (2004): 711-717.
31. Kashinakunti SV., et al. “Serum ferritin level in type 2 diabetes mellitus - A case control study”. International Journal of Clinical Biochemistry and Research 1 (2016): 62-66.
32. Pramiladevi R., et al. “Serum Ferritin Levels in Type II Diabetes Mellitus”. Scholars Journal of Applied Medical Sciences (SJAMS)5 (2013): 472-475.
33. Senghor A., et al. “Serum Ferritin, Iron, TIBC, Hb in male patients with dysglycemia”. International Journal of Biological and Medical Research2 (2012): 1609-1611.
34. Dhawale S., et al. “Original Article - Role of Serum Iron and Serum Ferritin in Type II Diabetes”. International Journal of Multidisciplinary Research and Development8 (2015): 504-511.
35. Sharifi F., et al. “Elevated serum ferritin concentrations in prediabetic subjects”. Diabetes and Vascular Disease Research1 (2008): 15-18.
36. Wrede CE., et al. “Association between serum ferritin and the insulin resistance syndrome in a representative population”. European Journal of Endocrinology 154 (2006): 333-340.
37. Kim NH. “Serum ferritin in healthy subjects and Type2 Diabetes Mellitus”. Med Korea3 (2000): 387-392.
38. Maheshwari A., et al. “Correlation between serum ferritin and glycaemic control in patients of type 2 diabetes mellitus: a case control study”. International Journal of Research in Medical Sciences 9 (2015): 2327-2330.
39. Padma JA., et al. “Serum Ferritin and HbA1C Level in Type 2 Diabetes Mellitus”. International Journal of Clinical and Biomedical Research 3 (2015): 30-37.
40. Chandrashekhar HR., et al. “Association of Serum Ferritin Levels with Glycemic Control in type-2 Diabetes Mellitus”. Indian Journal of Pharmacy Practice 1 (2014): 58-61.
41. Vari IS., et al. “Ferritin and Transferrin Are Associated with Metabolic Syndrome Abnormalities and Their Change Over Time in a General Population”. Diabetes Care7 (2001): 1795-1801.

Citation

Citation: Nusrat Zerin., et al. “Iron Status in Type 2 Diabetes Mellitus Patients: A Tertiary Care Hospital Study”.Acta Scientific Medical Sciences 7.9 (2023): 120-129.

Copyright

Copyright: © 2023 Nusrat Zerin., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.