IJCRR - Vol 07 Issue 04, February, 2015
Association of Serum Uric Acid with anthropometric, HbA1c and Lipid profile in Diabetic Retinopathy
Author: Munilakshmi U., Prabhavathi K., Shashidhar K. N., Madhavi Reddy, Lakshmaiah V.
Introduction: Diabetic Retinopathy (DR), one of the leading cause of visual impairment in adults, a kind of serious microvascular complication of Diabetes Mellitus. It is well known that purine metabolites are strongly associated with the development of diabetic microvascular complications. Uric acid, an end product of the purine metabolism, acts as a pro-oxidant and it may thus be a marker of oxidative stress.
1. To Estimate and Compare Anthropometric and Biochemical parameters in Diabetic Retinopathy patients, Diabetes without Retinopathy and clinically proven healthy controls.
2. To correlate Serum Uric acid levels with Anthropometric and Biochemical indices in Diabetic Retinopathy patients. Materials and Methods: Study group consisted total of 150 subjects divided into three groups- Group I (Clinically proven healthy controls), Group II (Type 2 Diabetes Mellitus without retinopathy) and Group III (Diabetic retinopathy), visiting RL Jalappa hospital and Research centre Kolar. Anthropometric & Biochemical parameters were estimated by standard methods.
Results: Comparison of Anthropometric & Biochemical parameters were done among the three Groups, we observed Age, Obesity index, Fasting Blood Sugar, HbA1c, Total Cholesterol, high density lipoproteins, low density lipoproteins & Uric acid were statistically significant with p value <0.05 and also positive correlation was observed for Body mass index,Fasting Insulin, Total Cholesterol, high density lipoproteins and low density lipoproteins with Uric Acid in Group III.
Conclusion: Hyperglycemia and Oxidative stress in Type 2 Diabetes Mellitus leads to micro and macrovascular complications. In Group III, there was positive correlation of serum Uric Acid with Anthropometric & Biochemical Indices. Therefore uric acid can be considered as a reliable marker which is less expensive and helps clinicians in controlling the progression of DM to microvascular complications like DR.
Keywords: Diabetic Retinopathy, Diabetes Mellitus, Uric Acid, Obesity index
Munilakshmi U., Prabhavathi K., Shashidhar K. N., Madhavi Reddy, Lakshmaiah V.. Association of Serum Uric Acid with anthropometric, HbA1c and Lipid profile in Diabetic Retinopathy International Journal of Current Research and Review. Vol 07 Issue 04, February, 20-26
1. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res ClinPract2011;94:311-321.
2. Harris MI, Klein R, Welborn TA, Knuiman MW. The onset of NIDDM occurs at least 4-7 years before its clinical diagnosis. Diabetes Care 1992; 15:815-819.
3. Klein, BE, Klein. K, Moss. SE, “The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years,” Archives of Ophthalmology, 1984;102(4):520–526
4. Ames BN, Cathcart R, Schwiers E, Hochstein P. Uric acid provides an antioxidant defence mechanism in humans against oxidants and radicals which cause aging and cancer: a hypothesis. ProcNatlAcadSci USA 1981;78:6858- 6862.
5. Nakagawa T, Zharikov S, Tuttle KR, Short RA, Glushakova O. A causal role of uric acid in the fructose- induced metabolic syndrome. Am. J. Physiol. Renal. Physiol. 2005;290:625-631.
6. Murea M Advanced kidney failure and hyperuricemia. Adv Chronic Kidney Dis. 2012;19:419-424.
7. Tassone EJ, Presta I, Sciacqua A, Rotundo M. Uric acid promotes endothelial dysfunction: A new molecular model of insulin resistance. Eur J Clin Invest 2011;41: 81-82.
8. P. Cirillo, W. Sato, S. Reungjui. “Uric acid, the metabolic syndrome, and renal disease, Journal of the American Society of Nephrology 2006;17(3):S165–S168.
9. Anwar MM,Meki AM. “Oxidative stress in streptozotocininduced diabetic rats: effects of garlic oil and melatonin,” Comparative Biochemistry and Physiology A2003;135( 4):539–547.
10. Hsu SP, Pai MF, Peng YS, Chiang C, Ho T. “Serum uric acid levels show a “J-shaped” association with allcause mortality in haemodialysis patients,” Nephrology Dialysis Transplantation 2004;19(2):457–462.
11. David B Sacks MB. Estimation of Blood Glucose. In: Teitz, Burtis CA, eds. Clinical chemistry and Molecular Diagnostics. 4thed.New Delhi: Elsevier, 1999, pp 870-871.
12. Edmund Lamb, David J, Cristopher P. Creatinine estimation. In:Teitz, Burtis CA, eds. Clinical chemistry and Molecular Diagnostics. 4th ed. New Delhi: Elsevier, 1999, pp 798.
13. Nader Rifai, G. Russell Warnick. Friedewald Equation. In: Teitz, Burtis CA, eds. Clinical chemistry and Molecular Diagnostics. 4thed. New Delhi: Elsevier, 1999, pp 842-843.
14. Levy AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 1990; 130:461- 470.
15. Roglic G, Unwin N, Bennett PH. “The burden of mortality attributable to diabetes: realistic estimates for the year 2000,” Diabetes Care 2005;28(9):2130–2135.
16. Flack JM, Peters R, Shafi T, Alrefai H, Nasser SA. “Prevention of hypertension and its complications: theoretical basis and guidelines for treatment,” Journal of the American Society of Nephrology 2003;14(2):S92–S98.
17. Kureja S, Malhotra N, Chhabra N. Correlation of the Serum Insulin and the Serum Uric Acid Levels with the Glycated Haemoglobin Levels in the Patients of Type 2 Diabetes Mellitus. Journal of Clinical and Diagnostic Research. 2013;7(7):1295-1297.
18. Oliveira E P, MoretoF, Arruda L V, Burini R C. Dietary, anthropometric, and biochemical determinants of uric acid in free-living adults Nutrition Journal 2013; 12:1-10.
19. Matthews D. R, Stratton I. M, Aldington S. J, Holman R. R, Kohner E. M, “Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69,” Archives of Ophthalmology 2004;122(11):1631–1640
. 20. Schrier RW, Estacio RO,Mehler PS. “Appropriate blood pressure control in hypertensive and normotensive type 2 diabetes mellitus: a summary of the ABCD trial,” Nature Clinical Practice Nephrology 2007;3(8):428– 438.
21. Srinivasa NR, Gurumurthy P, Gururajan P, SarasaBarathi A, Krithivasan V, Saibabu R, et al. Comparison between Serum Insulin levels and its Resistance with Biochemical, Clinical and Anthropometric Parameters in South Indian Children and Adolescents. Indian Journal Clin. Biochem. 2011; 26(1): 22-27.
22. Pagano G, Pacini G, Musso G Non alcoholicsteatohepatitis, insulin resistance and metabolic syndrome: Hepatology. 2002; 35: 367-72
. 23. Correa Z, FreiatasAM, Macron IM. Risk factors related to the severity of diabetic retinopathy. Arq Bras Oftalmol. 2003;66:739-743
. 24. Ishrat K, Jaweed SA, Bardapurkar JS, Patil VP. Study of magnesium,glycosylated hemoglobin and lipid profile in diabetic retinopahy. Indian J ClinBiochem. 2004;19:124- 127.
25. Butturini U, Coscelli C, Zavaroni I. Insulin release in hyperuricemic patients. Harefuah. 1995;128:681-683.
26. Terrasa AM, Guajardo MH, Marra CA, Zapata G Alpha-Tocopherol protects against oxidative damage to lipids of the rod outer segments of the equine retina. 2009; 182: 463- 468.
27. Kowluru RA Diabetic retinopathy: mitochondrial dysfunction and retinal capillary cell death. Antioxid Redox Signal 2005;7: 1581-1587.
28. Plagemann PG. Transport and metabolism of adenosine in human erythrocytes: effect of transport inhibitors and regulation by phosphate, Journal of Cellular Physiology 1986;128,(3):491–500.
29. Ioachimescu AG, Hoogwerf BJ Comments on the letter by Pitocco et al. (Serumuric acid, mortality and glucose control in patients with type 2 diabetes mellitus: a PreCIS database study) Diabetic Medicine 2008;25(4):509.
30. Rema M, Srivastava BK, Anitha B, Deepa R , Mohan V. Association of serum lipids with diabetic retinopathy in urban South Indians-the Chennai Urban Rural Epidemiology Study (CURES) Eye Study-2. 2006;23(9):1029-1036.
31. Chew EY, Klein ML, Ferris FL III, Remaley NA, Murphy RP, Chantry K,Hoogwerf BJ, Miller D. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22 Arch Opthalmol. 1996;114 (9):1079- 1084.
32. Sachdev N, Sahni A. Association of systemic risk factors with the severity of retinal hard exudates in a north Indian population with type 2 diabetes. 2010;56(1):3-6.
33. Idiculla J, Nithyanandam S, Joseph M, Mohan VA, Vasu U, SadiqM.Serum lipids and diabetic retinopathy: A cross-sectional study. 2012:16(Suppl 2):S492-494.
34. Benarous R, Sasongko MB, Qureshi S, Fenwick E, Dirani M, Wong TY, Lamoureux EL. Differential association of serum lipids with diabetic retinopathy and diabetic macular edema. Invest opthalmolvis sci. 2011; 52(10):7464-7469.
35. Valtuena S, Numeroso F, Ardigo D, Pedrazzoni M, Franzini L, Piatti PM, Monti L, Zavaroni I: Relationship between leptin, insulin, body composition and liver steatosis in non-diabetic moderate drinkers with normal transaminase levels. Eur J Endocrinol 2005; 153:283–290.
36. Larsson LI, Alm A, Lithner F, Dahlén G, Bergstrm R. The association of hyperlipidemia with retinopathy in diabetic patients aged 15-50 years in the county of Ume? ActaOpthalmolScand 1999;77(5):585-591.