Serum triglycerides and cholesterol status in patients with and without gestational diabetes mellitus

Objective: To measure the differences of lipids including total cholesterol and triglycerides among subjects with or without GDM

Study Design: Cross sectional comparative study

Place and duration of study: This study was carried out between Dec 2010 to Jun 2012 at the department of gynecology and obstetrics Pakistan Naval Ship [PNS] Shifa and department of pathology, PNS Rahat

Material and Methods: Pregnant women who presented in outpatient department of gynaecology between 24-34 weeks of gestation were randomly selected, and were requested to undergo 100 Gm oral glucose tolerance test for diagnosis of gestational diabetes mellitus [GDM]. A total of 93 pregnant women were included in the study

Afterwards they were divided in 2 groups on basis of presence and absence of GDM. Later all the patients were analyzed for total cholesterol and triglycerides. Results of triglycerides and total cholesterol were compared among subjects with or without GDM

Results: The differences for serum triglycerides and total cholesterol were not found to be significant among subject with or without gestational diabetes mellitus, where 0.05 was considered significant

Conclusion: There was no difference between serum triglyceride and total cholesterol levels among subjects with or without gestational diabetes mellitus

Platelet indices among subjects with and without diabetes mellitus and hypertension: a cross-sectional analysis at Karachi, Pakistan

Objective: to measure differences of platelet indices in subjects with and without diabetes mellitus and hypertension

Methodology: this was a cross-sectional analysis from Jan-11 to Feb-2012. From a target population of non-pregnant adult subjects being advised a fasting blood glucose or OGTT for confirming or excluding diabetes, we finally selected 820 individuals for inclusion into study. Fifty known diabetics were also included in the study. Subjects were formally interviewed and sampled for fasting blood glucose, and platelet indices [including platelet count, platecrit [PCT], mean platelet volume [MPV] and platelet distribution [PDW]. The results of platelet indices were compared between 4 groups based on OGTT. Platelet indices were also compared between groups based upon post-load glycemic status and hypertension

Results: age and MPV showed slight positive and significant correlations with fasting blood. [Age: r2=0.117 [p<0.001] and MPV: r2=0.116 [P=0.001]; other platelet indices did not show significant correlations. Out of the 4 platelet indices studied, MPV and PCT were found to significantly increase from normoglycemia to individuals with established diabetes mellitus in one way ANOVA analysis. Subjects demonstrating post load hyperglycemia [n=47] had higher mean platelet volumes than individuals having post load normoglycemia [n=30] [MPV: 9.63 + 1.51vs 8.90 + 0.98, p=0.012]. Hypertensive subjects did not demonstrate higher MPV results than normotensive subjects in our study

Conclusion: mean platelet volume and platecrit increases across various grades of hyperglycemia. However, the changes become quite prominent in subjects having established diabetes with marked hyperglycemia. Post load hyperglycemia was more predictive of rises in mean platelet volumes

Relationship between platelet indices and lipidemias: a cross-sectional study at Karachi

To compare platelet indices among patients with low and high levels of cholesterolemia and triglyceridemia. This cross-sectional study was conducted from January 2011to May 2012 at the departments of pathology, PNS Rahat and Baqai medical and dental university, Karachi. A total of 867 subjects presenting for estimation of fasting triglycerides and total cholesterol were selected after excluding patients receiving anti-platelet or lipid medication, pregnancy, acute in factious disorders. They were interviewed, examined and sampled for measurement of total cholesterol, triglycerides and platelet indices including total platelet count, mean platelet volume [MPV], platelet distribution width [PDW] and platecrit [PCT]. The results of platelet count and mean platelet volume were found to be significantly different among subjects with normal cholesterolemia [<5.2mmol/L], borderline raised cholesterol group [5.2-6.3 mmol/L] and hypercholesterolemia [>6.3 mmol/L]; however, post-hoc comparison did not show any significant difference between all groups. Using age as a variable and segregating total cholesterol results into 7 groups, starting from very low cholesterol values [<4.0 mmol/L] to highest [>6.5 mmol/L], in a univariate general linear model, higher mean platelet volume were observed at the extremes of cholesterolemia groups [p=0.039]. A similar trend was observed for platelet count after adjusting for age, where low levels of platelet levels were associated with hypocholesterolemia and hypercholesterolemia [p=0.021]. Higher MPV and low total platelet counts were associated with the observed extremes of cholesterol range. No significant differences were observed for platelet indices across various groups formulated based upon fasting triglycerides

Association of blood lipid and glucose levels with carotid intima media thickness

To measure the differences in CIMT across groups based upon normal and higher levels of fasting glucose and lipids. This cross sectional study was carried out between January to June 2011 at department of radiology and pathology, PNS Rahat hospital Karachi. From a target population of patients presenting for fasting blood glucose measurement, a total 0f 201 subjects were short listed and consented after various exclusion. These patients were sampled for glucose and lipids after brief clinical evaluation. Later subjects underwent CIMT measurement in radiology department. Age showed moderate positive correlation with CIMT readings [r=0.493, p=0.000], while BMI[r=0.038, p=0.636], fasting blood glucose [r=0.038, p=0.646], triglyceride [r=0.179, p=0.029], and total cholesterol [r=0.221, p=0.007] showed lesser correlations. Patients with hyperglycemia had higher CIMT [[Group-1, Normolycemia, FBG 5.5mmol/L= 0.7180 +/- 0.147cm][p=0.028]]. Mean CIMT values among subjects with hypertriglyceridemia and hypercholesterolemia were higher than patients with normal triglycerides and cholesterol [[triglyceride:p=0.040] [total cholesterol: p=0.055]]. The carotid intima medial layers were found to be thicker in subjects having higher blood levels of fasting blood glucose, triglycerides and total cholesterol

Diabetes mellitus prediction; Serum lipids, ALT and fasting blood glucose: using serum lipids and ALT

The rapid change in lifestyles and dietary has led to a pandemic of diabetes mellitus. The diagnosis of diabetes mellitus sometimes requires 2 hr OGTT sampling. Recent evidence has shown that there are lipid related abnormalities associated with diabetes mellitus, so a consideration comes in fortheir utilization as a marker to support diabetes mellitus. [1] To correlate serum total cholesterol, triglycerides and ALT with fasting blood glucose [2]. To predict diagnosis of diabetes mellitus using above serum markers. Cross-sectional analysis, descriptive study. This study was carried out between Mar-2010 to Jan-2011 at the department of pathology, PNS RAHAT in collaboration with PNS SHIFA. A total of 251 subjects were screened for presence of glucose dysregulation. Based upon the results of fasting blood glucose, subjects were grouped as having normal glucose tolerance [NGT], impaired fasting glucose [IFG], and newly diagnosed diabetes mellitus [NDDM]. A comparison of lipids including triglycerides, total cholesterol and alanine aminotransferase [ALT] were made in the above groups to measure the differences between the above mentioned three groups. ALT, triglyceride and total cholesterol were correlated with results of fasting blood glucose through pearson's correlation. Later the performance of different cut-offs of triglycerides, total cholesterol and two mathematical models [[Factor-l=FBG [mmol/L] + triglycerides [mmol/L]] and [Factor-ll=FBG [mmol/L] + triglycerides [mmol/L] + total cholesterol [mmol/L]]] were evaluated for detecting diabetes mellitus against the gold standard 2 hr OGTT in 71 subjects. The results of triglycerides, total cholesterol and serum ALT between the three groups were as: [[Triglycerides: NGT =1.91, IFG =2, 10, NDDM= 2.75, p=0.003] [total cholesterol: NGT=5.03, IFG=5.19, NDDM=5.74, p=0.056] [ALT:NGT=28.47, IFG=27.95, NDDM=25.78, p=0.846]]. Most correlation was found between serum triglycerides and fasting blood glucose [r2=0.235, p<0.001]; while serum total cholesterol and ALT showed lesser correlations [[total cholesterol:r2= 0.172, P=0.007], [ALT:r2= 0.010, p= 0.877]]. While triglycerides demonstrated superiority in terms of sensitivity to total cholesterol for detection of diabetes mellitus, the factors incorporating lipids and glucose had the highest overall diagnostic efficiency. Triglycerides and total cholesterol levels rise from normoglycemic individuals to subjects having impaired fasting glucose and newly diagnosed diabetics. The inclusion of triglycerides and total cholesterol for diagnosis of diabetes mellitus improves the chances of for detection of diabetes mellitus

Evaluation of fasting and random plasma glucose for diagnosis of gestational diabetes

To compare different cut-off values of fasting and random plasma glucose as a screening test for diagnosis of gestational Diabetes in comparison to the 50 grams Glucose Challenge Test [GCT]. Comparative, cross-sectional study. This study was carried out between July 2006 to September 2007 at Departments of Pathology, Obstetrics/Gynaecology and Medicine, PNS Rahat Hospital, Karachi. A total of 53 pregnant subjects at 24-28 weeks of pregnancy were selected to undergo random and fasting blood sugar level estimation and 50-g GCT. All the subjects later underwent 100-g OGTT as well. The results were evaluated by both "Carpenter and Coustan criteria" and "NDDG criteria". The results of random plasma glucose random [cut-off: >/= 11.1 mmol/L], fasting plasma glucose [cut-off: > 5.3 mmol/L and > 5.1 mmol/L] and plasma glucose results post 50-g GCT [cut-off: >/= 7.8 mmol/L and >/= 7.2 mmol/L] were evaluated against 100-g OGTT results through ROC curve analysis. Finally, various diagnostic parameters including sensitivity, specificity, predictive values, likelihood ratios [LR] and efficiency were evaluated. Nineteen subjects were diagnosed to have GDM as per the "Carpenter and Coustan criteria" and 13 met the "NDDG criteria" as per the results of 100-g OGTT. Fasting plasma glucose at was the most efficient investigation at cut- off of 5.1 mmol/L sensitivity=66.66%, specificity=81.25%, PPV=70%, NPV=78.78%, LR+ =3.56, LR- =0.41, efficiency=75.47%. At the cut-off value of 5.3 mmol/L, the results had 64% sensitivity, 85.71% specificity, 80% PPV, 72.72% NPV, 4.48 LR+, 0.42 LR-, 75.97% efficiency]. It was followed by plasma glucose post 50-g GCT [53.57% sensitivity at cut-off of >/= 7.2 mmol/L and 54.54% sensitivity at cut-off of >/= 7.8 mmol/L]. Fasting plasma glucose is a better investigation for the screening of gestational Diabetes than plasma glucose post 50-g glucose challenge

Common anthropometric indices and insulin resistance

To correlate common anthropometric indices with insulin resistance. A cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, between April 2004 to March 2006.The target population constituted subjects who presented at the institute for evaluation of their glucose fasting. A total of 141 subjects were selected for the study and they were categorized into 4 groups depending upon their glucose levels. Normoglycemic [plasma glucose fasting /= 5.6 to 6.9 mmol/L] diabetes mellitus [plasma glucose fasting 7.0 to 9.9 mmol/L] and severe diabetes mellitus [plasma glucose fasting >/= 10 mmol/L]. Common anthropometric indices including weight, body mass index, waist circumference, waist to hip ratios, waist to height ratios and body mass index adjusted for waist to hip ratio were measured on each individual as per World Health Organization guidelines on physical status. Homeostasis Model Assessment for Insulin Resistance was used as a marker for measuring insulin resistance and the calculations were made following Mathew's method. Waist to hip ratio proved to be the most useful anthropometric index in the evaluation of insulin resistance and obesity [r= +0.5361]; while it's adjustment with body mass index or with waist to hip ratio did not improve the diagnostic performance[r= +0.507 and r=+0.333 respectively]. Parameters like weight [r=+0.137], waist circumference [r= +0.196] and body mass index [r= +0.299] were not useful in the assessment of insulin resistance. Waist circumference correlated better with insulin resistance than other routinely used anthropometric parameters. Waist to hip ratio can be used for evaluation of insulin resistance and obesity

Spectrum of lipid and lipoprotein indices in human subjects with insulin resistance syndrome

Insulin resistance syndrome or metabolic syndrome is one of the major metabolic threats our recently urbanized society is going to face in near future. The management of this syndrome requires a very effective biochemical marker for screening. The objective of this cross sectional study were to compare various lipid and lipoprotein indices in human subjects with insulin resistance syndrome This study was carried out between April 2004 to January 2006 at the department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. A total of forty-seven subjects with metabolic syndrome were selected as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III] from a target population diagnosed to have impaired glucose regulation at AFIP. Forty-seven age and sex-matched healthy controls were also included in the study. Insulin resistance was calculated by the method of HOMA-IR, using the formula of Mathew's et al. The various lipid and lipoproteins, their ratios and log-transformed versions were evaluated for differences between subjects with metabolic syndrome and controls. Finally the diagnostic performances of these candidate lipid markers were evaluated. Results between subjects with metabolic syndrome and controls were found to be significant for serum triglyceride [P < 0.05], HDL-C [P < 0.05], triglyceride/HDLC [P < 0.01], Log triglyceride/HDL-C [P < 0.01], total cholesterol/HDL-C [P < 0.01], LDL-C/HDL-C [P < 0.01]. However there was weak correlation between these lipid based markers and HOMA-IR [[serum triglyceride: r= 0.225], [HDL-C: r= -0.235], [triglyceride/HDL-C: r= 0.333], [total cholesterol/HDL-C: r= 0.239]]. The AUCs for the diagnosis of metabolic syndrome remained highest for HOMA-IR [0.727 [95%CI: 0.642-0.812]], followed by triglyceride/HDL-C [0.669 [95%CI: 0.572-0.766]] and LDLC/ HDL-C [0.639 [95%CI: 0.537-0.742]]. The differences for lipids and lipoproteins between subjects with metabolic syndrome and controls remained significant. However, these markers have shown poor correlations with HOMA-IR along-with weaker diagnostic accuracy for the diagnosis of metabolic syndrome. Recommended cut-offs must be used, once these markers are employed in the diagnosis of metabolic syndrome

Role of glycated hemoglobin in the diagnosis of Diabetes mellitus

To evaluate glycated hemoglobin as a marker for diagnosis of diabetes mellitus. Comparative cross-sectional study This study was carried out between July 2005 to April 2006 at department of chemical pathology and endocrinology, Armed Forces Institute of Pathology [AFIP] Rawalpindi. Subjects [n=104] demonstrating impaired glucose regulation at the endocrine clinic of AFIP were selected. Forty seven age and sex matched normoglycemic healthy looking controls were also included in the study. Samples under complete medical fasting state were collected for glucose and glycated hemoglobin analysis, and then samples were collected at 1 hour and 2 hour for plasma glucose as part of oral glucose tolerance testing [OGTT]. These subjects were later stratified to have all the disease ranges in terms of severity by 75 g OGTT results into following groups: Group-1: Controls, Group-2: Subjects with impaired fasting glucose [IFG], but became normoglycaemics on performing OGTT [Plasma glucose fasting result = 5.6 -6.9 mmol/L, but 2 h OGTT result < 7.8 mmol/L], Group-3: Subjects with impaired glucose tolerance [IGT] as per ADA recommendations [2 h OGTT result between 7.8-11.1 mmol/L], and Group-4: Subjects with diabetes mellitus as per American diabetic association [ADA] recommendat ions [2 h OGTT result >11.1 mmol/L]. Receiver operating curve [ROC] curve analysis and diagnostic performance in terms of sensitivity, specificity, predictive values were used to evaluate the performance characteristic of glycated hemoglobin, in comparison with plasma glucose fasting and 1 hour OGTT results against 2 hour OGTT results taken as gold standard. ROC curve analysis showed an area tinder the curve [AUC] of 0.722 for plasma glucose fasting, 0.607 for 1 hour OGTT and 0.564 for glycated hemoglobin. Moreover, the diagnostic performance as measured by sensitivity, specificity, predictive values and efficiency stood higher for plasma glucose fasting than glycated hemoglobin in the diagnosis of diabetes mellitus. Glycated hemoglobin, as determined by ion exchange resin chromatography is less useful for the diagnosis of diabetes mellitus than plasma glucose fasting. So the present approach for using plasma glucose fasting for diagnosing diabetes mellitus must remain in vogue

Hypertension and metabolic syndrome: impact of clustering of hypertension in subjects with metabolic syndrome

To compare insulin resistance between hypertensive and non-hypertensive subjects. It is a comparative cross-sectional study which was carried out between April 2004 to March 2006 at department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. A total of sixty-three subjects with metabolic syndrome were selected as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III] from a target population diagnosed to have impaired glucose regulation at AFIP, along with forty-seven age and sex-matched controls. Insulin resistance was calculated by the method of HOMA-IR, using the formula of Mathew's et al. Blood pressure was measured as per recommendations of JNC7 report on prevention, detection, evaluation and treatment of high blood pressure. The difference for hypertension for diastolic blood pressure between subjects with and without metabolic syndrome were found to be significant [Metabolic syndrome: 86.79 mm of Hg [95% CI: 83.75-89.84], Age and sex matched controls: 80.21[95% CI: 76.80-83.62] [p<0.05]. However the difference for systolic blood pressure were not found to be significant between the two groups [p=0.860].Hypertensive individuals had higher HOMA-IR [[n=33]: 2.87 [95% CI: 2.37-3.05]] than non-hypertensive [[n=30]: 1.76[95% CI: 1.53-2.05]] [p<0.05].The effect of obesity as determined by waist circumference between patients with and without hypertension remained significant [p=< 0.05]. Hypertensive individuals have higher insulin resistance than subjects without hypertension. Thus it is recommended that vigorous search be made to diagnose insulin resistance in subjects diagnosed to have hypertension, and to demonstrate other components of metabolic syndrome

Insulin resistance in human subjects having impaired glucose regulation

To determine insulin resistance in human subjects having impaired glucose regulation [IGR] by Homeostasis Model Assessment for Insulin Resistance [HOMA-IR]. Comparative cross-sectional study. This study was carried out between September 2004 to September 2005, at the Department of Chemical Pathology and Clinical Endocrinology, Armed Forces Institute of Pathology [AFIP], Rawalpindi. A total of 100 subjects with impaired glucose regulation were selected for evaluation of metabolic syndrome as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III], along with 47 healthy age and gender-matched controls. Physical examination to determine blood pressure and waist circumference was carried out and so was sampling for plasma glucose, serum triglycerides, HDL-cholesterol and insulin. Insulin resistance was calculated by the HOMA-IR. Finally, subjects with and without metabolic syndrome were compared with controls [n=47], using one-way ANOVA for studying insulin resistance between groups, with Tukey's post-hoc comparison. The frequency of finding metabolic syndrome in cases of IGR remained 47%. The insulin resistance demonstrated stepwise worsening from control population [mean=1.54, 95% Cl: 1.77 - 2.37] to subjects suffering from only IGR [mean=2.07, 95% Cl: 1.77- 2.37] to metabolic syndrome [mean= 2.67, 95%, Cl: 2.34 - 3.00] [p < 0.001]. Patients with impaired glucose regulation may have significant insulin resistance. It is, thus, recommended that a vigorous search be made to measure insulin resistance in all cases diagnosed to have impaired glucose regulation