Serum Gamma Glutamyl Transferase (GGT) Level in Newly Diagnosed Type 2 Diabetes Mellitus patients and Its Correlation with HbA1C Level

Vinothan, A J (2020) Serum Gamma Glutamyl Transferase (GGT) Level in Newly Diagnosed Type 2 Diabetes Mellitus patients and Its Correlation with HbA1C Level. Masters thesis, Madurai Medical College, Madurai.


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BACKGROUND: Serum gamma glutamyl transferase (GGT) which is a simple and reliable marker of liver fat deposition and oxidative stress, leads to hepatic insulin resistance and long term hepatic insulin resistance may lead to type 2diabetes mellitus (DM). The present study was under taken to study the serum GGT levels and its possible associations with serum HbA1C, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C) and high density lipoprotein cholesterol (HDL-D) in type 2 DM. OBJECTIVE: We studied the relationship between HbA1C and Gamma glutamyl transferase and fasting lipid profile during the initial presentation of type 2 diabetes mellitus in our hospital. BASIS OF THE STUDY: Liver is the major site of insulin clearance. It plays a major role in maintaining serum glucose levels, both during fasting and post-prandially. Liver is more important in the pathogenesis of diabetes. High levels of GGT is associated with increased risk of pre-diabetes and T2DM in several observational studies. GGT level is increased in metabolic syndrome and may be an early predictor.How increased liver enzymes are associated with metabolic syndrome and T2DM is unclear. One explanation is metabolic syndrome is characterised by excessive deposition of fat in liver (hepatic steatosis), mainly in the periportal region and increases liver enzymes release. Since fat deposition is closely to obesity and visceral fat deposition, it may be considered as a part of metabolic syndrome. Second mechanism is metabolic syndrome causing hepatitis and raising GGT levels resulting in impaired hepatic and systemic insulin signalling predisposing to pre-diabetes on long run. In short, elevated GGT reflects subclinical inflammation. The loss of direct effect of insulin to suppress hepatic glucose production and glucogenolysis in liver causes an increase in hepatic glucose production. Free fatty acid is the major substrate for triglyceride synthesis by liver. Since GGT has a central role in glutathione homeostasis, increase in GGT level may be a response to oxidative stress. Pancreatic beta cells are vulnerable to oxidative stress as they have relatively low level of reactive oxygen intermediate scavenging enzymes such as superoxide dismutase, catalase, glutathione peroxidase, etc. These patients are more pronefor the insulin resistance and diabetes mellitus. MATERIAL AND METHODS: The study was conducted at Govt. Rajaji Hospital, Madurai from May 2019 to October 2019. The diagnosis of DM was based on WHO criteria. Hundred subjects participated in this study. Fasting sample was collected and fasting blood sugar (FBS), HbA1c, GGT, and lipid parameters were estimated. Serum gamma glutamyl transferase was measured by calorimetric kinetic assay. Fasting blood sugar was measured by glucose oxidase method using automated analyzer. Serum triglycerides, total cholesterol and high density lipoprotein are measured by standard enzymatic procedures and low density lipoprotein by Friedwald equation. HbA1C levels were analysed by HPLC method. Data was analysed using SPSS software. Student’s t test and Pearson correlation was applied for quantitative data. RESULTS: The serum levels of FBS, PPBS, HbA1c, Total cholesterol, TGL, LDL, HDL and VLDL were raised significantly in newly diagnosed patients with elevated HbA1C values than those with less elevated. There was statistically significant (p=0.001) positive correlation between the HbA1C and GGT, Total cholesterol, TGL, LDL and VLDL with GGT. HDL-C was significantly, negatively correlated with GGT. CONCLUSION: There was positive correlation between GGT and HbA1C and TG, TC, LDL-C and VLDL-C, and there was significant negative correlation between HDL and GGT. Hence serum GGT can be used as marker in the pathogenesis and control of type 2 DM patients.

Item Type: Thesis (Masters)
Additional Information: 201711122
Uncontrolled Keywords: HbA1C, Gamma-glutamyl transferase, type 2 diabetes mellitus and fasting lipid profile.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 28 Jan 2021 16:15
Last Modified: 28 Jan 2021 16:15

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