Document Type : Research Paper

Authors

1 * University Of Al- Anbar - College of Sciences

2 Baghdad University – College of Sciences for Women

3 Al-Mustansiriya University - National Diabetes Center for Treatment and Research

10.37652/juaps.2013.84992

Abstract

Metabolic disorder of multiple causes characterized by chronic hyperglycemia and disorders of carbohydrate, fat, and protein metabolism… that have higher than normal serum creatinine and urea levels .The present study was carried out in patients with T2DM to evaluate the status of vitamin C, uric acid, urea and creatinine in total 51 (Iraqi females) patients and 31 control subjects matched for age, sex and ethnic background.Uric acid, urea and creatinine were measured by using commercially available kits. Serum vitamin C levels were measured by high performance liquid chromatography (HPLC). In type 2 diabetic patients serum creatinine and ureasignificantly elevated(P<0.001[HS]) and (P=0.021[S]) respectively while SUA and serum vitamin C were non significantly and significantly decreased (P=0.09 [NS]) and (P=0.005[S]) respectively as compared to control group.The normal levels of serum creatinine (0.76±0.15.1mg/dl) , urea (26.1±4.6mg/dl),uric acid (4.3±0.6mg/dl), and vitamin C (1.07±0.27mg/dl) recorded for the non-diabetic females were recorded in the diabetic females (0.94±0.17mg/dl); (28.8±5.3mg/dl) ; (4.1±0.7mg/dl ) and(0.92±0.19 mg/ml)for serum creatinine, urea , uric acid and vitamin Crespectively.In conclusion study shows significant increasing in urea and creatinine in type 2 diabetes mellitus patients when compared to control. Low levels of vitamin C and uric acid in diabetic patients indicating to an increased oxidative stress.Vitamin C level trying to fight against oxidative stress.

Keywords

Main Subjects

Padayatty SJ, Katz A, Wang Y, Eck P, Kwon O, Lee JH, et al. (2003) .Vitamin C as an antioxidant: evaluation of its role in disease prevention. J Am Coll Nutr; 22 : 18-35.
[2]. Ting HH, Timimi FK, Boles KS, Creager SHJ, Gans P, Creager MA (1996) .Vitamin C improves endothelium dependent vasodilation in patients with non-insulin dependent diabetes mellitus. J Clin Invest 97: 22-8.
[3].Afkhami-Ardekani M, Vahidi AR, Borjian L, Borjian L (2003). Effect of vitamin C supplement on glycosylated hemoglobin in patients with type 2 diabetes. J Shah Sad Univ 10 : 15-8.
[4].Simom JA (1992). Vitamin C and cardiovascular disease: a review. J Am Coll Nutr 11 : 107-25.
[5]. Ness AR, Khaw KT, Bingham S, Day NE  (1996) .Vitamin C status and serum lipids. Eur J Clin Nutr  50 : 724-9.
[6].Chen MS, Hutchinson ML, Pecoraro RE, Lee WY, Labbe RF (1991) .Hyperglycemic-induced intracellular depletion of ascorbic acid content in adults with insulin-dependent diabetes mellitus consuming adequate dietary vitamin C. Metabolism 40 : 146-9.
[7]. Dyer RG, Stewart MW, Metcheson J, George K, Alberti MM, Laker MF, et al. (1997) .Ketocholesterol, a specific indicator of lipoprotein oxidation and malondialdehyde in non-insulin dependent diabetes and peripheral vascular diasease. Clin Chim Acta 260 : 1-13.
[8]. Evans M, Anderson RA, Smith JC, Khan N, Graham JM, Thomas AW, et al.( 2003) . Effects of insulin lispro and chronic vitamin C therapy on postprandial lipaemia, oxidative stress and endothelial function in patients with type 2 diabetes mellitus. Eur J Clin Invest 33 : 231-8.
[9].Tousoulis D, Antoniades C, Tountas C, Bosinkou E, Kotsopoulou M, Toutouzas P, et al.(2003) .Vitamin C affects thrombosis/fibrinolysis system and reactive hyperemia patients with type 2 diabetes and coronary artery diseases. Diabetes Care 26 : 2749-53.
[10]. Moriarity JT, Folsom AR, Iribarren C, Nieto FJ, Rosamond WD (2000). Serum Uric Acid and Risk of Coronary Heart Disease: Atherosclerosis Risk in Communities (ARIC) Study. Annals of Epid 10(3):136-143.
[11]. So A, Thorens B (2010). Uric acid transport and disease. J. Clin. Invest 120(6):1791-1799.
[12]. Koenig W, Meisinger C (2008). Uric acid, type 2 diabetes, and cardiovascular diseases: Fueling the common soil hypothesis? Clin Chem 54(2):231-233.
[13]. Culleton BF, Larson MG, KannelWB, Levy D (1999). Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 131: 7–13.
[14]. Fang J, Alderman MH (2000). Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992: National Health and Nutrition Examination Survey. JAMA 283:2404–2410.
[15]. Niskanen LK, Laaksonen DE, Nyyssönen K, et al (2004). Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch. Intern. Med 164:1546–1551.
[16]. Chen JH, Chuang SY, Chen HJ, Yeh WT, Pan WH (2009). Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Arthritis .Rheum 61:225–232.
[17]. Ioachimescu AG, Brennan DM, Hoar BM, Kashyap SR,Hoogwerf BJ (2007). Serumuric acid, mortality and glucose control in patients with type 2 diabetes mellitus: a PreCIS database study. Diabet. Med 24 : 1369–1374.
[18]. Zoppini G, Targher G, Negri C, et al (2009). Elevated serum uric acid concentrations. independently predict cardiovascular mortality in type 2 diabetic patients. Diabetes Care 32:1716–1720.
[19]. Lee K (2009). Relationship between uric acid and hepatic statuses among Koreans. Diabetes. Metab 35: 447-51.
[20]. Lee YJ, Lee HR, Lee JH, Shin YH, Shim JY (2010). Association between serum uric acid and non-alcoholic fatty liver disease in Korean adults. Clin. Chem. Lab. Med 48: 175-80.
[21]. Li Y, Xu C, Yu C, Xu L, Miao M (2009). Association of serum uric acid level with non-alcoholic fatty liver disease: a cross-sectional study. J. Hepatol 50: 1029-34.
[22]. Harita N, Hayashi T, Sato KK, Nakamura Y, Yoneda T, Endo G, et al. (2009). Lower of type 2 diabetes: serum creatinine is a new risk factor the Kansai healthcare study. Diabetes Care, 32:424-426.
[23].Tomaszewski M, Charchar FJ, Maric C, McClure J, Crawford L, Grzeszczak W, et al, (2007). Glomerular hyperfiltration: a new marker of metabolic risk. Kidney International 71:816-821.
[24]. Lorenzo C, Nath SD, Hanley AJ, Abboud HE, Gelfond JA, Haffner SM (2009). Risk of type 2 diabetes among individuals with high and low glomerular filtration rates. Diabetologia, 52:1290-1297.
[29]. Mogensen CE (1990). Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? Diabetes 39:761.
[30]. Faber M, Kupin W, Krishna, Narins R(1993). The differential diagnosis of acute renal failure. In Lazarus JM, Brenner BM. Acute renal failure. New York. Churchil Livingstone.: 133-192.
[31]. Bataller R, Arroyo V (2000). Fracaso renal agudo asociado a enfermedades hepáticas. Síndrome hepatorenal. In Liaño F, Pascual J. Fracaso renal agudo. Barcelona. Masson.: 103-125:313-326.
[32]. Musso CG, Giordani C, Stonski E, Peralta M, Bonetto A, Jauregui R, Algranati L (2004). Acute renal failure with normal plasma urea levels: a marker proximal tubular dysfunction with diabetes insipidus. biomed. uninet.edu.
[33]. Simon SR, Majumdar SR, Prosser LA, Salem-Schatz S, Warner C, Kleinman K, Miroshnik I, Soumerai SB (2005). Group versus individual academic detailing to improve the use of antihypertensive medications in pri­mary care: a cluster-randomized controlled trial. Am J Med;118:521–528.
[34]. Peterson KA, Radosevich DM, O’Connor PJ, Nyman JA, Prineas RJ, Smith SA, Arneson TJ, Corbett VA, Weinhandl JC, Lange CJ, Hannan PJ (2008). Improving diabetes care in practice: findings from the TRANSLATE trial. Diabetes Care; 31:2238–2243.
[35]. Krein SL, Klamerus ML, Vijan S, Lee JL, Fitzgerald JT, Pawlow A, Reeves P, Hayward RA (2004). Case management for patients with poorly controlled diabetes: a random­ized trial.  Am. J. Med 116:732–739.
[36]. Roumie CL, Elasy TA, Greevy R, Griffin MR, Liu X, Stone WJ, Wallston KA, Dittus RS, Alvarez V, Cobb J, Speroff T (2006). Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann. Intern. Med 145:165–175.
[37]. Choma NN, Huang RL, Dittus RS, Burnham KE, Roumie CL (2009). Quality improve­ment initiatives improve hypertension care among veterans. Circ. Card. Qual. Outcomes 2:392–398.
[38]. Estrada C, Salanitro A, Safford M, Curry W, Williams J, Ovalle F, Payne-Foster P, Kim Y, Houston T, Allison JA (2010). cluster-randomized trial of a web-based physician intervention to improve diabetes care (Abstract). J. Invest. Med 58:512.
[39]. Huggett AST, Nixon DA (1957). Use of glucose oxidase peroxidase and O-dianisine in the determination of blood and urine glucose. Lancet  2:368 –370.
[40]. Mustafa K  (2004). Simultaneous Determination of Ascorbic Acid and Free Malondialdehyde in Human Serum by HPLC-UV. LCGC ASIA PACIFIC 7-2:36-38.
[41]. American Diabetes Association (2010). Executive summary: standards of medical care in diabetes—2010. Diabetes Care 33 (Suppl. 1):S4–S10,
[42]. Yasunori T, Haruhiko O, Mie K, et al (2008). Hyperresistinemia Is Associated With Coexistence of Hypertension and Type 2 Diabetes. Hypertension  51:534-539.
[43]. Nabil M, Intissar E, Molka C, et al (2007). MTHFR C677T and A1298C gene polymorphisms and
hyperhomocysteinemia as risk factors of diabetic nephropathy in type 2 diabetes patients. Diab. Res. Clin. Prac. 75 :99–106.
[44]. Kramer CK, vonMu D, Jassal SK & E. Barrett-Connor (2010). A prospective study of uric acid by glucose tolerance status and survival: the Rancho Bernardo Study. J. I. Med. 267; 561–566.
[45]. Nehal H EL-Said, Abd El Salam F ,Nagwa A E (2011)Retinol Binding Protein 4 And Insulin Resistance In Egyptian Type 2 Diabetics . Aust. J. Basic & Appl. Sci. 5(10): 265-271
[46]. Morteza A, Yaser J , Arash AN ,et al, (2012) .Urea and Oxidative Stress in Type 2 Diabetes. J. Metab. Synd. 1(2):1-5
[47]. Surapon T, Praparporn P, Orathai T, Viruch S (2009). Serum Levels of Malondialdehyde in Type 2 Diabetes Mellitus Thai Subjects. Siriraj. Med. J. 61(1):20-23.
[48]. Tuomilehto J, Zimmet P, Wolf E, Taylor R, Ram P, King H  (1988). Plasma uric acid level and its association with diabetes mellitus and some biological parameters in a biracial population of Fiji. Am. J. Epidemiol. 127: 321–336.
[49]. Herman J.B, Medalie J.H. (1976). Goldbourt, Diabetes, prediabetes and uricaemia. Diabetologia 12: 47–52.
[50]. Golembiewska E, Ciechanowski K, Safranow K, Kedzierska K, Kabat-Kopersk J (2005). Renal handling of uric acid in patients with type 1 diabetes in relation to glycemic control. Arch. Med. Res. 36 32-35.
[51]. Shabana S, Sireesha M, Satyanaryana U (2012). Uric Acid in Relation to Type 2 Diabetes Mellitus Associated with Hypertension. J. Clin. Diagn. R. 6(7): 1140-1143.
[52]. Beatriz GS, Andreia B, Carisi A et al , (2000). Increased Plasma Levels of Endothelin 1 and von Willebrand Factor in Patients With Type 2 Diabetes and Dyslipidemia . Diabetes Care 23( 9):1395-1400 .
[53]. Hairong N ,Yanhu D, Weiguo G et al , (2006). Diabetes associated with a low serum uric acid level in
a general Chinese population. D. R. Clin.Prac.76 (2007): 68–74
[54]. Gopaul N.K, Manraj M.D, Hebe A, Lee Kwai Yan S, Johnston A, Carrier M.J, et al., (2001). Oxidative stress could precede with impaired glucose metabolism. Diabetologia 44 :706–712.
[55]. D. Konukoglu, E. Dogan, M.S. Turhan, H. Husrev Hatemi, (2003).  Impaired glucose tolerance: its relevance to early endothelial dysfunction, Horm. Metab. Res. 35 607–610.
[56]. K. Nyyssonen, E. Porkkala-Sarataho, J. Kaikkonen, T. Salinen J (1997). Ascorbate and urate are the strongest determinants of plasma antioxidative capacity and serum lipid resistance to oxidation in Finnish men. Atherosclerosis130 :223–233.
[57]. Bankir L, Trinh-Trang-Tan M (2000). Urea and the kidney. In Brenner B, The Kidney. Philadelphia. W.B. Saunders 637-679
[58]. Robertson G, Berl T (2000). Pathophysiology of water metabolism. In Brenner B, The Kidney. Philadelphia. W.B. Saunders 1996: 873-928
[59]. Kunying Z, Li L, Xuyang C, Jie D, Qiuming G , Li Z (2011). Low levels of vitamin C in dialysis patients is associated with decreased prealbumin and increased C-reactive protein. BMC Nephrology 12:18.
[60]. Yoon JW, Pahl MV, Vaziri ND (2007). Spontaneous leukocyte activation and oxygen-free radical generation in end-stage renal disease. Kid. Int 71(2):167-172.
[61]. Carr A, Frei B (2000). The role of natural antioxidants in preserving the biological activity of endothelium-derived nitric oxide. F. R. Biol. Med  28:1806–1814.
[62]. Sinclair AJ, Taylor PB, Lunec J, Girling AJ, Barnett AH (1994). Low plasma ascorbate levels in patients with type 2 diabetes mellitus consuming adequate dietary vitamin C. Diabet. Med11:893–898.
[63]. Bode AM, Yavarow CR, Fry DA, Vargas T (1993). Enzymatic basis for altered ascorbic acid and dehydroascorbic acid levels in diabetes. Biochem. Biophys. Res. Commun 191:1347–1353.
[64]. West IC (2000). Radicals and oxidative stress in diabetes. Diabet Med,17: 171–180.
[65]. Jackson TS, Xu A, Vita JA, Keaney JF (1998). Ascorbate prevents the interaction of superoxide and nitric oxide only at very high physiological concentrations. Circ. Res 83:916–922.
[66]. Grundy SM (1997). Small LDL, atherogenic dyslipidemia, and the metabolic syndrome. Circ 95:1–4.
[67]. Carr AC, Frei B (1999). Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am. J. Clin. Nutr  69:1086–1107.
[68]. Baker TA, Milstien S, Katusic ZS (2001). Effect of vitamin C on the availability of tetrahydrobiopterin in human endothelial cells. J. Card. Pharm 37:333–338.
[69]. Murphy ME (1999). Ascorbate and dehydroascorbate modulate nitric oxideinduced vasodilations of rat coronary arteries. J. Card. Pharm 34:295–303.
[70]. Paolisso G, Balbi V, Volpe C, Varricchio G, Gambardella A, Saccomanno F, Ammendola S, Varricchio M, D’Onofrio F (1995). Metabolic benefits deriving from chronic vitamin C supplementation in aged noninsulin dependent diabetics. J. Am. Coll. Nutr. 14:387–392.
[71]. Hirashima O, Kawano H, Motoyama T, Hirai N, Ohgushi M, Kugiyama K, Ogawa H, Yasue H (2000). Improvement of endothelial function and insulin sensitivity with vitamin C in patients with coronary spastic angina: possible role of reactive oxygen species. J. Am. Coll. Cardiol. 35: 1860–1866.
[72]. Steinberg HO, Brechtel G, Johnson A, Fineberg N, Baron AD (1994). Insulinmediated skeletal muscle vasodilation is nitric oxide dependent: a novel action of insulin to increase nitric oxide release. J. Clin. Invest. 94: 1172–1179.
[73]. International Diabetes Federation and the International Society of Nephrology. Diabetes and Kidney Disease. Time to Act (2003).
[74]. Nnodim , Opara AU (2012). The Plasma Vitamin C and E Status in Type II Diabetes with Malaria in Owerri, Nigeria. Pak. J. Nutr 11 (1): 62-63.
[75]. Jyoti MS, Uchita V, Moulick N (2007). Association Of Poor Glycemic Control With Increased Lipid Peroxidation And Reduced Antioxidant Vitamin Status In Diabetic Neuropathy. I. J. Endo 3 (2):210-216.
[76]. Onyesom I, Agho JE, Osioh H. E (2011). Levels of antioxidant vitamins in newly diagnosed cases of
type 2 diabetes mellitus in South Eastern Nigeria. Afr. J. Pharm. Pharmacol  5(150): 1787-1791.