Correlation between Serum Ferritin levels and HBA1c in Type 2 Diabetes Mellitus

REVIEW ARTICLE

https://meditropics.com/748-2/

Aditya S Agarwal*

*Postgraduate resident, Lady Hardinge Medical college, New Delhi

INTRODUCTION

The explosive increase of diabetic population worldwide is a major public health concern both in developing and developed countries. The most common form of diabetes in the world is type 2 diabetes mellitus, affecting 85-90% of all people with diabetes1.

The pathogenesis of type 2 diabetes mellitus is not fully understood as multiple factors appear to be involved. One of these factors may be an excessive absorption and storage of dietary iron2. Increased body iron store has been emerging as putative risk factor for development of insulin resistance and cardiovascular diseases (CVD)3. The nature of the association between abnormal iron storage and the development of type 2 diabetes among individuals without haemochromatosis remains uncertain4.

There is a link between development of diabetes and iron overload. Increased serum ferritin, reflecting body iron overload, is often associated with measures of insulin resistance, such as elevated blood glucose and insulin levels.5

The mechanism for the association between serum ferritin and type 2 diabetes mellitus is not clear yet, but iron deposition in the liver may cause insulin resistance by interfering the ability of insulin to suppress hepatic glucose production, and also by tissue damaging as a result of changing membrane properties by free radicals which are formed by auto-oxidation of iron.1

Glycemic status improvement was seen in the patients when the decrement in body iron stores by phlebotomies was performed. Hence, this provides an insight that diabetes mellitus can be a secondary and reversible manifestation of iron overload.6

Raised Serum Ferritin may possibly be related to the occurrence of long-term complications of diabetes, both micro vascular and macro vascular.7,8 

DISCUSSION

Multiple studies conducted worldwide have shown an association between development of insulin resistance and body iron stores. The level of serum ferritin has been found to be elevated in patients with diabetes and it has also shown an association with complications of diabetes.

In a study conducted at Jadarda university in Jordan in April 2021, by Saad AL-Fawaeir et al1, the mean serum ferritin was found to be significantly higher in patients group (213.87±114.23 ng/ml) than control group (98.34±18.45 ng/ml, P < 0.05). There was a positive association between serum ferritin and FBS and HbA1C . A study conducted at Trivandrum9, in February 2013, showed that serum ferritin levels had a positive correlation with FBS and HbA1C. This reflected the relation between serum ferritin and glycemic control, both short term and long term. They confirmed in their studies that poorly controlled diabetes patients had hyper-ferritinemia. This showed that serum ferritin was increased in diabetes as long as glycemic control was not achieved. They also found a correlation between ferritin level and diabetic retinopathy. In diabetic subjects, a positive correlation between increased serum ferritin and poor glycemic control, reflected by higher HbA1C, has been suggested by them.

A systematic review and metanalysis done at the University of Cambridge, Cambridge10 ,UK in May 2013, by Kunutsor SK et al concluded that elevated levels of serum ferritin may help identify individuals at high risk of T2diabetes mellitus. In a prospective study conducted by N.G. Forouhi et al4, they found a strong association between clinically raised ferritin, below the range indicative of clinical haemochromatosis, and development of incident diabetes. The risk was elevated sevenfold in the clinically raised ferritin group compared with the lowest ferritin category. This striking association is of potential importance in understanding the etiology of type 2 diabetes.

In a study done by K Dubey et al11, mean serum ferritin levels were significantly higher in patients having microalbuminuria as against patients having normal urinary albumin- creatinine ratio. Patients having poor glycemic control had higher ferritin levels. There was a near-significant association between serum ferritin and triglyceride levels. Patients having microalbuminuria had a higher prevalence of diabetic retinopathy and higher triglyceride levels. They concluded that ferritin can act as a marker of diabetic nephropathy, poor glycemic control and dyslipidemia in type 2 diabetic patients and programs to prevent complications of diabetes would be more effective by placing greater emphasis on patients having higher ferritin levels.

 CONCLUSION

Serum ferritin, a reflector of body iron stores was significantly higher in diabetic patients when compared to controls and this significantly increased as duration of diabetes increased.

Increased body iron stores are possibly associated with occurrence of glucose intolerance, type-2 diabetes and gestational diabetes.

Serum Ferritin had a positive correlation with FBS and HbA1c. This reflected the relation between serum ferritin and glycaemic control, both short term and long term.

REFERENCES

  1. AL-Fawaeir S, Daradka HM, Siyam AAA. Study of the association between serum ferritin levels and HbA1c in patient with type 2 diabetes mellitus in Jordanian population sample. J Pharm Res Int. 2021;33(33B):1–5.
  2. Dymock IW, Cassar J, Pyke DA, Oakley WG, Williams R. Observations on the pathogenesis, complications and treatment of diabetes in 115 cases of haemochromatosis. J. Med. 1972;52(2):203-10.
  3. Bozzini C, Girelli D, Olivieri O, Martinelli N, Bassi A, De Matteis G et al. Prevalence of body iron excess in the metabolic syndrome. Diabetes care. 2005;28(8):2061-3.
  4. Forouhi NG, Harding AH, Allison M, Sandhu MS, Welch A, Luben R et al. Elevated serum ferritin levels predict new-onset type 2 diabetes: results from the EPIC-Norfolk prospective study. Diabetologia. 2007;50(5):949-56.
  5. Jiang R, Manson JE, Meigs JB, Ma J, Rifai N, Hu FB. Body iron stores in relation to risk of type 2 diabetes in apparently healthy women. Jama. 2004;291(6):711-7.
  6. Houschyar KS, Lüdtke R, Dobos GJ, Kalus U, Broecker-Preuss M, Rampp T et al. Effects of phlebotomy-induced reduction of body iron stores on metabolic syndrome: results from a randomized clinical trial. BMC Med. 2012;10(1):1-8.
  7. Kim NH, Oh JH, Choi KM, Kim YH, Baik SH, Choi DS et al. Serum ferritin in healthy subjects and type 2 diabetic patients. Yonsei Med. J. 2000;41(3):387-92.
  8. Eshed I, Elis A, Lishner M. Plasma ferritin and type 2 diabetes mellitus: a critical review. Res. 2001;27(1-2):91-7.
  9. Raj S, Rajan GV. Correlation between elevated serum ferritin and HbA1C in type 2 diabetes mellitus. Int J Res Med Sci. 2013;1(1):12-5.
  10. Kunutsor SK, Apekey TA, Walley J, Kain K. Ferritin levels and risk of type 2 diabetes mellitus: an updated systematic review and meta‐analysis of prospective evidence. Diabetes Metab. Res. Rev. 2013;29(4):308-18
  11. Dubey K, Usman K, Chaudhary SC, Sawlani KK, Verma SK, Ali W. Association of Serum Ferritin Levels with Microalbuminuria, Glycemic Control and Dyslipidemia. J Assoc Physicians India. 2022;70(4):11-2.