Association of hyperuricemia with metabolic syndrome

Uric acid levels are often increased in subjects with metabolic syndrome but it is unclear whether it plays a causal role or it is a marker for metabolic syndrome. To find the association of hyperuricemia with various components of metabolic syndrome. The cross sectional analytical study was carried out in Sir Ganga Ram Hospital, Lahore, Pakistan. Total 600 subjects of both genders aged 30-70 years were recruited in the study. Demographic, clinical and biochemical variables were recorded by using a questionnaire. Fasting blood sample was used to estimate plasma glucose, serum lipid profile and uric acid. The cut-off for hyperuricemia was serum uric acid level >/=7.0 mg/dl for males and >/=5.7 mg/dl for females. Metabolic syndrome was diagnosed if subjects had any 3 of the 5 criteria described as per ATP III guidelines. The data was analyzed using SPSS Version 20. The study included 216 [36%] males and 384 [64%] females with mean age 47 +/- 10 years. Out of total 447 subjects, 62 [13.9%] with metabolic syndrome had hyperuricemia. Whereas 62 [75.6%] subjects out of total 82 subjects with hyperuricemia had metabolic syndrome. Different parameters of metabolic syndrome were statistically correlated with hyperuricemia but none showed significant correlation. Chi square and Wald Statistic [Logistic regression algorithm] showed that by using G-to-S [general to specific] approach hyperuricemia was significantly associated with female gender but did not show any association with metabolic syndrome. There was no association present between metabolic syndrome and hyperuricemia; therefore uric acid levels might not be important in the diagnosis of metabolic syndrome

Association of insulin resistance with obesity in children

Insulin resistance is the primary metabolic disorder associated with obesity. Little is known about its role as a determinant of the metabolic syndrome in obese children. To assess the association of insulin resistance with metabolic syndrome in obese and non obese children. Study type and settings: Cross sectional analytical study conducted among children of ten Municipal Corporation high schools of Data Ganj Buksh Town Lahore. A total of 46 obese and 49 non obese children with consent were recruited for the study. Fasting blood glucose, serum insulin, high density lipoprotein cholesterol, triglycerides, cholesterol, non HDL-cholesterol LDL cholesterol were measured using standard methods. Data were analyzed by using statistical software SPSS-Version 15. A total of 95 children 49 obese and 46 non obese were recruited for the study. A significant association of serum triglyceride [p<0.001], high density lipoprotein cholesterol [p<0.001], fasting blood glucose [p<0.001], and insulin levels [p<0.001], was seen between the two groups. For each component of metabolic syndrome, when insulin resistance increased so did odds ratios for cardio metabolic risk factors. Insulin resistance was seen in 34.7% children. Metabolic syndrome was found in 31.6% children reflecting that obese children are at high risk for metabolic syndrome and have low HDL-cholesterol and high triglycerides levels

Prevalence of dyslipidemia in patients with type-2 diabetes mellitus

The dyslipidaemia associated with type-2 diabetes is associated with raised plasma triglycerides, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels and is a risk factor of cardiovascular disease. To assess the lipid abnormalities in patients with type-2 diabetes. A cohort study carried out at Diabetic Clinic of PMRC Research Centre, FJMC, Lahore, Pakistan. Eight years case records of type-2 diabetic patients seen at the research centre from 1999-2006 were reviewed. The research centre is a specialized centre for diagnosing and treating diabetes mellitus. All the patients were recruited for their follow up check up and laboratory investigations for dislipidemia. Adult treatment panel III guidelines for dyslipidaemia were followed. A 12 hours fasting blood sample was collected from each patient for serum total cholesterol, triglycerides, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and glucose as well as glycosylated hemoglobin [HbA1c] by using standard methods at Biochemistry laboratory of the research centre. LDL-C/ HDL-C ratios, Very low-density lipoprotein cholesterol [VLDL-C] and body mass index was calculated after anthropometery body mass index [BMI] >/= 25 was considered as overweight while >/= 30 obese. HbA1c<6.1 was considered as poor glycemic control. Data was analyzed by using statistical software SPSS-15. a total of 1200 type-2 diabetes were seen in 8 years. There was poor glycemic control, in 87.5% subjects judged on blood HbA1c levels. These patients had higher total cholesterol, LDL-C and low HDL-C levels in blood. The percentage of patients with high, borderline and near optimal risk LDL-C was 62.7, 26.9 and 10.4% respectively, while HDL-C >40mg/dl were seen in 67%. Raised VLDL-C [above 40 mg/dl] was seen in 32.9% cases. The group with high LDL and VLDL is at risk of developing cardiovascular disease. Hypertriglyceridaemia was found in 55% and hypercholesterolaemia in 45.4% cases. Obesity as indicated by body mass index was found in 53.7% patients. Statistically significant association of hypercholesterolemia, hypertriglyceridemia, hypo HDL cholesterolemia and VLDL-C was found with advancing age while only hypertriglyceridemia and VLDL-C showed a positive association with duration of diabetes. A significant association of hyperglycemia [raised HbA1c] was seen with hypertriglyceridemia and high LDL-C along with high body mass index i.e. obesity. Hypertriglyceridemia, high LDL-C and VLDL-C, low HDL-C levels and obesity were the pattern of dyslipidemia found in our diabetic population

Detection of peripheral arterial disease [PAD] in diabetics using ankle brachial index [ABI]

To evaluate the Ankle Brachial Index [ABI] in the detection of peripheral arterial disease [PAD] among diabetic patients. Diabetic clinic of PMRC Research Centre, Fatima Jinnah Medical College, Lahore. Cross sectional descriptive. This pilot study included 95 diabetic patients with ages 40 years or above and duration of the disease was more than 5 years. Detailed history including treatment was documented. During examination systolic blood pressure in the right and left arms [Brachial Pressure] was measured and documented. Systolic Blood Pressure in both ankles was measured using ultrasound Doppler probe [Huntleigh Super Doppler - II]. Left and right ABI were obtained by dividing brachial systolic pressure with ankle systolic pressure. A ratio of 0.9 or above was taken as normal. The study included 95 patients [15 males and 80 females] with mean age 51.90 +/- 9.49 years and mean duration of diabetes 13.23 +/- 5.83 years. Smoking was observed in 53.30%, hypertension in 57.89% and 71.57% had dyslipidemia. ABI ratio was mildly abnormal in 52.68%, moderately abnormal in 7.38% while it was normal in 38.94% cases. Duration of thedisease was negatively correlated [r = - 0.650 and 0.937] with ABI and correlation was highly significant [p < 0.047 and 0.008]. Blood sugar and lipid levels were not significantly correlated with ABI. The results conclude the detection of high percentage [60.08] of abnormal ABI in this group of patients. Ankle brachial index, a non-invasive and simple technique, may be used to screen the detection of PAD and diabetic foot

Insulin resistance, liver enzymes and the metabolic syndrome

The objective of the study was to test the hypothesis that enzymes conventionally associated with liver dysfunction [alkaline phosphatase, aspartate aminotransferase, alanine arninotransferase] may predict diabetes. Three hundred type-2 diabetics were selected from Diabetic clinic and one hundred and fifty non-diabetes control from population. Biochemical testing of fasting and 2 hours serum insulin, renal, liver functions and protein was measured by using standard method and instruments. Insulin resistance was calculated using the homeostasis model assessment for insulin resistance [HOMA-IR] method. Statistical analysis of samples and control subjects were done by using SPSS-13. At baseline all three enzymes were related to most of the features of the metabolic syndrome. Serum alkaline phosphatase levels as well as serum transaminases also showed a statistical significant difference at P<0.05. The HOMA-IR in the type-2 diabetic group was significantly greater than that of the control group [mean +/- SD 3.84 +/- 2.3 vs. 1.62 +/- 0.79 units [P<0.05]. Serum total proteins and albumin significantly reduced in type-2 diabetic subjects. Mild elevations in liver enzymes and decreased levels in serum proteins are associated with features of the metabolic syndrome

C-reactive protein levels in type-2 diabetes mellitus amongst the local population

The objective of this study was to assess the levels of C-reactive protein in type-2 diabetes mellitus patients in the local population. Serum samples of patients of sixty type-2 diabetes mellitus and thirty healthy subjects acting as control of same age and sex matched were included from the general community, ensuring similarities of their basic confounding factors. Duration of type-2 diabetes of these subjects was also recorded. Sera were stored at-80°C till analysis. Estimation of CRP was done by a microplate immunoenzymometric assay. HbAlc levels in blood were done by using a commercial kit. Baseline values for HbAlc and CRP were assayed in the diabetic as well as control samples. CRP levels in serum were significantly higher among diabetic participants compared to the control subjects [P<0.05]. Among diabetic participants, higher levels of HbAlc were associated with higher level of CRP. CRP levels during different duration of type-2 diabetes were 3.4 +/- 1.35 micro g/ml in type-2 diabetics and 1.37 +/- 1.10 micro g/ml in control subjects having duration less than one year [P<0.05] similarly, 1-5 years 6-10 years and 11-15 years of duration had levels 4.90 +/- 1.57 micro g/ml, 4.60 +/- 1.90 micro g/ml and 4.42 +/- 1.20 micro g/ml respectively in type-2 diabetics and control subjects had 1.85 +/- 1 .20 micro g/ml, 1.40 +/- 1 .70 micro g/ml and 1.22 +/- 1.10 micro g/ml respectively. Diabetes having 16-20 years duration showed a non significant behavior. Our findings show that patients having type 2 diabetes had higher CRP levels in serum compared to the control subjects. Duration of disease and HbAlc levels showed statistical significant differences

Insulin resistance and cardiovascular risks in type-2 diabetic population

To determine the presence of diabetes mellitus and other conventional coronary heart disease risk factors such as hypertension, hyperlipidemia and sedentary lifestyles in patients with acute coronary events in Pakistani population. This study included 300 type-2 diabetic patients selected from diabetic clinic of PMRC Research Centre Fatima Jinnah Medical College and Sir Ganga Ram Hospital Lahore with insulin resistant type-2 diabetics, unstable angina or myocardial infarction [MI]. One hundred and fifty control subjects without diabetes, myocardial or other coronary artery disease were also included in this study. Out of all patients 41.66% were female while 58.34% males and duration of diabetes was 0-3 years in 8% cases. Frequency of cardiovascular complications in type-2 diabetics were noted in 40.66% having hypertension, angina pectoris in 12.33%, congestive cardiac failure in 2% and MI in 2% cases. Location and extension of MI and myocardial enzymes did not differ between diabetics and non-diabetic patients. Age, duration of diabetes and HbA1c levels, did not differ between diabetic patients with or without MI. Hypertension and current smoking was significantly higher in patients with MI compared to patients with unstable angina [P< 0.05]. Serum TG, HDL-C, LDL-C and total cholesterol level did not differ between patients with MI and unstable angina. In this study insulin resistant type-2 diabetic patients have at least one of conventional cardiac risk factors. Diabetes and hypertension are leading risk factors, which may directly or indirectly interfere and predict more serious complications of coronary heart disease