Association of serum lipoprotein ratios with insulin resistance in type 2 diabetes mellitus.

Background: The fasting serum total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) levels are used to calculate following lipid ratios: TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C. Cholesterol retention fraction (CRF), non-HDL-C, LDL-C, TG and waist circumference (WC) one considered as markers for the identification of individuals with an increased risk for cardiovascular diseases (CVD). These individuals frequently show insulin resistance as well. We analyzed the association of lipoprotein ratios with the homeostasis model assessment of insulin resistance (HOMA-IR). Methods: Type 2 diabetes mellitus (T2D) patients (92) and 40 age match healthy controls were randomized from the Tapho Primary Health Care Unit and the area in the same district. The HOMA-IR was used to calculate for insulin resistance. The areas under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum lipoprotein ratios markers. Results: All lipoprotein ratios, lipid profile, blood pressure, and WC were significantly higher in T2D patients as compared to healthy controls (P<0.05). TC/HDL-C ratio, TG/HDL-C ratio, non-HDL-C, WC, TG, and TC were significantly correlated with HOMA-IR (P<0.05) as obtained by Spearman correlation analysis. The largest AUC of the ROC curve was obtained with the TC/HDL-C ratio as one parameter. Conclusion: TC/HDL-C ratio, TG/HDL-C, ratio, Non-HDL-C, WC, TG, and TC can be used as the markers of insulin resistance and CVD risk in T2D patients.

Effect of moderate-intensity exercise training on body weight, serum uric acid, serum hs-CRP, and insulin sensitivity in type 2 diabetic patients.

Objective: Exercise is considered to be an essential component of diabetes medical management. We assessed the effects of an eight-week period of exercise, three times per week, without a concomitant weight loss diet, on the biochemical variables and anthropometric indicators known to be risk factors for cardiovascular disease in type 2 diabetic (T2D) patients. Methods: A group of 18 T2D patients (as DMex group) volunteered to participate in an eight-week progressive exercise training study, and twenty additional T2D patients who did not participate in the exercise program (as DMnoex group). Results: Biochemical variables and anthropometric indicators were measured before and after the exercise training period. Body weight (P=0.004), BMI (P=0.004), uric acid (UA) (P=0.001), hs-CRP (P=0.047), insulin (P=0.039), and HOMA-IR (P=0.039) were significantly decreased in the DMex group. The other biochemical variables showed no significant differences. Body weight (P=0.003), BMI (P=0.003), UA (P=0.001), insulin levels (P=0.005), and hs-CRP (P=0.042) had significantly greater changes in the DMex group than in the DMnoex group. Conclusion: An eight-week period of progressive exercise training program was associated with a significant decrease in cardiovascular risk factors in T2D patients.

Estimated creatinine clearance and microalbumin levels for early prediction of nephropathy in adults with diabetes mellitus.

Objective: To evaluate the association of microalbumin, estimated creatinine clearance (eCrCl), and the other variables in type 2 diabetes (T2D) patients for the prediction of early nephropathy. Methods: Fasting plasma glucose, serum BUN, total cholesterol (TC), triglyceride (TG), HDL-C, serum creatinine, and urine microalbumin were measured with a Hitachi 912 autoanalyzer as microalbumin/gram of creatinine (g CT). The Cockroft-Gault formula was used to calculate the eCrCl and the eCrCl was subdivided as defined by the Kidney Disease Outcome Quality Initiative. Results: In a total of 93 patients, these were 50 patients having T2D and 43 control patients having non-diabetes (NDM). The T2D patients were significantly higher in systolic, diastolic blood pressure, serum creatinine, and urine microalbumin than the NDM patients (P<0.05), and the T2D patients were significantly lower in eCrCl than the NDM patients (P<0.001). The eCrCl was significantly reverse correlated with the duration of abnormal glucose metabolism and age (P<0.05). Conclusion: The eCrCl is important in T2D patients. A decrease in eCrCl with or without an increase in microalbumin excretion may be the universal indication of the presence of diabetic glomerular pathology.

Non-HDL-cholesterol and total cholesterol to HDL-C ratio in abdominally obese adults in phitsanulok.

Objective: To compare non-HDLc and the TC/HDLc ratio in men and women with and without abdominal obesity (AO). To evaluate the association of non-HDLc and the TC/HDLc ratio with the other risk factors and to estimate the non-HDLc and TC/HDLc ratio level in both men and women with AO to establish the cutoff point by using ROC curve analysis. Methods: Data (n=533) was used from adult Phitsanulok participants (aged ³40 years) who came for their health check ups in the service project. AO was defined as waist circumference (WC) of ³90 cm for men and ³80 cm for women. The t- test was used to compare the difference in non-HDLc and the TC/HDLc ratio and other risk factors. The Pearson bi-variate correlation analysis was used to quantify the association of non-HDLc and the TC/HDLc ratio with blood pressure (BP) and other lipids. Results: Both non-HDLc and the TC/HDLc ratio levels were elevated in men and women with AO. However in men neither two variables were significantly different, both non-HDLc and TC/HDLc ratio levels were elevated in men with and without AO. Non-HDLc and the TC/HDLc ratio were significantly higher in women with AO than without AO. We used the ROC curve to estimate cutoff values for non-HDLc and TC/HDLc ratio levels and also other lipids in our Thai subjects. The area under the curve of ROC of triglycerides may be superior to other risk markers for men and women in the present study. Conclusion: Both non-HDLc and the TC/HDLc ratio were elevated in men and women with AO. WC and BP may be better associated markers for non-HDLc and the TC/HDLc ratio for men participants. The combination of elevated non-HDLc, the TC/HDLc ratio, BP, and WC may identifiy a group of participants with more marked risk of CVD, metabolic syndrome, and type 2 diabetes.

Serum levels of malondialdehyde in type 2 diabetes mellitus Thai subjects.

Objective: To investigate the serum MDA levels, as a biomarker of lipid peroxidation in T2D patients and the association with the other conventional cardiovascular risk factors (Glu, TC, TG, HDL-C, LDL-C, waist circumference, and BP). Methods: Serum levels of malondialdehyde (MDA) are the most commonly used markers of this process measured as thiobabituric acid reaction substances (TBARS). The MDA-TBA adduct has a colorimetric measurement of 532 nm. A total of 50 T2D patients and a group of 40 healthy controls participated in this study. Results: The MDA concentrations of the 40 healthy controls ranged from 0.699 to 2.684 mol/l. The serum levels of MDA concentration in type 2 diabetes patients were significantly elevated (P<0.001) compared with the healthy controls. MDA levels were significantly correlated (P<0.05) with conventional cardiovascular risk factors (age, Glu, LDL-C, HDL-C, TC, TG, UA, waist circumference, and blood pressure). Conclusion: Serum levels of MDA were significantly increased in T2D patients. It may be a good marker for lipid peroxidation or an oxidative stress event that is implicated in various pathological conditions.

Predictive WBC count and differential WBC on time variation.

Objective: To evaluate the storage time that the concentration of all blood parameters are stable and to propose the predictive formula for the unstable blood parameters. Methods: EDTA blood samples from 22 healthy volunteer subjects were aliquot and separated into 2 parts, one kept at refrigerator temperature (4oC) and the other kept at room temperature (RT). Complete blood counts (CBC) were determined in each blood sample with a CELL DYN 3200 hematology analyzer every hour for 24 hours and every 2 hours from 26 to 72 hours. Results: The RBC count, RBC indicies, platelet count, and differential WBC were stable for 72 hr blood storage at 4oC except the WBC count was decreased after 15 hr storage. The predictive WBC count after 15 hr storage at 4oC was WBC0 = WBCT + 0.081(T-15). Conclusion: This study establishes the predictive formula for the initial time value which is useful for laboratories that have a problem with instrument failure or for mobile units that cannot measure CBC immediately.

Antimutagenic activity of Sesbania javanica Miq. flower DMSO extract and its major flavonoid glycoside.

The antimutagenic activity of Sesbania javanica Miq. or Sano, an edible vegetable flower DMSO extract against aflatoxin B1 (AFB1) benzo (a) pyrene [B(a)P], was evaluated by means of the Ames' test. The Sesbania javanica Miq. flower DMSO extract showed a strong inhibitory effect against AFB1 and B(a)P mutagens. A search to isolate the major flavonoid in Sesbania javanica Miq. flower extract found the flavonol glycoside, Quercetin 3-2(G)-rhamnosylrutinoside, which was confirmed by its physicochemical properties as a major constituent of the flower. Quercetin 3-2(G)-rhamnosylrutinoside (207 microg/plate) also showeda strong inhibitory effect against AFB1 and B(a)P with a more than 70% inhibition rate.

Microalbumin detection in diabetes mellitus patients.

Diabetes nephropathy is one of the microangiopathic disorder in diabete mellitus patients. It can be predicted by mean of the microalbumin in urine. In this study, we determined microalbumin in 143 NIDDM patients, 24 men, 119 woman, aged 24-82 years old, in a random or early morning urine sample, by Immunoturbidimetric method. According to those urine samples were divided into three groups; normoalbuminuria (<20 mg/L, n = 74, 51.75%), microalbumin (20-200 mg/L, n = 55, 38.46%), and macroalbumin (>200 mg/L, n = 14, 9.79%). The microalbumin was significant correlation with years that cause diabetes mellitus (r = 0.204, P = 0.014), and mean arterial blood pressure (r = 0.244, P = 0.003). And the microalbumin was no significant correlation with blood glucose levels (r = -1.145, P = 0.084), patient’ age (r = 0.039, P = 0.643), and proteinuria (r = 0.076, P = 0.365). The microalbumin determination was good correlation with microalbumin/ gm. of creatinine (r = 0.866, P = 0.0001). And the microalbumin/ gm. of creatinine was more sensitive than only measured microalbuminuria (mg/L) in urine to predict or prevent diabetic nephropathy.

Measurement of HDL-cholesterol in serum by a new enzymatic method.

High density lipoprotein (HDL) are responsible for the reverse transport of cholesterol from the peripheral cells to the liver. Here, cholesterol is metabolised. Monitoring of HDL-C in serum is of clinical importance since an inverse correlation exists between serum HDL-C concentrations and the risk of atheroselerotic disease. Elevated HDL-C concentrations are protective against coronary heart disease. In this study, an automated enzymatic method for the direct determination of HDL-C in serum was found to have good precision and accuracy. Reproducibility was determined daily using control precinorm? L in an internal protocol (n=20), within-run CV = 1.3% and between-day CV = 2.013%. The comparison of the HDL-C enzymatic assay with HDL-C precipitating agent was good with a correlation coefficient r = 0.965, Y = 1.981+ 0.959X, n =172. The normal range of HDL-C concentration in serum by this enzymatic method was 36.16 -86.08 mg./dl. Thus, a HDL-C level of over 35 mg/dl., shows the risk is not high and is protective against coronary heart disease.

Measurement of LDL-cholesterol in serum by new enzymatic method.

Low density Lipoprotein (LDL) plays a key role in causing and influencing the progression of atherosclerosis and coronary sclerosis in particular. The LDLs are derived from Very Low Density Lipoproteins (VLDLs). The elimination of LDL from plasma takes place mainly by the liver parenchymal cells via specific LDL receptors. The LDL-cholesterol value is the most powerful clinical predictor among all of the individual parameters with respect to coronary atherosclerosis., Therefore, therapies focusing on lipid reduction primarily target the reduction of LDL-cholesterol which is then expressed in prevention of atherosclerosis. This new enzymatic automated method for direct determinaton of LDL-cholesterol in serum had good precision and accuracy. Reproducibility was determined daily using control precinorm? L in an internal protocol (n = 20), within-run CV = 0.856%, and between-run CV = 2.6%. The comparison of the LDL-C level by enzymatic assayed with the calculated LDL-C using the HDL-C determination by enzymatic assayed and by precipitation, showed a good correlation ( r = 0.989, Y = 0.966X - 7.255, n = 188 and r = 0.977, Y = 0.957X - 7.049, n = 188). The normal range of LDL-C concentration in serum by this enzymatic method was 57.47 - 221.39 mg./dl. Thus,a normal level of LDL-C should be < 200 mg./dl. for good warning. A level > 200 mg/dl warns the doctors that the patient has a high risk of coronary atherosclerosis.

Reference values for serum fructosamine of selected healthy Thais.

The level of fructosamine was determined in the serum of 278 individuals ranging in age from 20 to 80 years who passed a physical check-up. The 130 males and 148 females had mean ages + standard deviation of 44.0+15.0 and 40.3+12.0 years, respectively. Serum fructosamine concentration was assayed using nitroblue tetrazoleum (NBT) reduction in alkaline medium. The reference values of serum fructosamine were 226 µmol/L to 296 µmol/L (Mean = 260.7, SD = 17.6 µmol/L). The serum fructosamine is unaffected by sex. Effect of food intake on fruc tosamine level has been carried out on a group of healthy subjects (n = 36). The means and SDs of serum fructosamine at eight-hour fasting, two-hour post-prandial and non-fasting specimens were studied and values of 269.4+17.9, 269.3+14.8 and 268.6+15.3 µmol/L respectively, were obtained. Results reveal that food intake has virtually no effect on fructosamine values (Analysis of variance p>0.05). Parallel assays of 46-paired sera was Y = 17.5 + 0.95 X, whereas X and Y were serum and plasma fructosamine levels, respectively. Values of plasma fructosamine were statistical significantly difference from those of serum (p<0.001). A small discrepancy of 1.9 percent was observed. Thus, whenever plasma is used as sample for fructosamine test, a slightly higher value of fructosamine would be obtained.

Long-term consistency of 19-biochemical tests of home-made lyophilzed control serum.

Two batches of lyophilized control serum, LYOPHIL (M.Tech. Diagnostics, Thailand) and VALIDATE (General Diagnostics, USA) were distributed weekly as blind internal quality control for our central clinical chemistry laboratory. The precision of 19 biochemical tests was studied. We found that the routine condition variance (RCV) of most tests was not greater than the RCV claimed by Wilding at al except for the test of chloride and amylase. Chisquare test and Youden plot were used to analyze the two batches of control serum. The results show good correlation for both in and out control except for creatinine and phosphate. Consistency of the biochemical tests in both batches was evaluated by analysis of variance (ANOVA) of sets of consecutive 10-week period means for 1 year. Most of the mean values of each test in LYOPHIL and VALIDATE were not significantly different except those of bilirubin and creatinine (p>0.05).