Zinc and Copper status among Egyptian Type 2 Diabetics and their relationship to glycemic control and micro vascular complications

INTRODUCTION

Diabetes is spreading like an epidemic across the globe, with third world nations with growing economies seeing the most startling increases. The Middle East and North Africa (MENA) area, which has the greatest incidence of adult diabetes, is where this phenomenon is most noticeable.¹

When the current number of 8.2 million people with diabetes doubles to 16.7 million by 2045, Egypt will move up to position 6 on the list of the top 10 nations in terms of this statistic. However, it's possible that Egypt's diabetes prevalence number is understated.²

Diabetes Mellitus (DM) is a metabolic condition that may cause both macro and microvascular issues. It has been discovered that this illness has an impact on the levels of trace elements (TEs), such zinc (Zn) and copper (Cu). Cells are harmed as a result of this metabolic anomaly. Levels of TEs have been shown to be directly correlated with both health and sickness.³

In diabetic rats, Zn supplementation boosted glutathione peroxidase enzyme activity and lowered malondialdehyde and nitric oxide levels, demonstrating Zn's anti-oxidant defense against oxidative stress seen in T2DM. The scientists also noted that consuming Zn enhanced liver functioning and reduced diabetes-related pancreatic tissue damage.⁴

There is contradiction between the results of the different studies searching for the relationship between DM on one hand and Zn and Cu on the other hand. Where the result of one meta-analysis concluded that there is significant decrease in Zn and significant increase in Cu in patients with DM ⁵, there is another study concluded that both Zn and Cu are significantly decreased in patients with DM. ⁶

PATIENTS AND METHODS

A total of a hundred adult Egyptian patients of both sexes (33 males and 67 females) with T2DM, their age ranges between 29 and 73 years, with their duration of suffering From T2DM ≥ 5 years irrespective to their glycemic control or the therapeutic agent(s) being used for that purpose. Exclusion criteria include patients with T1DM, GDM i.e. DM which occur during pregnancy, patients who receive Zn and/or Cu supplementation or replacement for any reason, patients with history of bariatric surgery or any mal-absorption disorder; e.g. coeliac disease, IBD, etc, patients with any acute inflammatory conditions; e.g.  Sepsis, collagen vascular diseases, etc, and finally, patients with chronic illnesses; e.g. chronic liver disease, chronic end stage kidney disease on renal replacement therapy (chronic peritoneal dialysis or hemodialysis), etc.

All procedures of this study were following Al-Azhar University committee regulations and standards.

Biochemical parameters: All participants were submitted to thorough medical history taking and physical examination focusing on optic fundi assessment for diabetic retinopathy and its grading using direct ophthalmoscope as well as laboratory tests including serum Cu level, serum Zn level, FPG and 2HPPPG levels, HbA1c, Serum creatinine and serum urea.

All samples (about 5 mL each) were collected using disposable syringes and were kept in the suitable tube for each test.

Samples for serum Zn and Serum Cu were collected in plain tubes, then after being left to clot for 30 minutes at room temperature, the serum was obtained by performing a 4,000×g centrifugation.

Colorimetric method was used for measuring levels of both serum Zn (with 5-Bromo-PAPS method) and Serum Cu (Dibrom PAESA method) and were measured using the auto analyzer (Biotecnica BT1500 via Licenza, 18, 00156 Roma RM, Italy). 

Statistical analysis: The Statistical Package of Social Sciences (SPSS), version 25, was used to examine the data employing Pearson Correlation.  

RESULTS

Table 1: showing the variation of the age of the participants, where 1 participant only was in the second decade of life, 9 patients in the third decade of life, 26 participants were in the fourth decade of life, 32 participants were in the fifth decade of life, 31 participants were in the sixth decade of life and 1 participant only was in the seventh decade of life.

Table 2: showing the duration of suffering from T2DM among the patients of the study where 80 patients suffered from T2DM for 5-10 years, 12 patients suffered from T2DM for 11-15 years, 4 patients suffered from T2DM for 16-20 years, 1 patient suffered from T2DM for 21-25 years, 2 patients suffered from T2DM for 26-30 years, 1 patient suffered from T2DM for 31-35 years.

*. Correlation is significant at the 0.05 level (1-tailed).

Table 3: correlation between serum Cu and glycemic control evidenced by HbA1c level. There is a significant correlation at the 0.05 level.

Table 4: correlation between serum Zn and glycemic control evidenced by HbA1c level. It was noted that there is no significant correlation.

Table 5: correlation between serum Cu and DR. It was noted that there is no significant correlation.

Table 6: correlation between serum Zn and DR. It was noted that there is no significant correlation.