Pavana A

Abstract

Background: Microalbuminuria is a reversible stage of renal dysfunction and its detection allows early intervention and treatment of diabetic nephropathy. Therefore, a more reliable biomarker is required to diagnose early, reversible stage of renal dysfunction. Aim: To evaluate the utility of urinary transferrin (UTRANS) as an early predictive marker in type II diabetes mellitus (T2DM). Settings and Design: This cross-sectional study included 40 normoalbuminuric and 20 microalbuminuric T2DM patients and 20 clinically healthy controls. Materials and Methods: All baseline characteristics such as glucose (fasting and postprandial), serum creatinine, HbA1c, urinary albumin, creatinine, and UTRANS were estimated. Statistical Analyses: SPSS software version 20, R studio 3.6.2. Shapiro test, Chi-square test, Analysis of variance, Kruskal Wallis, and receiver operating characteristic (ROC). Results: Urinary albumin-to-creatinine ratio and UTRANS showed a significant difference among normoalbuminuric and microalbuminuric T2DM patients compared to controls (P = 0.000). UTRANS and TRANS/creatinine ratio positively correlated in normoalbuminuric, macroalbuminuric and control groups (P < 0>0.9), indicating UTRANS was able to differentiate between healthy controls, normoalbuminuric, and microalbuminuric T2DM subjects. Conclusion: UTRANS may act as a potential biomarker that can be used as an early screening marker for renal injury, even before progression to the stage of microalbuminuria. Keywords: Type 2 diabetes mellitus, Diabetic nephropathies, Albuminuria, Transferrin, Kidney tubules.

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Abstract

Introduction: Prediabetes is an insulin resistant state where blood glucose levels are higher than normal but not high enough to be classified as Diabetes. Lifestyle modifications such as diet and physical exercise can prevent its progression to Type 2 diabetes. The adipose tissue and skeletal muscle are dependent on insulin for glucose uptake. Myostatin is a myokine known to restrict muscle growth by activation of SMAD(homologues of the Drosophila protein, mothers against decapentaplegic (Mad) and the Caenorhabditis elegans protein Sma signaling pathways). Myostatin expression is down regulated by exercise and weight loss. Myostatin levels have been shown to be increased in the causal pathway of acquired insulin resistance associated with physical inactivity. Increased serum Myostatin levels also are seen in cancer and obesity. Objectives: To assess the effect of lifestyle modification on Myostatin levels in patients with pre-diabetes and to correlate the same with insulin resistance. Materials and Methods: After obtaining ethical clearance from Ethics Committee of the Institute, 40 pre-diabetics visiting the Ramaiah Medical Hospital for treatment were included in the study. With their consent, blood samples were drawn for estimation of FBS, Insulin and Myostatin. The patient was advised moderate intensity physical activity comprising of brisk walk for 150 minutes a week for a period of 3 months. They were called for a follow up after 3 months and blood samples were drawn for estimation of FBS, Insulin and Myostatin. Results and Conclusion: Serum Myostatin levels decreased significantly in individuals who exercised (P-value of 0.002) and increased in individuals who did not exercise with a P-value of 0.048. Serum Myostatin appears to be a promising biomarker to objectively assess lifestyle modifications introduced in pre-diabetics. Keywords: Prediabetes, Myostatin, Exercise, Insulin resistance.

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