Published: 2017-01-14

Glycemic control, micronutrients and some metabolic enzyme activity in type 2 diabetes

Augusta C. Nsonwu-Anyanwu, Edmund R. Egbe, Jeremaiah S. Offor, Chinyere A. O. Usoro


Background: Alterations in the metabolism of some essential micronutrients and activities of some metabolic enzymes have been reported in diabetes mellitus. These changes have been attributed to hyperglycemia and increased protein glycosylation associated with diabetes and seems to be more pronounced in poor glycemic states. The influence of glycemic control on serum levels of calcium (Ca), Iron (Fe), phosphorus (P), vitamin C, and lactate dehydrogenase (LDH) and amylase activity in type 2 diabetes were determined in this study.

Methods: Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), serum calcium (Ca), Iron (Fe), phosphorus (P), vitamin C, LDH and amylase activity were determined in fifty type 2 diabetic subjects aged between 40-70 years and fifty age matched apparently healthy non-diabetic subjects in Calabar, Nigeria using colorimetric methods. Socio-demographic characteristics, anthropometric indices (body mass indices (BMI), waist to hip ratio (WHR)) and blood pressure were determined using standard methods. Data was analyzed using t-test, ANOVA and Pearson correlation analysis at p = 0.05.

Results: The FPG, HbA1c, serum vitamin C, Iron and calcium levels were significantly higher and serum phosphorus lower in diabetics than in non-diabetics. Diabetics with poor glycemic control (HbA1c >8.0%) have higher serum calcium and LDH activity compared to those with good glycemic control (HbA1c <8.0%).

Conclusions: Diabetes may alter the metabolism of vitamin C, Iron, calcium and phosphorus while poor glycemic control may be associated with changes in calcium and LDH activity.



Diabetes, Micronutrients, Enzymes, Glycemic control

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Abou-Seif MA, Youssef AA. Evaluation of some biochemical changes in diabetic patients. Clinica Chimica Acta. 2004;346:161-70.

Al-Yassin A, Hussein AM, Ali T, Dohan CE. Calcium and Diabetes Mellitus type two a prospective study done on people with Type 2 Diabetes in Diwaniya Teaching Hospital. Kufa Med. Journal. 2009;12(1):468-75.

Fujita T, Palmieri GM. Calcium paradox disease: calcium deficiency prompting secondary hyperparathyroidism and cellular calcium overload. J. Bone Miner Metab. 2000;18:109-25.

Abdel-Gayoum AA, Musa AS. The effect of Glycemic control on serum Lipids and Calcium-Phosphate profiles in patients with Type 2 Diabetes Mellitus. The Egyptian Journal of Biochemistry & Molecular Biology. 2008;2(1):79-92.

Hamad NA, Eltayeb LB, Brair SL, Bakheit KH, Hamdan HZ, Omer WH. A clinical study of serum calcium, phosphorus, and alkaline phosphates level in type II Diabetes mellitus among Sudanese population in Khartoum State. Al Neelain Medical Journal. 2013;3(10):43-50.

Knochelle JP. Nutrition in Health and Disease. Shills M et al. eds. 9th edition. Baltimore Williams press. 1999;7:56-60.

Fernandez-Real JM, Lo´ pez-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes 2002;51:2348-54.

Vantyghem MC, Haye S, Balduyck M, Hober C, Degand PM, Lefebvre J. Changes in serum amylase, lipase and leukocyte elastase during diabetic ketoacidosis and poorly controlled diabetes. Acta Diabetol. 1999;36(1):39-44.

Dakhale GN, Chaudhari HV, Shrivastava M. Supplementation of Vitamin C Reduces Blood Glucose and Improves Glycosylated Hemoglobin in Type 2 Diabetes Mellitus: A Randomized, Double-Blind Study. Advances in Pharmacological Sciences. 2011;2:1-5. doi:10.1155/2011/195271.

American Diabetes Association (ADA). Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62-69.

World Health Organisation (WHO). Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation, 1999.

World Health Organisation (WHO). Obesity; Preventing and Managing the Global Epidemic. Report of aWHO Consultation 2000, WHO Technical Report Series 894.

American Diabetes Association (ADA). Clinical practice recommendations: standards of medical care for patients with diabetes mellitus. Diabetes care. 2002;25(suppl. 1):S33-49.

Barham D, Trinder P. An improved colour reagent for the determination of blood glucose by the oxidase system. Analyst. 1972;97:142-45.

Trivelli LA, Ranney PH, Lai HT. Column chromatography method with cation exchange resin for glycated Haemoglobin separation. New England Journal of Medicine. 1971;284:353.

Caraway WT. Amylase estimation using the amyloclastic method. Annals. Clin. Chem. 1959;32:97.

Stern J, Lewis WHP. The colorimetric estimation of calcium in serum with O-cresolphthaleincomplexone. Clinica Chimica Acta. 1957;2(6):576-80.

Alessandro T, Edoardo M, Paolo T, Paolo N. Brief technical note; An improved,highly sensitive method for the determination of serum iron using chromazurol B. Clinicu Chimica Acta. 1981;114:287-90.

Young DS. Phosphorus Metabolism. Clin. Chem. 1975;21:342.

Roe JH, Kuether CA. Determination of vitamin C. J. Biol. Chem. 1943;147:399.

Schumann G, Bonora R, Ceriotti F, Clerc S, Renaud P, Ferrero CA. IFCC primary reference procedures for the measurement of catalytic activity concentrations of enzymes at 37°C. Part 3. Reference procedure for the Measurement of catalytic concentration of LDH. Clin Chem Lab Med. 2002;40:643-8.

Wokoma FS. Diabetes and hypertension in Africa – an overview, Diabet. Int. 2002;12:36-40.

Stanaway SE, Gill GV. Protein glycosylation in diabetes mellitus biochemical and clinical considerations. Practical Diabetes International. 2000;17:21-25.

Becerra-Tom´as N, Estruch R, Bull M, Casas M, D´ıaz-L ´opex A, Basora J, Fit ´ o M, Serra-Majem L, Salas-Salvad´o1 J. Increased Serum Calcium Levels and Risk of Type 2 Diabetes in Individuals at High Cardiovascular Risk. Diabetes care. 2014. DOI: 10.2337/dc14-0898.

Ojuka EO, Jones TE, Nolte LA, et al. Regulation of GLUT4 biogenesis in muscle: evidence for involvement of AMPK and Ca (2+). Am. J. Physiol. Endocrinol. Metab. 2002;282:E1008–013.

Wang S, Hou X, Liu Y, Lu H, Wei L, Bao Y, Jia W. Serum electrolyte levels in relation to macrovascular complications in Chinese patients with diabetes mellitus. Cardiovascular Diabetology. 2013;12:146-55.

Bellan M, Guzzaloni G, Rinaldi M, Merlotti E, Ferrari C, Tagliaferri A, Pirisi M, Aimaretti G, Scacchi M, Marzullo P. Altered glucose metabolism rather than naïve type 2 diabetes mellitus (T2DM) is related to vitamin D status in severe obesity. Cardiovascular Diabetology. 2014;13:57-66.

Comstock GW, Menkes MS, Schober SE, Vuilleumier JP, Helsing KJ. Serum levels of retinol, beta-carotene, and alpha-tocopherol in older adults. Am. J. Epidemiol. 1988;127(1):114-23.

Forgani B, Goharian V, Kasaeeian N, Amini M. The Influence of Supplemental Vitamin C on Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus. 2003;1(2):67-70.

Shetty JK, Prakash M, Ibrahim MS. Relationship between free Iron and Glycated haemoglobin in uncontrolled Type 2 Diabetes patients associated with complications. Indian Journal of Clinical Biochemistry. 2008;23(1):67-70.

Simcox JA, McClain DA. Iron and Diabetes Risk. Cell Metabolism Review. 2013;17:331-441.

Jomova K, Valko M. Advances in metal-induced oxidative stress and human disease. Toxicology. 2011;283:65-87.

Ponugoti B, Dong G, Graves DT. Role of forkhead transcription factors in diabetes-induced oxidative stress. Exp. Diabetes Res. 2012;7:939-51.

Najeeb Q, Aziz R, Hamid S. To evaluate the levels of glycated hemoglobin, serum calcium, magnesium, phosphate, uric acid and microalbuminuria in patients with newly diagnosed type 2 diabetes mellitus. Int. J. Res. Med. Sci. 2014;2:1462-5.

Vorum H, Ditzel J. Disturbance of Inorganic Phosphate Metabolism in Diabetes Mellitus: Its Relevance to the Pathogenesis of Diabetic Retinopathy. Journal of Ophthalmology, 2014.

Cirillo H, Ciacci C, de Santo NG. Age, renal tubular phosphate reabsorption, and serum phosphate levels in adults. The New England Journal of Medicine. 2008;359(8): 864-6.

Yegin E, Odabasoglu F. Effect of Experimental Diabetes Mellitus on Plasma Lactate Dehydrogenase and Glutamic Oxaloacetic Transaminase Levels in Rabbits. Turk. J. Biol. 2002;26:151-4.

Ikmal SQ, Huri HZ, Vethakkan SR, Ahmad WA. Potential Biomarkers of Insulin Resistance and Atherosclerosis in Type 2 Diabetes Mellitus Patients with Coronary Artery Disease. International Journal of Endocrinology, 2013.

Sreenivasan RS, Krishna P, Deecaraman MM, Prakash N, Renganathan NG. Variations in the Enzyme Activity of Carbohydrate Metabolic Disorder on Cardiac Function. European Journal of Applied Sciences. 2010;2(2):62-9.

Oliver, R.C., Tervonen, T., Flynn, D.G., Keenan, K.M. Enzyme activity in crevicular fluid in relation to metabolic control of diabetes and other periodontal risk factors. J. Periodontal. 1993;91(5):423-6.