History

Background: Type 2 diabetes is a chronic metabolic illness characterized by insulin resistance and hyperinsulinemia, and affects 90-95% of patients. Trace elements are very small amounts of chemical elements that are present in natural materials and are necessary for the appropriate growth, development, and functioning of the organism. Pyruvate kinase inactivation by glucagon can be reversed by zinc without affecting protein phosphorylation. Copper is a trace but necessary metal that functions as an enzyme cofactor in numerous metabolic processes, and magnesium is the fourth most abundant cation in the human body and the second most abundant intracellular cation. Aim: The aim of the work is to measure and compare serum levels of zinc, copper, and magnesium in order to shed a light on the pathophysiology of the disease. As these trace elements might have a precise role in the pathogenesis and development of this disease. Subjects and Methods: A total of 200 subjects will be enrolled in this study with age range between 35-60 yrs. And BMI category ranging between overweight and obese. The subjects will be divided into two groups of 100 patients and control respectively. Serum sample will be used in the analyses of the following biochemical parameters, trace elements (zinc, copper, and magnesium) measured by atomic absorption technique. Insulin hormone measured by ELISA. Glucose measured spectrophotometrically. Whole blood for HbA1c measured by HPLC technique. Insulin resistance will be calculated semi empirically by the following equation: HOMA-IR (homeostatic model assessment for insulin resistance) = Glucose * insulin / 405 (glucose in mg/dl).  Statistical analysis was done using a case-control study and the ANOVA test to compare the differences in the mean level of numerical data among more than two variables. The association between the study variables was established using Pearson's correlation. Results: When compared to healthy controls, diabetics had significantly higher blood glucose, serum copper mean ± S.D (160.6 ± 6.4 µg/dl), and HbA1c levels (7.8±1.17). Serum levels of zinc, magnesium, where mean ± S.D (43.9 ± 11.6 µg/dl), (1.84 ± 0.17 mg/dl) respectively) and p-value < 0.05 all significantly decreased when comparing diabetics to controls but serum copper increased. In diabetes individuals, there is a highly significant negative correlation between blood zinc, magnesium, and HbA1c. However, there is a positive correlation between serum copper and HbA1c. When comparing insulin levels in patients with type 2 diabetes with the control group, insulin was elevated mean and S.D (18.6 ± 4.1mlU/L) and p-value <0.001. Conclusions: Trace elements are necessary for the human body. The homeostasis of trace elements is necessary for a number of cellular metabolic activities. The homeostasis of trace elements may be disturbed by diabetes mellitus. On the other hand, abnormalities in the metabolism of glucose cause the occurrence of type 2 D.M., and disruption of some trace element status seen in diabetes mellitus may be a contributing factor.