Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients: comparative based cross-sectional study.
Ferritin
Glycemic control
HbA1c
T2DM
Journal
BMC endocrine disorders
ISSN: 1472-6823
Titre abrégé: BMC Endocr Disord
Pays: England
ID NLM: 101088676
Informations de publication
Date de publication:
07 Aug 2024
07 Aug 2024
Historique:
received:
08
06
2024
accepted:
23
07
2024
medline:
7
8
2024
pubmed:
7
8
2024
entrez:
6
8
2024
Statut:
epublish
Résumé
Uncontrolled type 2 diabetes mellitus (UT2DM) and its associated consequences nowadays have been a global health crisis, especially for adults. Iron has the property to oxidize and reduce reversibly, which is necessary for metabolic processes and excess accumulation of iron indicated by serum ferritin levels could have a significant impact on the pathophysiology of T2DM via generation of reactive oxygen species (ROS). However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control status. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups. A hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups of uncontrolled T2DM, controlled T2DM, and non-diabetic control groups from October 2 to December 29, 2023 at St. Paul's Hospital Millennium Medical College. A pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p < 0.05. The mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p < 0.001). It was significantly correlated with HbA1c [r = 0.457, p < 0.001], fasting blood sugar (FBs) [r = 0.386, p < 0.001], serum iron [r = 0.430, p < 0.001], and systolic blood pressure (SBP) [r = 0.195, p = 0.047] in T2DM patients. A multivariate logistic regression model revealed that a rise in HbA1c (AOR = 3.67, 95% CI(1.50-8.98), serum iron (AOR = 1.02, 95% CI(1.01-1.04), male gender (AOR = 0.16, 95% CI(0.05-0.57) and being on oral hypoglycemic agent (OHA) monotherapy (AOR = 0.26, 95% CI(0.07-0.95) were key associated factors for the elevated serum ferritin among T2DM patients. The present study demonstrated that T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycaemia and that serum ferritin had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients.
Sections du résumé
BACKGROUND
BACKGROUND
Uncontrolled type 2 diabetes mellitus (UT2DM) and its associated consequences nowadays have been a global health crisis, especially for adults. Iron has the property to oxidize and reduce reversibly, which is necessary for metabolic processes and excess accumulation of iron indicated by serum ferritin levels could have a significant impact on the pathophysiology of T2DM via generation of reactive oxygen species (ROS). However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control status. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups.
METHODS
METHODS
A hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups of uncontrolled T2DM, controlled T2DM, and non-diabetic control groups from October 2 to December 29, 2023 at St. Paul's Hospital Millennium Medical College. A pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p < 0.05.
RESULT
RESULTS
The mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p < 0.001). It was significantly correlated with HbA1c [r = 0.457, p < 0.001], fasting blood sugar (FBs) [r = 0.386, p < 0.001], serum iron [r = 0.430, p < 0.001], and systolic blood pressure (SBP) [r = 0.195, p = 0.047] in T2DM patients. A multivariate logistic regression model revealed that a rise in HbA1c (AOR = 3.67, 95% CI(1.50-8.98), serum iron (AOR = 1.02, 95% CI(1.01-1.04), male gender (AOR = 0.16, 95% CI(0.05-0.57) and being on oral hypoglycemic agent (OHA) monotherapy (AOR = 0.26, 95% CI(0.07-0.95) were key associated factors for the elevated serum ferritin among T2DM patients.
CONCLUSION
CONCLUSIONS
The present study demonstrated that T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycaemia and that serum ferritin had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients.
Identifiants
pubmed: 39107753
doi: 10.1186/s12902-024-01665-7
pii: 10.1186/s12902-024-01665-7
doi:
Substances chimiques
Ferritins
9007-73-2
Blood Glucose
0
Glycated Hemoglobin
0
Biomarkers
0
Types de publication
Journal Article
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
144Informations de copyright
© 2024. The Author(s).
Références
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. Idf Diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183. https://doi.org/10.1016/j.diabres.2021.109119 .
Roglic G. Who global report on diabetes: a summary. Int J Noncommunicable Dis. 2016;1(1):3–8. www.ijncd.org .
doi: 10.4103/2468-8827.184853
Classification and diagnosis of diabetes. Standards of medical care in diabetes-2022. Diabetes Care. 2022;45(1):17–38. https://doi.org/10.2337/dc22-S002 .
doi: 10.2337/dc22-S002
Hurtado MD, Vella A. What is type 2 diabetes? Medicine. 2019;47(1):10–5. https://doi.org/10.16/j.mpmed.2018.10.010
Shaaban MA, Dawod AEA, Nasr MA. Role of iron in diabetes mellitus and its complications. Menoufia medical journal. 2016;29(1):11. https://doi.org/10.4103/1110-2098.178938
Moore Heslin A, O’Donnell A, Buffini M, Nugent AP, Walton J, Flynn A, et al. Risk of iron overload in obesity and implications in metabolic health. Nutrients. 2021;13(5). https://doi.org/10.3390/nu13051539 .
Ezegbogu M, Abdulsalam K. Glycated haemoglobin (hba1c): an update on available methods. Bayero J Pure Appl Sci. 2018;11(1):8–14. https://doi.org/10.4314/bajopas.v11i1.2 .
doi: 10.4314/bajopas.v11i1.2
Backe MB, Moen IW, Ellervik C, Hansen JB, Mandrup-Poulsen T. Iron regulation of pancreatic beta-cell functions and oxidative stress. Annu Rev Nutr. 2016;36:241–73. https://doi.org/10.1146/annurev-nutr-071715-50939 .
doi: 10.1146/annurev-nutr-071715-50939
pubmed: 27146016
Shetty JK, Prakash M, Ibrahim MS. Relationship between free iron and glycated hemoglobin in uncontrolled type 2 diabetes patients associated with complications. Indian J Clin Biochem. 2008;23:67–70.
doi: 10.1007/s12291-008-0016-4
pubmed: 23105724
pmcid: 3453647
Fillebeen C, Lam NH, Chow S, Botta A, Sweeney G, Pantopoulos K. Regulatory connections between iron and glucose metabolism. Int J Mol Sci. 2020;21(20). https://doi.org/10.3390/ijms21207773 .
Fernández-Real JM, López-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes. 2002;51(8):2348–54.
doi: 10.2337/diabetes.51.8.2348
pubmed: 12145144
Wang H, Li H, Jiang X, Shi W, Shen Z, Li M. Hepcidin is directly regulated by insulin and plays an important role in iron overload in streptozotocin-induced diabetic rats. Diabetes. 2014;63(5):1506–18.
doi: 10.2337/db13-1195
pubmed: 24379355
Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95–104. https://doi.org/10.1016/j.blre.2008.08.001 .
doi: 10.1016/j.blre.2008.08.001
pubmed: 18835072
Rajpathak SN, Crandall JP, Wylie-Rosett J, Kabat GC, Rohan TE, Hu FB. The role of iron in type 2 diabetes in humans. Biochim et Biophys Acta (BBA)-General Subj. 2009;1790(7):671–81. https://doi.org/10.1016/j.bbagen.2008.04.005 .
doi: 10.1016/j.bbagen.2008.04.005
Saeedi P, Salpea P, Karuranga S, Petersohn I, Malanda B, Gregg EW, et al. Mortality attributable to diabetes in 20–79 years old adults, 2019 estimates: results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract. 2020;162. https://doi.org/10.1016/j.diabres.2020.108086 .
Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of hba1c test in diagnosis and prognosis of diabetic patients. Biomark Insights. 2016;11:38440. https://doi.org/10.4137/Bmi.s .
doi: 10.4137/Bmi.s
ADA. Glycemic targets: standards of medical care in diabetes—2022. Diabetes Care. 2022;45(1):83–96. https://doi.org/10.2337/dc22-S006 .
doi: 10.2337/dc22-S006
Imran SA, Agarwal G, Bajaj HS, Ross S, Committee DCCPGE. Targets for glycemic control. Can J Diabetes. 2018;42:42–6. https://doi.org/10.1016/j.jcjd.2017.10.030 .
doi: 10.1016/j.jcjd.2017.10.030
Tekalegn Y, Addissie A, Kebede T, Ayele W. Magnitude of glycemic control and its associated factors among patients with type 2 diabetes at tikur anbessa specialized hospital, addis ababa, Ethiopia. PLoS ONE. 2018;13(3). https://doi.org/10.1371/journal.pone.0193442 .
Gebreyohannes EA, Netere AK, Belachew SA. Glycemic control among diabetic patients in Ethiopia: a systematic review and meta-analysis. PLoS ONE. 2019;14(8). https://doi.org/10.1371/journal.pone.0221790 .
Jung CH, Lee MJ, Hwang JY, Jang JE, Leem J, Park J-Y, et al. Elevated serum ferritin level is associated with the incident type 2 diabetes in healthy Korean men: a 4 year longitudinal study. PLoS ONE. 2013;8(9). https://doi.org/10.1371/journal.pone.0075250
Alqahtani N, Ghazwani EY, Al-Qahtani AM, Elmahboub RA. Correlation of iron levels with glycemia and microvascular complications among type ii diabetes mellitus patients in najran university hospital. J Family Med Prim Care. 2022;11(6). https://doi.org/10.4103/jfmpc.jfmpc_545_21
Sharifi F, Sazandeh S. Serum ferritin in type 2 diabetes mellitus and its relationship with hba1c. 2004.
Chen L, Li Y, Zhang F, Zhang S, Zhou X, Ji L. Association of serum ferritin levels with metabolic syndrome and insulin resistance in a Chinese population. J Diabetes Complicat. 2017;31(2):364–8. https://doi.org/10.1016/j.jdiacomp.2016.06.018 .
doi: 10.1016/j.jdiacomp.2016.06.018
Gandhi SJ, Chaudhari AS, Pratinidhi S, Sontakke A. Study of serum ferritin and hba1c in type 2 diabetes mellitus. Int J Clin Biochem Res. 2018;5(4):594–8. https://doi.org/10.18231/2394-6377.2018.0126 .
doi: 10.18231/2394-6377.2018.0126
Wolide AD, Zawdie B, Alemayehu T, Tadesse S. Evaluation of serum ferritin and some metal elements in type 2 diabetes mellitus patients: Comparative cross-sectional study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2016:417 – 24. https://doi.org/10.2147/DMSO.S120326 .
ADA. On diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(1):81–90. https://doi.org/10.2337/dc14-S081 .
doi: 10.2337/dc14-S081
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121–6. https://doi.org/10.4103/0253-7176.116232 .
doi: 10.4103/0253-7176.116232
pubmed: 24049221
pmcid: 3775042
Tummalacharla SC, Pavuluri P, Maram SR, Vadakedath S, Kondu D, Karpay S et al. Serum activities of ferritin among controlled and uncontrolled type 2 diabetes mellitus patients. Cureus. 2022;14(5) https://doi.org/10.7759/cureus.25155 .
Jan A, Weir CB. Bmi classification percentile and cut off points. StatPearls: Treasure Island, FL, USA. 2021:1–4. https://www.researchgate.net/publication/337153906 .
Himmelmann A, Kjeldsen S, Hedner T. Recent hypertension guidelines: Jnc-7 and 2003 esh/esc. Blood Press. 2003;12(4):196–7. https://doi.org/10.1080/08037050310015854 .
doi: 10.1080/08037050310015854
pubmed: 14596354
WHO. On use of ferritin concentrations to assess iron status in individuals and populations. World Health Organization Geneva; 2020. https://creativecommons.org/licenses/by-nc-sa/3.0/igo .
Frozen. I, Nhanes. 2019–2020.
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Glycemic targets: standards of care in diabetes—2023. Diabetes Care. 2023;46(1):97–110. https://doi.org/10.2337/dc23-S006 .
doi: 10.2337/dc23-S006
WHO. Development group for the updating of the 2010 global recommendations on physical activity in youth, adults and older adults. 12–20 June 2019 Geneva, Switzerland.
Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):1–8. https://doi.org/10.1186/751-0473-3-17 .
doi: 10.1186/751-0473-3-17
Bao W, Rong Y, Rong S, Liu L. Dietary iron intake, body iron stores, and the risk of type 2 diabetes: a systematic review and meta-analysis. BMC Med. 2012;10:1–13. http://www.biomedcentral.com/1741-7015/10/119 .
doi: 10.1186/1741-7015-10-119
Tummalacharla SC, Pavuluri P, Maram SR, Vadakedath S, Kondu D, Karpay S, et al. Serum activities of ferritin among controlled and uncontrolled type 2 diabetes mellitus patients. Cureus. 2022;14(5). https://doi.org/10.7759/cureus.25155 .
Canturk Z, Çetinarslan B, Tarkun İ, Zafer Canturk N. Serum ferritin levels in poorly-and well‐controlled diabetes mellitus. Endocr Res. 2003;29(3):299–306. http://10.1081=ERC-120025037
doi: 10.1081/ERC-120025037
pubmed: 14535631
Raj S, Rajan G. Correlation between elevated serum ferritin and hba1c in type 2 diabetes mellitus. Int J Res Med Sci. 2013;1(1):12 – 5. https://doi.org/10.5455/2320-6012.ijrms20130203
Guo L, Jiang F, Tang Y-T, Si M-Y, Jiao X-Y. The association of serum vascular endothelial growth factor and ferritin in diabetic microvascular disease. Diabetes Technol Ther. 2014;16(4):224–34. https://doi.org/10.1089/dia.2013.0181
doi: 10.1089/dia.2013.0181
pubmed: 24279470
pmcid: 3952528
Kuba RH, Saheb EJ, Mosa IS. Detection of iron and ferritin in diabetes mellitus type 2 patients. Malaysian J Med Health Sci. 2022;18: https://www.researchgate.net/publication/359048957 .
Chawla R, Bhoopathi A, Punyani H. Ferritin and serum iron as surrogate markers of poor glycemic control and microvascular complications in type 2 diabetes mellitus. Int J Diabetes Developing Ctries. 2019;39(2):362–8. https://doi.org/10.1007/s13410-018-0687-1 .
doi: 10.1007/s13410-018-0687-1
Li S, Chen F, Li T, Cheng Y, Huang G, Hou D, et al. Higher serum ferritins are associated with higher blood pressure: a cross-sectional study. Medicine. 2024;103(12). https://doi.org/10.1097/MD.0000000000037485 .
Sarin S, KK SK, Bhaskar BV, Valliyot B. Association of serum ferritin in type 2 diabetes mellitus patients-an observational study. Int J Pharm Clin Res 2022.: https://www.researchgate.net/publication/360449123 .
Son NE. Influence of ferritin levels and inflammatory markers on hba1c in the type 2 diabetes mellitus patients. Pak J Med Sci. 2019;35(4):1030–5. https://doi.org/10.12669/pjms.35.4.1003 .
doi: 10.12669/pjms.35.4.1003
pubmed: 31372137
pmcid: 6659066
Al-Miraj A, Khan I. Correlation between serum ferritin and glycated haemoglobin levels in type-2 diabetes mellitus patients. J Diabetes Metab. 2021;12:893.
Ahmed HEA, Ali NMA. Evaluation of serum ferritin in type-2 diabetes mellitus sudanese patients. Journal of Bioscience and Applied Research. 2022;8(3):132-7. https://doi.org/10.21608/jbaar.2022.247840
Marku A, Galli A, Marciani P, Dule N, Perego C, Castagna M. Iron metabolism in pancreatic beta-cell function and dysfunction. Cells. 2021;10(11). https://doi.org/10.3390/cells10112841 .
Pasricha SRS, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, et al. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust. 2010;193(9):525–32.
doi: 10.5694/j.1326-5377.2010.tb04038.x
pubmed: 21034387
WHO. Nutritional anemia: Tools for effective prevention and control. 2017.
Aschner P. New Idf clinical practice recommendations for managing type 2 diabetes in primary care. Diabetes Res Clin Pract. 2017;132:169–70. https://doi.org/10.1016/j.diabres.2017.09.002 .
doi: 10.1016/j.diabres.2017.09.002
pubmed: 28962686
Altunoğlu E, Müderrisoğlu C, Erdenen F, Ülgen E, Ar MC. The impact of obesity and insulin resistance on iron and red blood cell parameters: a single center, cross-sectional study. 2014 https://doi.org/10.4274/Tjh.2012.0187 .
Horita S, Seki G, Yamada H, Suzuki M, Koike K, Fujita T. Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens. 2011. https://doi.org/10.4061/2011/391762 .
doi: 10.4061/2011/391762
pubmed: 21629870
pmcid: 3095959
Iglesias-Vázquez L, Arija V, Aranda N, Aglago EK, Cross AJ, Schulze MB, et al. Factors associated with serum ferritin levels and iron excess: results from the epic-eurgast study. Eur J Nutr. 2022;61(1):101–14. https://doi.org/10.1007/s00394-021-2625-w .
doi: 10.1007/s00394-021-2625-w
pubmed: 34213605
Chaudhari R, Niraula A, Gelal B, Baranwal J, Sarraf D, Maskey R et al. Increased serum ferritin levels in type 2 diabetes mellitus patients: a hospital based cross-sectional study. 2021: https://doi.org/10.3126/jucms.v9i02.42009 .
Alfaro-Magallanes VM, Barba-Moreno L, Romero-Parra N, Rael B, Benito PJ, Swinkels DW, et al. Menstrual cycle affects iron homeostasis and hepcidin following interval running exercise in endurance-trained women. Eur J Appl Physiol. 2022;122(12):2683–94. https://doi.org/10.1007/s00421-022-5048-5 .
doi: 10.1007/s00421-022-5048-5
pubmed: 36129579
pmcid: 9613712
Aregbesola A, Voutilainen S, Virtanen JK, Mursu J, Tuomainen T-P. Body iron stores and the risk of type 2 diabetes in middle-aged men. Eur J Endocrinol. 2013;169(2):247–53. https://doi.org/10.1530/EJE-13-0145
doi: 10.1530/EJE-13-0145
pubmed: 23715774
Nauli AM, Matin S. Why do men accumulate abdominal visceral fat? Front Physiol. 2019;10. https://doi.org/10.3389/fphys.2019.01486 .
Kautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia. 2023;66(6):986–1002.
doi: 10.1007/s00125-023-05891-x
pubmed: 36897358
pmcid: 10163139