International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July ISSN

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1 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July PREVALENCE OF TYPE II DIABETES MELLITUS IN BORN BLIND SUBJECTS IN CORRELATION WITH SERUM MELATONIN LEVELS Prof. S.M. Rajendran 1, Dr. S. Balakrishnan 2, Mrs. P.J. Paramaeswari 3, Dr. P. Abhishaanth Prabu 4 SREE BALAJI MEDICAL COLLEGE & HOSPITAL, CHENNAI, TAMIL NADU, INDIA No: 7, Works Road, Chromepet, Chennai Tel. No: Fax No: ID: drsmrajendran@yahoo.co.in 1 Professor, Balaji Diabetes & Obese Research Centre (BALDORC), Sree Balaji Medical College & Hospital, Chennai. 2 Professor of Medicine (BALDORC) 1 3 Asst. Prof. Biostatistics (BALDORC) 4 Resident (BALDORC) Pineal Gland, Melatonin, FBS, PPBS, W/H Ratio, β Cell ABSTRACT: Increasing evidences revealed that melatonin plays a major role over the insulin secretion and sensitization in the normal objects. This research to explore the role of melatonin in the Born Blind subjects and it is compared with normal vision people. Out of 503 Born Blind Subjects with a age group of years with 407 males & 96 females were included for study. On analyzing the statistics of Waist-Hip Ratio 68.4% people were >1 & 26.2% people having diastolic BP (>90) 18.3% having systolic BP (>140) Analyzing the Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS), 95.2% having FBS <110 and 95.1% having PPBS <140. Astonishingly 96.4% having high values of Serum Melatonin >15pg In normal vision people with same age, around 70% having diabetes(t2dm) having their melatonin level <5pg. This study reveals the role of pineal gland and the hormone melatonin, will be an useful tool to detect T2DM in early stage.

2 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July Introduction: With curiosity, how the Born Blind subjects are able to lead a near normal life with a little percentage of chronic ailments like Hypertension, Renal disease and Cardio Vascular problems. Especially, these subjects with negligible percentage will be suffering from Diabetes mellitus. The previous study to prompt us to investigate these Blind subjects to assess the prevalence of Type II Diabetes Mellitus (T2DM) and other Metabolic Syndrome. With background history of Pineal Gland and recent scientific research on Pineal Gland leads to the correlation of Pineal Gland hormone and is role in Glucose Homeostasis. Being Melatonin produced by Pineal gland is termed as endogenous clock hormone. This hormone is one of the most reliable markers of the body clock hormone. The main feature and importance of this hormone is more on nocturnal time and less during day time in a normal vision subjects. With previous evidence, suggesting that melatonin may have a role in glucose metabolism and study reveals on independent association between diversed secretion and more incidence of T2DM in a normal vision subjects. (1,2) The receptors for Melatonin have been found in many organs of our body including pancreatic β cell and its effects on metabolism and regulating the body weight. When the metabolism receptor is mutated, leads to insulin resistance and T2DM. With reference to prior literature, data concerned only with normal vision people, but we stepped further to study Born Blind subjects. AIM : The primary aim is to detect the prevalence of T2DM in Born Blind subjects in correlation with their serum melatonin, waist hip ratio, systolic and diastolic Blood Pressure, fasting and post prandial Blood Sugar. With the correlation of all descriptive materials how Pineal gland was influenced for born blind subjects. As their Retino hypothalamic tract not functioning totally, how their Body clock hormone behaviour and how it helps islet cells.

3 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July SUBJECTS AND METHODS: 503 Blind subjects were recruited in and around Chennai. All of them are born blind. None of them are taking any drugs like hormonal drugs, steroids, Anti Hypertensive, Anti Depressant drugs. Majority of subjects belongs to low socio economic groups. Their lifestyle modification poor, none of them are known Diabetic or Hypertensive. All participants are within the age group of years. Both sexes are included. Among 503 participants, 407 males and 96 females. None of them are obese or over weight. The study includes the following parameters: 1) Waist Hip Ratio 2) Blood Pressure 3) FBS (FASTING BLOOD SUGAR) 4) PPBS (POST PRANDIAL BLOOD SUGAR) 5) ELETROCARDIO GRAM (ECG) 6) SERUM MELATONIN (early morning sample obtained around 04:30 a.m.) Serum melatonin sample obtained while participant on sound sleep. ASSAY TECHNIQUE: BG MLT ELISA KIT is used for quantitative determination of serum melatonin. By using quantitative sandwich enzyme immune assay technique the melatonin level estimated. 3

4 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July RESULTS: The information collected from 503 participants were analysed using SPSS 15.0 and the Descriptive statistics for the Qualitative and Quantitative parameters are presented in Table 1 and Table 2. Chi-square test was used to find the association between Morbidity and Serum Melatonin abnormality with 5% level of Significance. The values presented within parentheses represent percentages. TABLE 1: DESCRIPTIVE STATISTICS FOR QUALITATIVE INFORMATION 4 1. Age (years) Sex Male Female 3. Waist Hip Ratio < Systolic BP (mmhg) < Diastolic BP (mmhg) < Fasting BS(mg%) < VARIABLES N (%) 118 (23.5) 230 (45.7) 155 (30.8) 407 (80.9) 96 (19.1) 159 (31.6) 344 (68.4) 411 (81.7) 92 (18.3) 371 (73.8) 132 (26.2) 479 (95.2) 24 ( 4.8) 7. PostProndial BS(mg%) < (91.5) ( 8.5) 8. Serum Melatonin Level < 15 pg 18 ( 3.6) 15 pg 485 (96.4) 9. Morbidity Nil 455 (90.5) Prediabetes 18 ( 3.6) Diabetes & Hypertension 1 ( 0.2) Hypertension 29 ( 5.8) TABLE 2: DESCRPITIVE STATISTICS FOR QUANTITATIVE INFORMATION VARIABLES RANGE MEAN SE (MEAN) 1. Age (years) 2. Waist Hip Ratio 3. SBP(mmHg) 4. DBP(mmHg) 5. FBS (g%) 6. PPBS (g%) 7. Sr.Melatonin Level

5 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July In the present study majority 407 (80.9) of them were males compared to 96(19.1) females ranging between the age group of 30 to 60 years with a proportion of 344(68.4) abnormal waist hip ratio. Mean±SE(Mean) of the SBP/DBP were observed to be 125.3±0.6 / 80.3±0.4 and that of the Fasting glucose as 93.8±0.6 with a post prondial 139.7±0.9. A high level of Serum Melatonin level was observed among them as 38.5±0.6. The Prevalence of Prediabetes was 18(3.6), hypertension to be among 29(5.8) and a negligible case of 1(0.2) with both conditions by attaining our first objective. Fig 1. Bar diagram for 503 participants with Serum Melatonin Level 100.0% 80.0% Serum Melaton Level normal abnormal Percent 60.0% 40.0% 20.0% 0.0% DHT HT N PD Morbidity Error bars: 95% CI Fig 1, represents the distribution of 503 participants according to their Morbidity and Serum Melatonin level [<15 as Normal, 15 as Abnormal]. A Chi-Square value of (P=0.000) showed a statistically Significant association between Serum Melatonin abnormality and the morbidity conditions.(3) A very low prevalence of 8(1.6) with abnormal serum melatonin level were found to be PREDIABETIC in par with the prevalence of 28(5.6) hypertensives, hence achieving the second objective of this study.

6 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July Fig 2. Distribution of 48 Morbid Cases % Morbidity DHT HT PD 37.50% 60.42% Fig 2, depicts the distribution of 48 morbid cases with a maximum of 29(60.4) hypertensives, 18(37.5) prediabetic and 1(2.1) with both Prediabetics and hypertension. Among them 37(77.1) had abnormal serum Melatonin level. 38 were >1 waist hip ratio ( 79.2 %) last still non- diabetic.

7 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July Fig 3. Box-plot for 48 morbid cases with Serum Melatonin Level Sr.melatonin levels DHT HT Morbidity PD Fig 3, highlights the Jenkins Box-Plot of Serum Melatonin level for 48 morbid cases. Pearson Chi- Square of 17.37(P=0.000) implies a statistically significant association, who had a waist hip ratio of 1.18±0.03 and were experiencing a BP of 143.2±2.7 / 87.1±1.7 with a BMI between 17 to 34.

8 International Journal of Advancements in Research & Technology, Volume 2, Issue 7, July DISCUSSION: 8 In all Diabetic population study especially in Tamil Nadu, the females outnumbered male in getting T2DM in normal vision subjects, where in this study male out numbers females around 80.9%. Among the Born Blind subjects male are outnumbered compared to females. Similarly middle age subjects recruited as they are prone for Diabetic and Metabolic syndrome which will be always high. In our study also around 76%, were in the age group of years. In Tamil Nadu, majority of them are short stature. So we calculate waist hip ratio(w/h Ratio) instead of body mass index (BMI). Like normal subjects, our blind subjects also having waist hip ratio >1 i.e 68.4% (344) Related to Hypertension, our study reveals Systolic Hypertension around 18.3 % and Diastolic Hypertension around 26.2% In normal vision subjects, with same age group and waist hip ratio in Chennai, around 70% will be having T2DM where as in this study none of them having frank diabetes just around 2% are having pre diabetic level. In strict sense no one having Diabetes. After considering all the parameters especially none of them are diabetic, stepped further to study the estimation of serum melatonin, surprisingly around 96.4% people having higher level of serum melatonin levels (more than 15 pg). Only 3.6% levels are low (less than 5 pg), these correlate with the prediabetic subjects. Previous study reveals in a normal vision people with diabetes having low melatonin level. In the present study, Melatonin levels are so high. So melatonin plays a vital role in preventing the diabetes, probably by means of insulin secretion and sensitization, through melatonin receptor 1B also known as MT 2.(4) CONCLUSION: Higher melatonin secretions were associated with a lower risk of developing T2DM. Further research is warranted to assess whether melatonin estimation will be an useful tool to detect the Diabetes in the early stage in general population. ACKNOWLEDGEMENT We like to acknowledge Chennai Blind People Association, Chennai, TN, India. As well as the management of Sree Balaji Medical College & Hospital, Chromepet, Chennai, TN, India, for the gesture to give a free health checkup. REFERENCE : 1. Science daily JUNE 13, /01/120129/ JAMA: April 3, 2013, 309(13), , CIANAN J, Mc MULLAN, EVA S. SCHERY, HAMMER, etall. 3. J. AVENST 1995 Melatonin and Mammalian Pineal gland, London : Chapman & Hall 4. Journal of pineal research, Oct 2011, Volume 51, issue 3, pages , ECKHARD MUHIBAUER, ELKE ALBRECHT, ELMAR PESCHKE, etall.