Study of biochemical parameters in type 2 diabetes Tunisians mellitus patients 1,2
Aicha Bouaziz , Soumaya Ben Nasr , Hend Tlili Zinelabidine , Wissem Mnif
Ecole Supérieur des Sciences et des Techniques de Santé de Sousse, PB n° 103 - La Poste Sahloul - 4054 Sousse, Tunisie. LR11-ES31 Biotechnologie et Valorisation des Bio-Géo Ressources, Institut Supérieur de Biotechnologie de Sidi Thabet, BiotechPole de Sidi Thabet, 2020, Université de la Manouba, Tunisie. 3 Service endocrinologie, groupement de santé de base, Sousse-Tunisie. 2
ABSTRACT Diabetes mellitus has become, in less than a quarter century, a public health problem in developing countries. It is among the top five chronic diseases. Diabetes is a chronic, incurable disease so there is no treatment to cure. The main causes of diabetes are visceral obesity and lack of physical activity in addition to a supply and too much high fat could also be a risk factor. We evaluated the status of two study populations: one healthy and one diabetic for a number of biochemical parameters in direct relation with this disease, to dissect the key risk factors in the latter. For some clinical settings, we found increased levels compared with healthy subjects despite the adoption of necessary measures for diabetes and appropriate treatment to maintain it normal, such as blood glucose and glycated hemoglobin. In contrast, exploration showed lipid disturbances unpleasant compared to diabetics, and this result is observed in other parameters such as iron status. Results of analyses shows that an increase in the average rate of glucose in our patients is estimated to 8.82mmol/L and the glycated hemoglobin level ranges from 4.7 to 12.4% with an average of 7.2% which is a value greater than normal. Regarding the cholesterol, HDL, LDL and triglyceride form of lipid reserves is often associated with a diabetic condition imbalance. Key words: Biochemical parameters; type 2 diabetes; Tunisians patients.
Microbiol. Hyg. Alim.-Vol 24, N° 71– décembre 2012
RÉSUMÉ Le diabète sucré est devenu, en moins d'un quart de siècle, un problème de santé publique dans les pays en cours de développement. Il est parmi les cinq premières maladies chroniques. Le diabète est une maladie chronique incurable de sorte qu'il n'existe aucun traitement pour guérir. Les principales causes de diabète sont l'obésité viscérale et le manque d'activité physique en plus d'une offre et trop riche en graisses pourrait également être un facteur de risque. Nous avons évalué la situation de deux populations à l'étude: une population de bonne santé et l’autre diabétique, pour un certain nombre de paramètres biochimiques en relation directe avec cette maladie, de disséquer les principaux facteurs de risque dans le second. Pour certains paramètres cliniques, nous avons constaté une augmentation des taux par rapport aux sujets sains, malgré l'adoption des mesures nécessaires pour le diabète et le traitement approprié de maintenir ce normal, comme la glycémie et l'hémoglobine glyquée. En revanche, l'exploration a montré des perturbations des lipides par rapport aux diabétiques, et ce résultat est observé dans d'autres paramètres tels que le fer. Les résultats des analyses montrent que l'augmentation du taux moyen de glucose dans nos patients est estimée à 8,82mmol / L et le taux d'hémoglobine glyquée gammes de 4,7 à 12,4% avec une moyenne de 7,2%, ce qui est une valeur supérieure à la normale. En ce qui concerne le cholestérol, sous forme de triglycérides HDL, LDL et des lipides de réserve est souvent associé à un déséquilibre état diabétique. Mots clés: Paramètres biochimiques ; diabète de type 2 ; patients Tunisiens.
I. Introduction Glycemia is the concentration of glucose circulating in the blood. The glucose in the blood from two sources: an exogenous origin (food provides carbohydrates such as sugar, starches, fruits, which are degraded by enzymes, mainly glucose) and endogenous origin since the liver is an organ producing glucose through two pathways, glycogenolysis and gluconeogenesis. The morning fasting blood glucose is around 5.5 mM or 1g/L in men. A carbohydrate meal increased temporarily until the 1.2 to 1.3 g/L. After a fast of 24 hours, it
remains at around 0.6 to 0.7 g/L (Figure 1). Diabetes is defined by the presence of symptoms of diabetes (polyuria, polydipsia, and weight loss) associated with blood glucose (in venous plasma) greater than or equal to 2 g/L (11.1 mmol/L) two hours after a hearing 75 gglucose (criteria proposed by the World Health Organization (WHO) . ------------------------------------------------------------------------------------------* Correspondence to: Dr. Mnif W, Institut Supérieur de Biotechnologie de Sidi Thabet. Pole Technologie Sidi Thabet, 2020 Ariana- Université de la Manouba-Tunisie. E-mail address: [email protected]
Microbiol. Hyg. Alim.-Vol 24, N° 71– décembre 2012
There are two main types of diabetes: diabetes Type 1 and Diabetes Type 2. The latter type of diabetes is a disease characterized by insulin resistance in peripheral tissues, associated with qualitative and quantitative deficiency of pancreatic secretion of insulin in response to glucose . It represents 80-90% of patients and affects more than 2% of the world population. The early type II diabetes is characterized by insulin resistance in peripheral tissues muscle and fat tissue. The insulin resistance typically refers to the reduction of the hypoglycaemic effect of insulin concentration usually effective. To address this inefficiency partial or total, it appears a compensatory hypersecretion of pancreatic P cells. The resulting hyperinsulinemia helps maintain normal glucose tolerance. In many individuals, this condition corresponds to the metabolic syndrome of insulin resistance which is defined by obesity, insulin resistance, hyperlipidemia, hyperinsulinemia and hypertension, and do not progress to diabetes always . During the progression of the disease, beta cell function declines and the patient then has a fasting hyperglycemia. It occurs mostly after 40 years in obese subjects and its prevalence increases with age. The causes of Type II diabetes is multifactorial involving, as with Type I diabetes, genetic predisposition and factors related to lifestyle accompanying industrialization and urbanization (unhealthy diet, overweight, sedentary lifestyle) triggering or exacerbating disease . Despite the development of molecules normalizing blood glucose and improved treatment regimens, the diabetic remains subject to on morbidity and mortality associated mainly with degenerative tissue damage including the nerves, kidneys, skin, the retina and heart. Diabetes mellitus induced frequently the onset of acute or chronic complications. The main complication is acute diabetic coma is caused by hyperglycemia (DKA) or hypoglycemia (eg due to a power too great a hypoglycemic medication). Chronic complications of diabetes consist mainly of degenerative vascular disease whose main features are the progressive obstruction of the lumen of the vessels and the microcirculation level, the abnormal passage of proteins from the bloodstream into tissues. These complications include both large vessels (macroangiopathy) and microvessels (microvascular disease). Persistent hyperglycemia is closely related to the increased incidence and severity of diabetic vascular complications . Two types of complications: acute and chronic complications: - Acute complications: They can occur (as malaise, up to coma) in case of changes in blood glucose too high or because the blood sugar is too high (hyperglycemia) or too low because it is under the influence treatment (hypoglycemia). 50
- Complications Chronic: For years, the excess sugar in the blood work done silently at the destruction of all the arteries. Excess blood sugar is toxic to nerves and vessels for all the smaller ones (kidney: renal dialysis with risk, eye: retinal disease with risk of blindness, nerves, neuropathy (pain and loss the sensitivity of the feet) and large vessels (heart: myocardial infarction, brain stroke, legs arteritis). When vessels are obstructed, the organs are not enough or more irrigated. Involvement of nerves and blood vessels cause complications. II. Material and methods We conducted an analytical study focused on 120 subjects (60 diabetics and 60 healthy subjects) from outpatient center outside of endocrinology through the center of Sousse. The biological parameters: 1. Balance carbohydrates a. Glucose Glucose is the main component of energy cells. Maintaining blood glucose at a physiological concentration is required for normal metabolism of cells. The glucose in plasma or serum and urine for glucose tests are required during routine visits to monitor glucose metabolism . Blood glucose is of interest in: 1. The diagnosis of diabetes and monitoring of diabetes. 2. The diagnosis of hypoglycemia, which is a medical emergency. The reference values of glucose in plasma or serum is about 4.5 to 6.1 mmol / L . b. Glycated hemoglobin HbA1c Glycation of hemoglobin is a two stage process: - Stage 1: rapid and reversible formation of an aldimine or Schiff base called labile HbA1c determination of a glucose molecule to the amino group of N-terminal valine is one or two beta chains of HbA1c. This fraction can represent up to 30% of HbA1c in diabetics and should be eliminated. - 2nd stage: Amadori rearrangement by which leads to a stable cétosamine. An increase of HbA1c is proportional to episodes of hyperglycemia. There are other glycated hemoglobin separable by isoelectric focusing: the HbA1 HbA1b and Hb which are respectively linked to hexose phosphate and unphosphorylated hexoses. These rates do not Hb glycation sufficiently correlated to changes in blood glucose, in contrast to HbA1c, to be quite reliable in
monitoring diabetes. The reference values of HbA1c in non-diabetics are about 4 to 6.2% .
3. Protein balance a. the micro albuminuria
2. Lipid a. Cholesterol Cholesterol is a lipid molecule, insoluble in an aqueous medium such as plasma where it circulates in the form of pseudo-emulsion: lipid-protein associations that constitute lipoproteins. These lipoproteins differ quantitatively and qualitatively in their lipid and protein composition, which gives them a structural difference but also functional. The most widely used classification is that based on their density difference. This explains the name High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL) and the existence of many intermediate fractions that correspond to all stages of lipid metabolism . For the baseline cholesterol, an international consensus conference recommended concentrations below 5.2 mmol / L. b. HDL HDL or high density lipoproteins contain about 50% fat, 20% cholesterol. The HDL molecule is responsible for ensuring the efflux of cholesterol from cell membranes and thus its treatment. Numerous epidemiological studies have confirmed the antiatherogenic role of this fraction leads to the concept of "good cholesterol" . The reference value of HDL should be greater than 1.0 mmol / L.
Microbiol. Hyg. Alim.-Vol 24, N° 71– décembre 2012
c. LDL LDL represents an element of risk assessment when there is an imbalance Atheromatous of total cholesterol / HDL cholesterol or LDL cholesterol / HDL cholesterol. LDL is calculated by applying the formula FRIEDWALD: Chol LDL = Chol T - Chol HDL - [Triglycérides / 2.2]
If the results are expressed in mmol /L. This formula is valid only if triglycerides are