Introduction
Prevalence of Type 2 diabetes mellitus (DM2) has continue to increase in recent decades.1, 2, 3, 4, 5 It is an important health problem worldwide affecting about 8 percent of population.6 Serum ferritin is storage form of Iron. It is globular protein. Ferrous form of Iron enters into cells in condition of oxidative stress and changes into Ferric form which is linked to ferritin and protect the cells from free radicals.7 Oxidative stress is linked with impairment in glucose tolerance and insulin resistance.8, 9, 10 Higher levels of Ferritin and Iron inside cells can produce Insulin resistance and malfunction of Beta cells of Pancreas. Hyperinsulinemia because of Insulin resistance may be responsible for high level of Ferritin. Derangement in metabolism of Iron may produce resistance to insulin, hyperinsulinemia, dyslipidemia and obesity.11, 12
Materials and Methods
The present cross sectional study was carried at Clinical Chemistry Laboratory, Laboratory Services, Department of Biochemistry, GMERS Medical College and Hospital, Vadnagar, Gujarat.
Study duration
The duration of study was four months.
There were 100 cases having minimum 5 years history of type 2 diabetes mellitus residing at North Gujarat. Patients having acute infections, chronic systemic diseases, cancer, thyroid disorders, history of smoking and alcohol were excluded from study.
Pregnant ladies and lactating mothers were not included.
Patients on Insulin were excluded.
There were 100 healthy controls in this study.
All participants were instructed to continue their usual physical activities and routine diet.
All cases were instructed to take their oral hypoglycemic drugs as per advice of physician.
Criteria for the diagnosis of diabetes mellitus13
Fasting Blood Sugar >126 mg/dL. Fasting is defined as no caloric intake for at least 8h.*
2 hour Post Prandial Blood Sugar > 200 mg/ dL
Laboratory samples
Two ml of venours blood was collected in fluoride vacutainer for estimation of glucose.
Four ml of venours blood was collected in plain vacutainer for estimation of Ferritin.
Four ml of venours blood was collected in EDTA vacutainer for estimation of HbA1c.
Collection of Blood was done in morning in fasting condition.
Samples were analyzed within two hours of collection.
GOD-POD (Glucose Oxidase- Peroxidase) method was used for estimation of glucose.
Nephelometry method was used for estimation of Ferritin and HbA1c.
Result
In the present study, 64 patients were males and 36 were females as illustrated in the Table 1. FBS(158.67±20.78), PPBS (176.19±19.84) and ferritin (202.31±17.27 in male and 105.09 ±10.66 in female) levels were significantly increased in type 2 diabetes mellitus patients compared with controls.
Discussion
Chronic disorders like diabetes mellitus and hypertension leads to mortality in present era. Conclusive evidences are available which clearly indicates derangement in trace elements metabolism in diabetes mellitus. Correlation exists between serum ferritin, FBS, HbA1c and Serum Insulin.12 Serum ferritin, a reflector of body iron stores was significantly higher in diabetic patients increased as duration of diabetes increased. This possibly reflects the subclinical hemochromatosis developing in a long standing diabetic patient. 14 Increased body iron stores are possibly associated with occurrence of glucose intolerance, type-2 diabetes and gestational diabetes.15, 16 Poorly controlled patients have hyperferritinemia and there is association between serum ferritin level and diabetic retinopathy.17 We found that high level of serum ferritin (p<0.05) is seen in patients of diabetes mellitus who have poor glycemic control which matches with other studies.17, 18 In diabetic subjects, a positive correlation between increased serum ferritin and poor glycemic control, reflected by higher HbAIc, has been suggested.18
Table 2
Serum ferritin and HbA1c level in Healthy controls and patients of diabetes mellitus
Conclusion
From the present study it may concluded that high level of serum ferritin is found in patients of type 2 diabetes mellitus who have poor glycemic control which may have role in prognosis and pathogenesis of diabetes mellitus. For better understanding effect of serum ferritin in diabetes mellitus, further clinical studies are needed which should enroll large number of patients and should use higher advanced methods.
