Age and Genderwise Comparison of Glycemic Parameters, LDL Levels, Blood Urea and Creatinine...

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1 J B B 3(1) 2012 Age and Genderwise Comparison of Glycemic Parameters, LDL Levels, Blood Urea and Creatinine... INTERNATIONAL SCIENCE PRESS Age and Genderwise Comparison of Glycemic Parameters, LDL Levels, Blood Urea and Creatinine Levels in Diabetic Patients DEVAKI R.N 1, MANJUNATHA GOUD B.K 2*, OINAM SARSINA DEVI 3, BHAVNA NAYAL 4, ASHA PRABHU 5, AND NAUREEN ANWAR 5. 1 Department of Biochemistry, JSS Medical College, JSS University, Mysore, India. 2* Department of Biochemistry, Ras Al Khaimah Medical and Health Sciences University Ras Al Khaimah, U.A.E. 3 Department of Nursing, Vidya Nursing College, Kapu, Udupi, India. 4 Department of Pathology, KMC, Manipal University, Manipal, India 5 Department of Biochemistry, SIMS & RC, Mukka, Mangalore, India ABSTRACT: Diabetes mellitus is a chronic metabolic disorder that can lead to severe cardiovascular, renal, neurologic and retinal complications. Diabetic nephropathy affects more than 30% of type 1 diabetic patients and it is a leading cause of end stage renal disease. This is a cross sectional study carried out on 40 diabetic patients and 40 normal individuals, between the age group of years attending medicine OPD were included as study subjects. The following parameters were analyzed LDL, serum urea, glycated hemoglobin, plasma creatinine and glucose.the results of the study were evaluated by SPSS statistical package version Pearson s co-relation test was performed to examine various co-relations. The results of the study showed no genderwise comparison between the cases and contorls, but age wise comparison has shown significance with blood urea and plasm creatinine levels (p < 0.05). As we thought gender influences progression of diabetic renal disease but, study showed no influence may be due to smaller study group. Hence, age and gender specific reference intervals should be established, by conducting a large population study. Keywords: Diabetes, Nephropathy, Glycated hemoglobin 1. INTRODUCTION Diabetes mellitus is a chronic metabolic disorder that can lead to severe cardiovascular, renal, neurologic and retinal complications (1, 2). Diabetic nephropathy affects more than 30% of type 1 diabetic patients and it is a leading cause of end stage renal disease (3). The most common lesions involve the glomeruli and are associated clinically with three glomerular syndromes, including non nephritic protienuria, nephrotic syndrome and chronic renal failure (4). Diabetes nephropathy is the kidney disease that occurs as a result of diabetes. After many years of diabetes the delicate filtering system in the kidney becomes destroyed, initially becoming leaky *Corresponding author: drmanjunathag@gmail.com to larger blood proteins such as albumin which are then lost in urine. This is more likely to occur if the blood sugar is poorly controlled (5). Measurement of the plasma urea and creatinine is widely regarded as a test of renal function. Lowdensity lipoproteins (LDL) are important targets of oxidation, and oxidative modification of LDL is involved in the pathogenesis of atherosclerosis (6). Glycated hemoglobin (HbA1c) in accordance with its function as an indicator for the mean blood glucose level over a long period, HbA1c predicts the risk for the development of diabetic complications in diabetes patients (7). Apart from classical risk factors like dyslipidemia, elevated HbA1c has now been regarded as an independent risk factor for cardiovascular events in subjects with or without diabetes. Vol. 3, No. 1, January-June

2 Devaki R.N, Manjunatha Goud B.K, Oinam Sarsina Devi, Bhavna Nayal, Asha Prabhu, and Naureen Anwar. The aim of our study was to measure serum urea, glcated hemoglobin, LDL cholesterol and plasma creatinine levels in diabetes and nondiabetic samples and to establish relationship with age and gender of study subjects. 2. MATERIALS AND METHODS This is a cross sectional study carried out on 40 diabetic patients and 40 normal individuals, between the age group of years attending medicine OPD were included as study subjects. Diabetes was diagonsed based on laboratory and clinical interpretation. Patients with dehydration, muscle dystrophy, glomerulonephritis, pyelonephritis, hypertension and congestive cardiac failure were excluded from the study. After obtaining informed consent from the study group, 5 ml of fasting venous blood sample was collected. Plasma glucose was estimated by GOD - PAP method (8). After estimating lipid profile, LDL-C was calculated by Friedwald and Frederickson formula (9).Glycated hemoglobin estimated by auto analyzer using Cobas commercial kit (10). Estimation of plasma creatinine was done by the modified Jaffe s method and serum urea was estimated by Urease- Berthelot s method (11, 12, 13). 3. STATSTICAL ANALYSIS The data were evaluated by SPSS statistical package version Pearson s co-relation test was performed to examine various co-relations. Kruskal Wallis test was applied for the comparison of age difference with various parameters and Man-Whitny test was done for gender differences. Value of HbA1c was given as percentage of total haemoglobin and values of all other parameters were given in mg/dl. All values were expressed as mean ± standard deviation. The results were considered significant when P < RESULTS The results of the study are shown in Table 1 and 2. The genderwise comparison between the cases and contorls showed no significance,but age wise comparison has shown significance with blood urea and plasm creatinine levels (p < 0.05). Table 1 Results Showing Genderwise Association Between Various Parameters Fasting plasma glucose (mg/dl) Contorls Cases P Value Female ± ± 17.7 NS Males ± ± 16.4 Blood Urea(mg/dl) Females ± ± NS Males ± ± Plasma Creatinine(mg/dl) Females 0.92 ± ± 0.5 NS Males 1.24 ± ± 3.32 Glycated Hemoglobin (%) Females 6.70 ± ± 2.05 NS Males 6.99 ± ± 1.62 LDL(mg/dl) Females ± ± NS Males ± ± Journal of Biochemistry and Biotechnology

3 Age and Genderwise Comparison of Glycemic Parameters, LDL Levels, Blood Urea and Creatinine... Table 2 Showing Comparison of Agewise Variation in Various Parameters in Non Diabetic and Diabetic Subjects Fasting plasma glucose(mg/dl) Contorls Cases P Value 35 and less ± ± NS ± ± 223 Above ± ± Blood Urea(mg/dl) 35 and less ± ± S ± ± Above ± ± Plasma Creatinine(mg/dl) 35 and less 0.90 ± ± 5.45 S ± ± 1.63 Above ± ± 1.04 Glycated Hemoglobin (%) 35 and less 5.8 ± ± 2.26 NS ± ± 1.31 Above ± ± 1.94 LDL(mg/dl) 35 and less ± ± NS ± ± Above ± ± NS: Not significant, S: Significant 5. DISCUSSION Impairment of renal function due to long standing type 2 diabetes was assesed by measurement of blood urea and creatinine levels and glycemic status, which will be assesed by fasting plasma glucose and glycated hemoglobin. Creatinine is formed from creatine. Muscle contains 98% of total body creatinine. Creatinine leaves muscle and enters blood, from where it is removed by kidneys. If the kidneys are failing serum creatinine levels increase. In our study we found that genderwise comparison between the cases and contorls showed no significance, but agewise comparison has shown significance with blood urea and plasma creatinine levels. Mitch and Walser believed that one can plot the inverse of creatinine (I/Cr) over time and get a straight line. Assuming that, the patient is losing kidney function at a constant rate, one can extend the line out in time to get a rough idea when kidney will fail completely and when initiation of dialysis may be required and to determine efficacy of treatment to halt progression of renal failure. Thus, Sr. creatinine is used for monitoring disease progression (14, 15). Results of present study shows that plasma creatinine levels in type 2 diabetic males were higher when compared with female group and also levels of blood urea was higher in males compared to female counterpart indicating the derangement of kidney function. The high plasma creatinine levels in male patients which may be due to the difference in muscle mass of males and females but it was not statstically significant. The age wise comparison showed that the levels of blood urea were higher in early age and late age ± , ± respectively but plasma creatinine were decreased in later age and were statsically significant. Vol. 3, No. 1, January-June

4 Devaki R.N, Manjunatha Goud B.K, Oinam Sarsina Devi, Bhavna Nayal, Asha Prabhu, and Naureen Anwar. Well-defined criteria for a specific age group, with respect to gender are not known in diabetic patients. This study will be very helpful to the clinicians to draw different baselines for various parameters in male and female type 2 DM patients. In conclusion, although we thought gender influences progression of diabetic renal disease and study showed no influence may be due to smaller study group. Hence, age and gender specific reference intervals should be established, by conducting a large population study. REFERENCES [1] Khawaja AK, Rafique G, White F, Azam I. Macrovascular Complications and Their Associated Factors Among Persons with Type 2 Diabetes in Karachi, Pakistan-a Multi- Center Study. J Pak Med Assoc 2004; 54: pp [2] Shera AS, Jawad F, Maqsood A, et al. Prevalence of Chronic Complications and Associated Factors in Type 2 Diabetes. J Pak Med Assoc 2004; 54: pp [3] Jeremy WT. Treating Hypertension in Diabetic Nephropathy. Diabetes Care 2003; 26: pp [4] Schrier RW, Gottschalk CW, Disease of the Kidney, (5th ed.). Boston, Little, Brown, 1993; pp [5] Saweirs Walaa. Diabetic nephropathy, Edren Juny 2006; 25. [6] Witztum JL, Steinberg D. Role of Oxidized Low Density Lipoprotein in Atherogenesis. J Clin Invest 1991; 88: pp [7] Glycosylaed Haemoglobin, HbA1C.hptt:// clinlabnavigator.com/test-interpretations/haemoglobin-a1c.html? letter=h (Updated on 18 June 2010). [8] Trinder P. Quantitative Determination of Glucose Using GOD-PAP Method. Ann Clin Biochem 1969; 6: pp [9] Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein choles-terol in plasma without use of the preparative ultracen-trifuge. Clin Chem 1972; 18: [10] Gold Stein DE, Malone J, Nathan D et al. Tests of Glycemia in Diabetes. Diabetes Care 1995; 18: pp [11] Bowers L D. Kinetic Serum Creatinine Assays. The Role of Various Factors in Determining Specificity. Clin Chem 1980; 26: pp [12] Bartel H, Bohmer M etal. Serum Creatinine Determination Without Protein Precipitation. Clin Chem Acta1 972; 37: pp [13] Richterich R and Kuffer H. The Determination of Urea in Plasma and Serum by a Urease/Berthelot Method. Klin Biochem 1973; 11: pp [14] Mitch WE. Measuring the Rate of Progression of Renal Insufficiency. In: Mitch WE, Brenner BM, Stein JH, eds. Contemporary Issues of Nephrology, 14. Progressive Nature of Renal Disease. NewYork: Churchill Livingstone 1986 : pp [15] Mitch WE, Walser M. Nutrition Therapy of Uremic Patients. In: Brenner BM, Rector Jr., eds. The kidney. Philadelphia: Saunders, 1986 : pp Journal of Biochemistry and Biotechnology

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