Geetha Bhaktha

Is HbA1c a risk factor for type 2 diabetic subjects without macro and micro vascular complications

Objective: Our study attempted to evaluate the diagnostic value of HbA1c in predicting diabetic dyslipidemia and cardiovascular diseases (CVD). Methods: Study comprised 229 subjects (156 males and 73 females) with diabetic dyslipidemia without any micro and macro vascular disorders. Fasting blood samples were taken to analyse biochemical parameters like HbA1c, sugar and lipid profile. Results: The HbA1c levels did not differ much between males (6.96 ± 1.11) and females (7.01 ± 1.19). HbA1c demonstrated a positive significant correlation with cholesterol, LDL and a negative significant correlation with HDL. Patients with HbA1c >7.0% had significantly higher value of cholesterol, LDL when compared with <7.0%. Conclusions: The findings of this study clearly suggest that HbA1c endures the ability of predicting CVD risk in the diabetic patients without any micro and macro vascular disorder. Therefore study recommends using HbA1c as a marker for predicting the risk of developing CVD.

Adiponectin in Diabetic Subjects Without Any Micro- or Macrovascular Complications: A Review.

Adipose tissue is an important endocrine organ responsible for the secretion of adipokines, which play important roles in glucose and lipid homeostasis. Type 2 diabetes (T2D) has been proven as a major result from fat accumulation thus leading to insulin insensitivity. This adipose specific secreted protein has important inflammatory properties that are present in the circulation and involved in the regulation of insulin sensitivity,1 thus making it an important modulator for T2D. The main purpose of this article is to understand the levels of adiponectin for diabetic subjects without any complications and its necessity for managing obesity. In a recent published article,2 a cross-sectional study of 229 cases of T2D and 205 healthy individuals of age 30-70 years was presented from the Dakshina Kannada district of Karnataka, India. Clinical examinations were done for the assessment of cardiovascular and abdominal system. Estimations of adiponectin levels were done using ELISA technique. Anthropometric variables were measured by standard procedure and HbA1c tested via immunoturbidometry. The results obtained were analyzed using SPSS 10.0, Student’s unpaired t test. Pearson correlation was analyzed between the parameters of the study population. The results showed the mean value of adiponectin of the diabetic study population was significantly less (15.98 + 6.02) when compared to normal subjects (18.14 + 8.32). An increase in the values for the nondiabetic population was seen in both female and male groups (P = .008). Negative correlations were observed between glycated hemoglobin and adiponectin in the diabetic group (P = –.361) and for body mass index (BMI) compared with adiponectin in normal group (P = −0.302). In addition, males in normal population had higher adiponectin levels than female but showed the opposite in the diabetic group as males in the diabetic had lower than females. With the use of observational research methods to determine the validity of this study, we relate to prospective studies showing how the levels of adiponectin have been supported as being lower in diabetic subjects2,3 when compared to normal as a good glycemic index in diabetic subjects helps to increase the levels of adiponectin. Though an inverse relation was observed between BMI and adiponectin in healthy individuals, the relation was lost in obese diabetic subjects free from micro- or macrovascular complications. Studies have produced negative correlations; however, they are inconsistently inversely correlated with BMI.1,3,4 Studies have also shown plasma adiponectin levels being negatively regulated by adiposity.5 Obese subjects express significantly lower levels of adiponectin in nondiabetic patients, and a strong correlation between adiponectin and systemic insulin sensitivity has been well established both in vivo and in vitro, in mice, other animals, and humans. A rise in adiponectin levels showed weight loss and across diverse populations from 13 prospective studies are associated with a lower risk of T2D.5 However adiponectin’s potential remains substantially weak since adiponectin is independent of obesity in diabetic patients from these studies. This very important adipocytokine is abundant, and it has important applications, but if it is to act as a marker for adiposity, more research is needed to support the value bounding this theory. The benefit of this study design allowed researchers to compare many different variables at the same time. The study also showed reproducibility as the measurements used were regarded as valid by other investigators. The quality of measurements and outcomes was controlled, and since all the patients were accounted for the study statistically showed completeness. However, longitudinal studies are required for a more definite understanding of cause and effect for clinical applications of adiponectin. From recent studies high serum adiponectin concentration and low BMI are significantly associated with the mortality in an elderly cohort of all cause and cardiovascular disease.6 Adiponectin administration also shows a promising pathway for managing obesity clinically; however, it remains to be determined whether adiponectin can be used effectively and safely as pharmacologic means to treat obesity in humans whether through pharmaceutical or lifestyle interventions. T2D in the world has reached epidemic proportions, and replenishment of adiponectin might represent a novel treatment for insulin resistance (IR) and T2D since it appears to be an important modulator. Future studies should therefore evaluate adiponectin as it is a target for the reduction of T2D. With the global increase in the incidence of diabetes, new strategies to prevent the complications are urgently needed.

Assessment of biomarkers in type 2 diabetic subjects without any complications.

BACKGROUND Type 2-diabetes (T2D), is a public health problem which has reached epidemic proportions due to the rapidly increasing rates of this disease worldwide. It is known that adipose tissue can synthesize and release pro-inflammatory cytokines, tumor necrosis factor-alpha, interleukin-1, adiponectin and leptin that are associated with body fat mass. Hence comparing the biomarkers with individuals without hyperglycemia would help us to understand the level of increase in their values though the vascular complications have not begun. MATERIALS AND METHODS This was a cross sectional study comprising 229 diabetic persons and 205 healthy individuals. High sensitivity reactive protein (hs-CRP) was estimated using nephelometry technique. Inflammatory markers and adiponectin were measured using ELISA instrument. RESULTS Tumor necrosis factor α (TNF-α) (40.56%) and Leptin (45.43%) were significantly increased in the diabetic group when compared with normal study population. Adiponectin was significantly decreased in diabetic study population (11.94%). This was supported by a significant correlation between the glycemic index HbA1c and TNF-α (r=0.376, p=0.01), adiponectin (r=-0.381, p=0.01) and leptin (r=0.269, p=0.01) in diabetic population, but the significance was lost among the normal healthy individuals. CONCLUSIONS The most promising biomarkers of diabetes such as TNF-α, adiponectin, leptin has shown a marked difference in this diabetic population. This study proves the assessment of these biomarkers as future predictors of type 2 diabetes.