Résumé
The aim of the present study was to assess Apolipoprotein B (Apo-B) and Triglyceride/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio as indicators of insulin resistance (IR) with Homeostasis Model of assessment of insulin resistance (HOMA IR)) in metabolic syndrome patients . Study Design: Observational and prospective. Place and Duration of Study: The study was carried out in Department of Biochemistry and Department of Medicine, MGM Medical College, Navi-Mumbai from March 2012 to June 2013. Methodology: Total 110 normal subjects and patients were recruited in the study after obtaining informed written consent. They were divided in to two groups. Group I was healthy controls (n=50) and Group II included subjects with MS (n=60) as per NCEP ATP III criteria. Anthropometric measurements & biochemical analysis was performed in all subjects. IR was defined by HOMA IR. Simple & multiple regression analysis were used to obtain relationship between IR (HOMA IR) using TG/HDL-C (model -1) and Apo-B (Model- 2) as independent variables. Result: There were statistically significant differences in anthropometric, glycemic and lipid parameters between the control and study group (p<0.0001).The regression model between HOMA IR and TG/HDL-C ratio showed a positive correlation, (r=0.29, p < 0.05). HOMA IR & Apo-B also showed a significantly positive correlation (0. 41, p < 0.001). But combined multivariate analysis indicated that Apo-B is a better predictor of IR compared to TG/HDL-C ratio. Conclusion: We concluded in our study that Apo-B may be a better predictor of IR than TG/HDL-C and hence could be adopted in routine laboratory practice as a lipid marker for prediction of insulin resistance (IR) in metabolic syndrome patients at an early stage. Keywords: Insulin resistance; Apo B; metabolic syndrome; Insulin resistance indicators; lipid
Résumé
Insulin resistance (IR) is hallmark of metabolic syndrome. It is important to identify IR as it is the early stage before development of diabetes mellitus. The standard method to measure insulin resistance is the euglycemic clamp technique, which is laborious. Hence, a number of surrogate measures like homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio have been developed. Both of the former involve calculations, while TG/HDL ratio may be readily available for clinicians. Therefore, this study was undertaken to assess whether TG/HDL-C ratio serves as a better predictive marker of IR. Objectives: The aim of the present study was to evaluate the triglyceride/HDL-C ratio as a surrogate marker of IR in metabolic syndrome patients. Materials and methods: Total 110 patients were recruited in the study after obtaining informed written consent. They were divided into two groups. Group I included healthy controls (n = 50) and subjects with metabolic syndrome (MS) (n = 60) as per NCEP ATP III criteria were included in group II. Anthropometric measurements and biochemical analysis was performed in all subjects. Results: There was statistically significant difference in anthropometric, glycemic and lipid parameters in control and study group (p < 0.0001). The regression model between HOMA-IR and TG/HDL-C ratio showed was positive correlation (r = 0.29, p = 0.01) while between QUICKI and TG/HDL-C ratio showed negative correlation (r = –0.37, p = 0.002). Conclusion: We report in our study that TG/HDL-C can be adopted in routine laboratory practice as a surrogate marker for prediction of insulin resistance. So that patients with metabolic syndrome may be beneficial at an early stage.
Résumé
Aim: This study aims to evaluate serum uric acid levels and assess its effect on endothelial dysfunction by measuring flow mediated vasodilatation (FMD) of brachial artery in type 2 diabetes mellitus. Study Design: Observational and prospective Place and Duration of Study: The study was carried out in Department of Biochemistry and Department of Radiology, MGM Medical College, Navi-Mumbai from August 2010 to 2012 Methodology: Total 90 patients were selected and divided in to three groups. Group I (n=30) – Controls, Group II A & B (n=60) –Diabetic patients without & with hyperuricemia (HUA). All subjects were examined by high resolution ultrasound to measure FMD. Serum uric acid and nitric oxide (NO) levels along with other biochemical parameters were estimated. Result: Group II B showed significantly increased serum uric acid levels (p<0.001) along with decreased levels of serum NO (p< 0.0001) and decreased vasodilatation when measured by FMD. (p<0.001). Conclusion: The FMD of brachial artery along with serum NO levels are reduced in patients of type 2 diabetes mellitus with HUA. Uric acid may be a contributing factor to endothelial dysfunction in type 2 diabetes. Such endothelial damage may be preventable by regularly monitoring uric acid levels and pharmacologically treating HUA.