SIGNIFICANCE OF GLYCAEMIC CONTROL IN TYPE 1 DIABETES
AbstractBackground: Diabetes mellitus is accompanied with drastic hormonal and metabolic alterations. In uncontrolled diabetes, these disturbances worsen the condition leading to development of life threatening complications. Present study was planned to compare hormonal and metabolic disturbances in controlled and uncontrolled type 1 diabetes (T1D). Methods: This retrospective, analytical case control study was carried out from Jan 2004 to July 2007. Sample size was 60, divided into 3 groups: Non-diabetic control (group A), controlled T1D (group B) and uncontrolled T1D (group C). Results: Uncontrolled type 1 diabetics when compared with control group, presented with significant hyperglycaemia (p<0.001), hypoinsulinemia (p<0.001), hyperglucagonemia (p<0.01), raised BMI (p<0.05), hyponatremia (p<0.01), hyperkalemia (p<0.01), acidemia (p<0.05), high arterial Pco2 (p<0.05), low plasma HCO3– (p<0.05), raised plasma triglyceride, LDL Cholesterol and total cholesterol level (p<0.01) but low HDL cholesterol (p<0.05). On similar comparison controlled type 1 diabetics showed significant hyperglycaemia (p<0.001) and hypoinsulinemia (p<0.05). Conclusion: Regular assessment, monitoring and control of T1D has positive impact in preventing development of diabetic dyslipidemia and other hormonal and metabolic derangements which, if left uncontrolled can lead to life threatening diabetic complications.Keywords: Type 1 diabetes, Diabetic Ketoacidosis, Dyslipidemia, Hypoinsulinemia, Hyperglycaemia, hyperglucagonemia
Wadwa RP, Kinney GL, Maahs DM, Snell-Bergeon J, Hokanson JE, Garg SK, et al. Awareness and Treatment of Dyslipidemia in Young Adults with Type 1 Diabetes. Diabetes Care 2005;28(5):1051–6.
Wang MY, Chen L, Clark GO, Lee Y, Stevens RD, Ilkayeva OR, et al. Leptin therapy in insulin deficient type 1 diabetes. Proc Natl Acad Sci USA 2010;107(11):4813–9.
Hancock AS, Du A, Liu J, Miller M, May CL. Glucagon deficiency reduces hepatic glucose production and improves glucose tolerance in adult mice. Mol Endocrinol 2010;24:1605–14.
Expert panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.
Mooradian AD. Dyslipidemia in type 2 diabetes mellitus. Nature Clinical Practice Endocrinology & Metabolism 2009;5:150–9.
Mehgjun HU. A 48-year-old man with uncontrolled diabetes. Cleveland Clinic Journal of Medicine 2009;76(7):413–6.
Giménez M, Aguilera E, Castell C, de Lara N, Nicolau J, Conget I. Relationship between BMI and Age at Diagnosis of Type 1 Diabetes in a Mediterranean Area in the Period of 1990–2004. Diabetes Care 2007;30(6):1593–5.
Report of a WHO consultation, Part 1: Diagnosis and classification of diabetes mellitus, Geneva, 59p, WHO/NCD/NCS/99.2
Dods RF. In: Kaplan LA, Pesco AJ, Kazmierczak SC. Clinical chemistry. 31st ed. New York: Maplevail Press; 1996. p.634–5.
Morris CJOR, Morris P. Separation methods in biochemistry. 2nd ed. London: The Pitman Press;1976. p.93–148.
Sherwin JE. Kaplan LA, Pesco AJ, Kazmierczak SC. Clinical chemistry. 3rd ed. New York: Maplevail press;1996. p.461–83.
Sheikh MH, Sheikh BA, Shah NA. Comparative study on lipid changes in glycemic uncontrolled diabetes type 1 and type 2. J Liaquat Uni Med Health Sci 2009;8(3):201–4.
Välimäki M, Liewendahl K, Nikkanen P, Pelkonen R. Hormonal changes in severely uncontrolled type 1 (insulin-dependent) diabetes mellitus. Scandinavian Journal of Clinical & Laboratory Investigation 1991;51(4):385–93.
Lee Y, Wang MY, Du XQ, Charron MJ, Unger RH. Glucagon receptor knockout prevents insulin-deficient type 1 diabetes in mice. Diabetes 2011;60(2):391–7.
Wahid M, Naveed AK, Mahmood S. Hyperglucagonemia –a potent threat which can worsen diabetes mellitus. Ann King Edward Med Uni 2007;13(4):247–51.
Bays HE, Chapman RH, Grandy S. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. Int J Clin Pract 2007;61(5):737–47.
Sotirakopoulos N, Kalogiannidou I, Tersi M, Armentzioiou K, Sivridis D, Mavromatidis K. Acid-base and electrolyte disorders in patients with diabetes mellitus. Saudi J Kidney Dis Transpl 2012;23(1):58–62.
Elisaf MS, Tsatsoulis AA, Katopodis KP, Siamopoulos KC. Acid-base and electrolyte disturbances in patients with diabetic ketoacidosis. Diabetes Res Clin Pract 1996;34(1):23–7.
Goldman JM, Chiriboga M. Diabetic ketoacidosis with alkalemia. J Emerg Med 1989;7(4):369–72.
Ginsberg H, Plutzky J, Sobel BE. A review of metabolic and cardiovascular effects of oral antidiabetic agents: beyond glucose-level lowering. J Cardiovasc Risk 1999;6:337–46.
Riitta TM. Treatment of Dyslipidemia beyond LDL Cholesterol: DAIS Trial. New Data from Clinical Trials of Lipid Research. Symposium. Program and abstracts of the 61st Scientific Session of the American Diabetes Association 2001, Philadelphia, Pennsylvania.