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Introduction: Urine Albumin Creatinine Ratio (UACR) has been the standard for detecting albuminuria in diabetes mellitus, but the presence of "non albuminuric renal impairment" has encouraged the search for novel markers. Recently, increased serum Ischaemia Modified Albumin (IMA) levels have been implicated in cases of Diabetic Nephropathy (DN). However, its estimation by conventional albumin cobalt assay is confounded by serum albumin levels. Aim: To estimate IMA and albumin-adjusted IMA levels to assess their utility in diagnosing early renal damage in diabetes mellitus. Materials and Methods: This hospital-based cross-sectional study was conducted from March 2014 to January 2015 at Kasturba Medical College, Mangaluru, Karnataka, India. The study included 30 healthy individuals and 60 patients with diabetes mellitus, which were further divided equally into three groups based on UACR. The groups were as follows: normoalbuminuria group (UACR <30 mg/g of creatinine), microalbuminuria group, and macroalbuminuria group (UACR 30-300 and >300 mg/g of creatinine, respectively). Serum IMA levels were estimated using Enzyme-linked Immunosorbent Assay (ELISA), while Glycated Haemoglobin (HbA1c), serum creatinine, urine albumin, and urine creatinine were measured using auto-analysers. Albumin-adjusted IMA values were measured, and correlation assays between IMA and serum albumin concentration were analysed in each group using one-way Analysis of Variance (ANOVA) and Pearson's correlation. Results: In the present study, out of the 60 diabetes mellitus patients, 27 were females and 33 were males, with a mean age of 53±17 years. Among the 30 controls, 14 were females and 16 were males, with a mean age of 51±17.5 years. Serum albumin had a significant negative correlation with IMA in the microalbuminuria (r=-0.4, p<0.01) and macroalbuminuria (r=-0.58, p<0.001) groups. A significant mean difference was found in serum IMA, albumin-adjusted IMA, IMA index, and IMA ratio between the normoalbuminuria group and the other groups. Receiver operating characteristic analysis was used to predict the early stage of nephropathy (albuminuria). High sensitivity and specificity were measured for IMA (97.5% and 78%, respectively) and IMA ratio (97.5% and 76%, respectively) at cut-off percentages of 99 and 24.5, respectively. Conclusion: The IMA ratio has greater diagnostic importance compared to other adjusted IMA values in discriminating diabetic patients with micro- and normoalbuminuria. [ABSTRACT FROM AUTHOR]

Prediabetes is associated with the features of metabolic syndrome and inflammation contributing directly to the pathogenesis of cardiovascular disease (CVD). This study was conducted to explore the utility of interleukin-6 (IL-6) in determining the risk of CVD in prediabetes. It involves estimation of IL-6 & insulin along with its correlation with insulin, fasting plasma glucose (FPG), Insulin resistance (IR) and physical measurements. Eighty subjects were grouped into 40 prediabetes and 40 normoglycemic on the basis of FPG values. The mean insulin, IL-6, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) and anthropometric measurements were found to be significantly higher (P <0.05) in prediabetes group. IL-6 had a significant correlation with fasting insulin (r = -0.413) and HOMA-IR (r = -0.413), but no correlation with FPG (r = -0.227) in the prediabetes group. IL-6 also showed a positive correlation with body mass index BMI(r = -0.339), waist circumference WC (r = -484) and waist-to-hip ratio WHR (r = -0.430). This study concludes that prediabetes is associated with inflammation, increasing the risk of CVD in these individuals. [ABSTRACT FROM AUTHOR]

Thalassemia is a group of disorders characterized by deficient production of the β-globin sub unit of hemoglobin. The mandatory blood transfusions in patients with thalassemia to maintain adequate erythrocyte levels, leads to iron overload. The prevalence of diabetes in patients with thalassemia varies from 6 to 14%. We here by present a known case of thalassemia major in an 18 year old boy. He was diagnosed with thalassemia before the age of one year and is on regular blood transfusion every two weeks since then. The repeated blood transfusion is one of the common causes for haemochromatosis. Iron overload initially leads to glucose abnormalities such as insulin resistance and hyperinsulinemia, which is followed by impaired secretion of insulin. Diagnosed as a case of bronze diabetes, this patient is on insulin therapy for the last two years. Currently the patient is on iron chelation therapy at Kasturba Medical College Hospital, Mangalore, Karnataka, India. [ABSTRACT FROM AUTHOR]

Introduction: Alteration in the glucose homeostasis is still the major cause of morbidity and mortality in the newborns. Intrauterine undernutrition plays an important role in causing adult insulin resistance and diabetes but the exact cause is still unknown., Aim: To estimate the plasma glucose, serum insulin and cortisol levels at birth in newborns at different gestational age., Materials and Methods: The present cross-sectional study conducted from December 2014 to June 2015 included 58 newborns enrolled as per the inclusion criteria and further categorized into Group I (very preterm; n=19; gestational age < 32 weeks), Group II (late preterm; n=20; gestational age between 32-37 weeks) and Group III (full term; n=19; gestational age >37 weeks) newborns. Venous Cord Blood (VCB) was collected and plasma glucose was analysed by GOD-POD (Glucose Oxidase-Peroxidase) method in auto analyser whereas serum insulin and cortisol were analysed by ELISA (Enzyme Linked Immunosorbent Assay). HOMA2-IR (Homeostatic Model Assessment) calculator was used to assess insulin resistance. All parametric data was expressed as mean±SD and analysed using ANOVA with Tukey's as the Post-Hoc test. Correlation analysis was done using Pearson's correlation co-efficient with scatter plot as the graphical representation., Results: Significantly increased insulin and HOMA2-IR levels were found in group I (13.7±4.7μIU/mL and 1.6±0.58 respectively) when compared to group II (8.3±2.9μIU/mL and 0.93±0.2 respectively) and group III (8.3±2.1μIU/mL and 1.03±0.26 respectively). A positive correlation between cortisol levels and gestational age (r = 0.6, n = 58, p < 0.001) and a negative correlation between insulin and gestational age (r = -0.654, n = 58, p < 0.001) was observed in the study population., Conclusion: Increased levels of insulin and HOMA2-IR as seen in the very preterm newborns signify the predisposition of these newborns to development of diabetes in later stages of life. The inverse association of cortisol and insulin with gestational age suggests that cortisol could also be responsible for impaired β cell function and insulin sensitivity.