ABSTRACT
Objective Prevalence of type-2 diabetes mellitus (DM) and diabetic nephropathy is growing rapidly in Asian countries, affecting low- and middle-income groups. One of the epidemiological issues of Kolar district is fluorosis; advanced glycation end product, carboxymethyl lysine (CML), and a molecule of interest Sirtuin1 are employed in the present study. In the correlation of fluoride with sirtuin1and CML with sirtuin1 of cases lies the important rationale of the study to assess the extent of kidney damage. Materials and Methods This is a comparative cross-sectional study with three groups, each with 70 patients, as follows: G1, control; G2, diabetes with diabetic nephropathy; and G3, type-2 DM without any complications. Informed written consent was obtained from all study patients. All the routine investigations were performed by fully automated Vitro 5, 1 Fs, Vitros. Fasting insulin was analyzed by Vitro eCI and glycated hemoglobin was estimated by BioRad D10. Sirtuin1, CML, and fructosamine were estimated by double antibody sandwich technique. Statistical Analysis The statistical analysis was performed by SPSS 20 (IBM) software. Means of normally distributed data were compared using analysis of variance (ANOVA), and not normally distributed data were compared by Kruskal-Wallis test. A p -value of less than 0.05 was considered statistically significant. Results A decrease in sirtuin1, serum, and urine fluoride of group 2 (34.74 [25.08-53.2], 0.24 [0.2-0.5], and 0.24 [0.16-0.41]) was observed compared with other groups. Increased CML and fluoride act as prooxidant, restricting the effect of sirtuin1 on cellular damage, causing further complications such as increased insulin resistance and decreased insulin sensitivity. Conclusion The alterations in serum sirtuin1 levels indicate the severity of damage due to stress during hyperglycemia and fluoride toxicity; hence, sirtuin1 can be considered as biomarker of aging. Subsequently, the correlation of CML, estimated glomerular filtration rate (eGFR), and fluoride with sirtuin1 indicates that increasing sirtuin1 may defend the forthcoming damage and could be considered in therapeutics.
ABSTRACT
Type 2 Diabetes Mellitus is leading cause of Diabetic microvascular complications. India stands second across the globe in prevalence of diabetes mellitus. Due to deficit rain fall, the water table is exposed to more of salts and minerals from the rocks underground. One of the minerals is the Fluoride. Fluoride in negligible amount is good for dental health, chronic exposure to higher range of fluoride causes various metabolic disturbances. Aim: To study the effect of chronic fluoride exposure on diabetes mellitus. A total of 288 study subjects were recruited. The blood samples and urine samples were collected from all the study subjects. Study groups; Group1: Healthy Controls, Group2: Type 2 Diabetes Mellitus and Group3: Diabetic Nephropathy. The serum (0.313± 0.154) and urine (0.3±0.6) fluoride values of diabetic nephropathy group were significantly decreased in comparison between groups. The primary objective of the fluoride with insulin (-0.06) levels are inversely correlating and fluoride with microalbumin (0.083) levels are directly correlating. Results of the study gave a clear picture of effect of fluoride on insulin action and renal damage. In conclusion, though there is no significant effect of fluoride on FBS, PPBS and HbA1c, insulin is the determining factor for glucose homeostasis which is decreased. Microalbumin is yet another marker for renal clearance which is increased. Therefore, fluoride shall be considered as a parameter in prognosis of metabolic disorder especially Diabetes mellitus in fluoride endemic areas.
