Leptin and C-peptide Level in North Indians in Relation to Subjects Underlying Type Two Diabetes Mellitus

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1 Reserch Article Jyoti Jin 1 *, Rti Mthur 1, Mnsi Jh 1, Schdev Ydv 2 1 Deprtment of Biochemistry, SMS Medicl College nd Hospitl, Jipur, Rjsthn, Indi. 2 Assistnt Professor, Deprtment of Phrmcy, Bnsthli University, Rjsthn, Indi. *Corresponding uthor s E-mil: jyotijin_1983@yhoo.com Accepted on: ; Finlized on: ABSTRACT Leptin nd C-peptide Level in North Indins in Reltion to Subjects Underlying Type Two Dibetes Mellitus Leptin is n dipocyte secreting hormone which regulte ppetite nd body weight more specilly body ft stores. Its concentrtion differs in vrious metbolic diseses, so the purpose of this study ws to mesure Leptin nd C-peptide level in dibetic nd helthy subjects nd find its ssocition with nthropometry mesurement nd vrious metbolic indices. The study ws conducted in SMS hospitl Jipur. 150 type two dibetes mellitus nd 150 helthy control ge nd sex mtched were recruited for this study. BMI, weight, height, wist circumference, hip circumference were mesured nd biochemicl prmeters fsting blood glucose, insulin, lipids, leptin nd C-peptide were mesured. Totl 150 control subjects (84 mle nd 66 femle) nd 150 dibetic subjects (86 mle nd 64 femle) with the men ge of (44.1±10.4) y for control subject nd (44.12±8.50) y for dibetic subjects were recruited. BMI, wist circumference, hip circumference were found significntly higher (p<0.05) in dibetic subjects thn control group. Biochemicl prmeters triglycerides, totl cholesterol, insulin nd C-peptide were found significntly higher (P<.05) in dibetic group wheres serum leptin concentrtion ws found significntly lower (p<.05) in dibetic subjects (11.54±5.47) thn control subjects (14.44±3.44). Serum leptin concentrtion ws found significntly higher in women thn men in both control nd dibetic subjects. The serum leptin ws significntly correlted with BMI, Hip circumference, wist circumference, Insulin, HOMA-IR nd C-peptide in both control nd dibetic subjects. The results of the study shows tht Serum leptin concentrtion decresed in dibetic subjects nd leptin correlted positively with BMI, hip circumference nd wist circumference. It ws lso correlted with insulin, HOMA-IR nd C-peptide. Serum C-peptide concentrtion incresed in dibetic subjects. Keywords: Leptin, C-peptide, Dibetes, Insulin, HOMA-IR. 92 INTRODUCTION I n the present scenrio the prevlence of chronic, noncommunicble diseses is incresing dy by dy. About 18 million people die every yer from crdiovsculr disese, for which dibetes nd hypertension re mjor predisposing fctors 1. It is estimted tht dibetes ffects bout 150 million people worldwide, nd this figure is expected to be doubled in the next 20 yers 2. T2DM is complex heterogeneous group of metbolic conditions chrcterized by incresed levels of blood glucose due to impirment in insulin ction nd insulin secretion 3. Insulin resistnce refers to suppressed or delyed responses to insulin. There re three defects in the onset of hyperglycemi in T2DM: incresed heptic glucose production, diminished insulin secretion, nd impired insulin ction 4. The dipose tissue not only releses free ftty cids but lso hormones nd cytokines such s leptin, diponectin, resistin, TNF-lph etc. These hormone nd cytokines modify insulin ction. Hence, the role of obesity in the genertion of insulin resistnce nd subsequently leding to impired glucose tolernce s well s overt type 2 dibetes mellitus hs been estblished 5. Low circulting levels of insulin is compelling for the nti-dibetic ctions of insulin 6. The two hormones nmely leptin nd insulin re producing the respective dipose tissue signlling by chnging the whole dynmics of energy homeostsis 7. Asin Indins re prticulrly susceptible to develop dibetes mellitus 8. It is well estblished tht leptin impirs insulin signlling nd confers insulin resistnce. Leptin replcement in hypoleptinemic, lipotrophic ptients, however, improved glucose tolernce nd decresed serum insulin concentrtions 9, 10. This clerly suggests tht leptin my possess insulin sensitizing properties. Leptin is crucil hormone in the regultion of body weight, more specificlly of body ft stores 11, 12. It is secreted by white dipose cells, nd is directly relted to body ft content. There is considerble inter individul vrition in plsm leptin concentrtions mong individuls with comprble degrees of obesity, suggesting tht other fctors re involved in the regultion of leptin production. Leptin modultes immune system, reproduction, ngiogenesis nd lipolysis 13. Centrlly, leptin is n essentil component of the feedbck circuitry tht integrtes energy homeostsis, primrily by modulting the hypothlmic peptidergic network involved in energy intke nd expenditure 14. Leptin improves glucose tolernce nd increses the expression of key enzymes, there by influencing the rte of gluconeogenesis nd glycogenolysis vi melncortin-dependent nd independent pthwys 15. Leptin is criticl signling molecule in the hypothlmus influencing ppetite nd stiety. There is positive correltion between the circulting levels of leptin nd dipocyte number nd size 16. Leptin levels hve been found to be correlted with fsting insulin levels, subcutneous dipose tissue nd BMI, but not with glucose disposl in Asin-Indin men 17. Hyperleptinemi hs been dvocted s Interntionl Journl of Phrmceuticl Sciences Review nd Reserch Avilble online t

2 component of the insulin resistnce syndrome, nd the insulin leptin xis my ply coordinting role in this syndrome 18. The gret interest in C-peptide is due to the limittions of the use of serum insulin s mesure of insulin secretion. After its secretion in to the portl vein, insulin psses through the liver where pproximtely 50% of the insulin delivered is extrcted 19. C-peptide is produced by series of enzymtic clevges of the precursor molecules preproinsulin nd proinsulin. Preproinsulin, precursor of proinsulin, is produced in the endoplsmic reticulum of pncretic β-cells in response to elevted blood glucose levels in helthy individuls; it is then cleved by microsoml enzymes into proinsulin. C-peptide is clered by the kidney nd hs hlf-life of bout 20 to 30 minutes compred to insulin which is clered through the liver nd hs hlf-life of bout 3 to 5 minutes 20.Becuse C peptide is secreted from islet cells into the circultion in equimolr concentrtions with insulin nd is not extrcted by the liver, mny investigtors hve used C peptide levels s biomrker of β-cell function 21. SUBJECTS AND METHODS Subjects Two group of subjects were recruited (1) Type 2 dibetes mellitus which included 150 ptients visiting endocrinology OPD of SMS hospitl Jipur ge Ptients with secondry Dibetes mellitus, other endocrinopthies, Ischemic hert disese, Clinicl condition tht influence insulin resistnce, nd ptients on drugs like steroids, pioglitzone, metformin nd ny mediction known to ffect body composition were excluded from the study. (2) Second group comprises 150 ptients, ge nd sex mtched helthy control group. The study protocol ws pproved by Ethics Committee SMS hospitl Jipur. Anthropometric mesurements were recorded for ll ptients. Height, weight, wist nd hip circumference were tken by stndrd procedures. Wist to Hip rtio (WHR) ws clculted s Wist circumference (cm) divided by Hip circumference (cm). Body mss index (BMI) ws clculted using the formul: weight (kg) divided by height in meters squred. Biochemicl ssy Blood smples were obtined by vein puncture fter overnight fsting (minimum 12 hours fsting) to estimte the following biomrker: (1) Serum leptin nd C-peptide Concentrtions enzyme- linked immunossy (i) Avi Bion Humn Leptin ElISA Kit; Orgenium lbortories business Unit Finlnd; (ii) Di Metr C-peptide ELISA Kit. (2) Serum insulin ws estimted by chemiluminescent immunometric ssy using Immulite 2000 mchine. (3) Fsting Blood glucose, Serum lipid profile (Totl cholesterol, Triglycerides, HDL,) were mesured using commercil vilble kits (Recombigen, Anmol, Becon, Logotech) on fully utomted nlyzer (AU400/Koprn). LDL ws clculted by fire wield formul. Serum ws stored t -20ºC for nlysis of leptin nd C-peptide. Indexes The BMI ws clculted s body weight (kg)/height (m) 2. Wist to Hip rtio (WHR) ws clculted s Wist circumference (cm) divided by Hip circumference (cm). The homeostsis model ssessment index HOMA-IR = (fsting plsm glucose (mg/dl) x insulin (µu/ml)/405.) for insulin resistnce ws clculted. Sttisticl nlysis Sttisticl nlysis ws performed using IBM Sttisticl Pckge for Socil Sciences SPSS for windows (version 19, Chicgo, IL, USA). Mens nd stndrd devitions (SD) were clculted for ll prmeters. The independent smple t-test ws used to compre the mens of different vribles in the two groups. In ddition, the Person correltion coefficient (r) ws used for correltion nlysis of leptin nd C-peptide in Dibetic nd Control Group. For ll sttisticlly ssessment vlue of p < 0.05 ws considered significnt. RESULTS Anthropometry, biochemicl prmeters, leptin nd C- peptide in Control group nd Dibetic group re summrized in Tble 1. The men ge of control group ws 44.1±10.4 yers nd tht of dibetic group 44.12±8.5 yers. Significnt differences in BMI, wist circumference, hip circumference, triglycerides, cholesterol nd HDL, were found between the two groups. The fsting blood glucose nd HOMA IR of dibetic group were significntly higher wheres the leptin concentrtions were found lower (11.54±5.47) thn the control group (14.44±3.44) nd C-peptide ws found significntly higher in dibetic ptients (3.13±1.02) thn the control group (2.18±1.41) when compred with group 1 vi independent t test. Tble1: Anthropometry nd biochemicl prmeter of the study subjects (men±sd) Vribles Totl Control Dibetic p N (Mle/Femle) Age(yrs.) 44.1± ±8.5 NS BMI(Kg/m 2 ) 23.45± ± WC(Cm) 82.28± ± HC(Cm) 87.96± ± WHR 0.93± ± TG (mg/dl) ± ± Cholesterol (mg/dl) ± ± HDL(mg/dl) 47.47± ± LDL ± ±37.90 NS HOMAIR 1.05± ± Insulin(µU/ml) 4.66± ± Glucose(mg/dl) 90.9± ± Leptin(ng/ml) 14.44± ± C-Peptide (ng/ml) 1.72± ± BMI= Body Mss Index; WC= Wist Circumference; HC= Hip Circumference; WHR= Wist to hip rtio; TG= Triglycerides; HDL= High Interntionl Journl of Phrmceuticl Sciences Review nd Reserch Avilble online t 93

3 density lipoprotein; LDL= Low Density lipoprotein. P<0.05 is significntly different. The comprtive study of dibetic mle nd dibetic femle nd control mle nd control femle ws shown in Tble 2. No significnt difference ws found in Anthropometry mesurement in both dibetic nd Control mle, femle except Wist to hip rtio which showed significnt difference in both dibetic mle nd dibetic femle nd control mle nd control femle. In biochemicl prmeters HDL showed significnt difference in control mle nd femle but no significnt difference ws found in dibetic mle nd femle. Serum leptin level ws found significntly higher in femle subjects in both dibetic nd control. Tble 2: Gender bsed Anthropometry nd biochemicl prmeter of the study subjects (men±sd) Vribles Dibetic mle Dibetic Femle P Control mle Control femle p N Age(yrs.) 45.71± ±9.61 NS 44.91± ±9.4 NS BMI(Kg/m 2 ) 26.60± ±4.43 NS 23.49± ±2.48 NS WC(Cm) 95.48± ±11.01 NS 83± ±12.73 NS HC(Cm) 97.55± ±12.9 NS 86.83± ±14.11 NS WHR 0.98± ± ± ± TG (mg/dl) ± ±70.18 NS ± ±49.87 NS Cholesterol (mg/dl) ± ± 44.2 NS ± ±35.73 NS HDL(mg/dl) 44.06± ±5.1 NS 45.92± ± LDL ± ±38.65 NS ± ±31.39 NS HOMAIR 2.5± ±2.50 NS 1.09± ±0.92 NS Insulin 6.4± ± 5.56 NS 4.76± ±4.01 NS Glucose(mg/dl) ± ± NS 92.14± ±9.8 NS leptin(ng/ml) 10.55± ± ± ± C-peptide (ng/ml) 3.1± ± 1.05 NS 1.66± ±0.92 NS P<0.05 is significntly Significnt. NS= Not significnt 94 There ws strongly significnt positive correltion of Leptin with BMI (r=.828, p=.0001) hip circumference (r=.254, p=.01), nd wist circumference (r=.320, p=.0001) in control nd (r=.756, p=.0001), (r=.514, p=.0001), (r=.522, p=.0001) in dibetic group ws found. There ws No correltion found with wist to hip rtio in both dibetic nd control group s shown in Tble 3. Tble 3: Correltion of leptin with Anthropometry in dibetic nd control group Vribles Control Dibetic r P r p BMI WC HC WHR In metbolic vrible leptin show significnt positive correltion with HOMA-IR (r=.197, p=.016) Insulin (r=.277, p=.001) nd C-peptide(r=.652, p=.000) in dibetic group. Leptin lso showed significnt positive correltion with HOMA-IR(r=.169, p=.038) nd Insulin (r=.175, p=.032) in control group lthough it is not s strong s showed in Dibetic group. Leptin did not show ny correltion with HDL nd LDL in both Control nd Dibetic group s shown in Tble 4. Tble 4: Correltion of leptin with biochemicl prmeter in dibetic nd control group Vribles Control Interntionl Journl of Phrmceuticl Sciences Review nd Reserch Avilble online t Dibetic r P r p HDL LDL HOMA IR Insulin C-peptide DISCUSSION In This present study we demonstrted serum leptin nd C-peptide concentrtion in dibetic ptients ginst control subjects. It ws found tht serum leptin concentrtion ws significntly lower in dibetic ptients nd it lso showed positive correltion with body mss index in both control nd dibetic subjects. Leptin is n dipose derived hormone tht hs been shown to be involved in pthwys influencing the risk of crdiovsculr disese nd dibetes 22. It hs been suggested tht the ssocition between plsm leptin nd dibetes my be mnifesttion of n underlying leptin resistnce medited by obesity 23. Our results consistent with previous study by ching chu chen, et l. Roden et l. 24 found tht both type 1 nd type 2 dibetic ptients in good metbolic control disply lower bsl plsm leptin concentrtions

4 thn non-dibetic humns suggesting potentil role of glycemi for leptin secretion. 25 However, the regultion of serum leptin levels in humns is not well understood. Some uthors reported tht serum leptin level increses s body ft mss increses 26, 27. Obese people hve incresed level of leptin nd it could be due to resistnt ction of leptin on inhibition of food intke nd increse in energy expenditure 28. Rohner-Jenrenud discussed tht if there is defect in the leptin pthwy in humn obesity, it could be due either to n inbility of the leptin to ppropritely enter the centrl nervous system or to post-receptor defect in the subsequent leptin signling cscde. It is likely tht the trnsmission of the signl will involve mny other molecules in the centrl nervous system. Prticulrly prominent studies hve focused on neuropeptide Y nd the proopiomelnocortin (POMC) (MSH precursor) pthwy 29. Clement K et l. reported tht plsm leptin ws significntly reduced in the dibetic individul in morbidly obese subjects who were in poor metbolic control 30. Our study reported tht women hve reltively high leptin concentrtion thn in men nd this study is supported by Hellstroem; provides evidence tht gender differences in circulting leptin levels re cused by two different mechnisms: lrger dipose tissue mss nd higher production rte of leptin per unit mss of dipose tissue in women thn in men 31. Luukk et.l. found the strong evidence tht the testosterone is probbly one of the most importnt fctors contributing to the lower serum leptin levels in men compred with women 32. Wbitsch reported tht testosterone nd its ctive metbolite dihydrotestosterone were ble to suppress leptin secretion nd leptin messenger ribonucleic cid in primry culture of humn dipocytes, suggesting direct effect of testosterone t the level of dipocytes 33 our study reported significnt positive correltion of leptin with insulin, HOMAIR nd C-peptide. Our study supported by Rdk Lichnovsk 34 nd discussed tht leptin could be mechnism by which incresed diposity increses insulin resistnce. Leptin ntgonizes insulin signling in heptom cells, decresing insulin-induced tyrosine phosphoryltion of IRS-1, step leding to mny of the metbolic ctions of insulin (glucose trnsport, kinse pthwy). Leptin lso ntgonizes the bility of insulin to decrese mrna encoding PEPCK, the enzyme ctlyzing the rte-limiting step in gluconeogenesis 35. In our study leptin significntly correlted with wist nd hip circumference nd this result is consistent with the finding of De courtesn 36. The leptin mrna levels nd secretion rtes re higher in subcutneous thn in viscerl dipose tissue nd positive correltion between leptin nd wist circumference my, therefore, reflect the contribution of subcutneous bdominl ft mss nd my link leptin with centrl obesity 37. In our study C- peptide ws tht significntly incresed in Dibetic ptients. The sme findings ws reported by bill b Abdullh 38 nd concluded tht the fsting c-peptide levels re useful in type 2 dibetic ptients with poor glycemic control to ssess the endogenous insulin reserve nd to lter the modlity of tretment. Insulin is secreted s proinsulin nd subsequently cleved into insulin nd C- peptide 39. C-peptide is mrker of pncretic insulin synthesis, nd severl epidemiologic studies hve utilized C-peptide s n lternte biomrker to insulin becuse it hs longer hlf-life thn insulin nd therefore is more stble 39. Our result did not show ny correltion of leptin with triglyceride, Totl cholesterol, LDL cholesterol, nd HDL cholesterol in both control nd dibetic ptients. The sme result ws reported by li l-sultn (2006) in norml weight nd obese Sudi dults 40. CONCLUSION In conclusion our findings reported tht serum leptin level decresed in type two dibetes mellitus subjects. The women hve reltively high concentrtion of serum leptin level thn in men. Leptin level incresed with body mss index. Our findings of strong ssocition between leptin nd insulin sensitivity suggest n importnt role for leptin in humn metbolism. C-peptide incresed in type two dibetes mellitus nd it is positively correlted with leptin. C-peptide is lso mrker of metbolic disese. REFERENCES 1. 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