Republic of Yemen
Hadramout University
College of Medicine and Health Sciences
Department of Medical Laboratories Sciences
Evaluation of Serum Zinc and Iron Levels in Yemeni Patients with Prediabetes and
Type 2 Diabetes Mellitus Attending Diabetic Clinic of Ibn-Sina Hospital in Mukalla
Prepared by:
1. Ali Abdullah Masood (Chairman)
2. Sara Salmen Bin Haiwel (Co-chairman)
4th Year ‫ ـــــــــــــــــ‬5th Group
8. Eman Obeed Bin Ageel
9. Fatima Awad Masjedi
3. Abdulraouf Abubaker Alamodi
10. Khaled Mohammed Alrrae
4. Abdulsalam Shafeeq Bafreej
11. Mahboba Mohammed Suleman
5. Aisha Hassan Bin salman
6. Ali Daroesh Ghuzi
7. Ashwaq Saleh Baqendwan
Under supervision:
Dr. Lotfi Saeed Bin Dahman
Associate Professor of Medical Biochemistry
2021 - 2022
12. Nadeer Mohammed Waked
13. Omar Aidah Alamodi
14. Wardah Mohammed Baqitian
1. Diabetes Mellitus
• Diabetes mellitus (DM), namely type 2 diabetes
mellitus (T2DM), constitutes a significant challenge
for health systems worldwide.
• Estimated prevalence of DM in adults worldwide
was 8.3% in 2013 and is expected to increase to
10.1% by 2035
2. Trace Elements
• Trace elements are micronutrients required by the body
to perform its normal functions such as action or
secretion of insulin , chronic excessive or reduced
concentrations of these elements can lead t toxic of
body health and may lead to sever disorder such as
DM, one of these trace elements is zinc (Zn).
Introduction
3. Zinc
•
Zinc (Zn) is an essential part of many enzymes and
is a cofactor in many catalytic activities
• Zinc plays an important role in glucose metabolism, which is
found to enhance insulin sensitivity , Abnormal levels of
serum Zn may contribute to the pathogenesis and some
complications of T2DM.
4. Iron
• Iron (Fe) is important in the synthesis of hemoglobin.
Furthermore, it is necessary in the production of elastin,
collagen, ascorbic acid synthesis and Zn
• It has a role in the development of T2DM through multiple
mechanisms, including in the modulation of insulin
sensitivity, resistance and causes hepatic dysfunction and
oxidative damage to pancreatic cells.
Introduction
• To our knowledge, there are no previous studies examined the
association between these trace elements and T2DM in
Yemeni population. Therefore, the present study was aimed to
evaluate the association between levels of serum Zn and Fe in
adult Yemeni subjects with and without T2DM as well as those
with prediabetes.
Justification
 Zinc and Fe play a role in the pathogenesis of DM. Thus, our
hypothesis suggests that low Zn levels and high Fe levels may
contribute in increased levels of Fasting Blood Glucose (FBG)
and HbA1c in individuals with and without T2DM.
Hypothesis
?
01 What are the differences between levels of
serum Zn and Fe in adult Yemeni subjects with
and without T2DM and prediabetes?
02 What are the associations between levels of
serum Zn and Fe in adult Yemeni subjects with
and without T2DM?
03 What are the associations between levels of
serum Zn and Fe in adult Yemeni subjects with
prediabetes and T2DM?
Research Questions
General Objective
• To evaluate the association between levels of serum Zn and Fe in adult Yemeni
subjects with and without T2DM as well as those with prediabetes.
Specific Objectives:
• To investigate the differences between levels of
serum Zn and Fe among adult Yemeni subjects with
and without T2DM and prediabetes.
• To determine the associations between levels of
serum Zn and Fe among adult Yemeni subjects with
and without T2DM.
• To ascertain the associations between levels of
serum Zn and Fe among adult Yemeni subjects with
prediabetes and T2DM.
Research Objectives
Study Design:
• This was cross-section study
Study Area:
• Diabetic clinic of Ibn-Sina Hospital
Study Population and Method:
• Adult Yemeni patients with T2DM and prediabetes,
aged ≥18 years will be randomly selected.
Exclusion criteria:
• Patients with :
1.
2.
3.
4.
5.
6.
Type 1 Diabetes Mellitus Gestational diabetes mellitus and any other type of diabetes
Co-morbidities such as cardiovascular disease
Zn and Fe supplements
Diagnosed with IDA
Blood transfusions
Peptic ulcer
Research Methodology
Sample Size
• The sample size was 174, 58 for each group of the tree groups
Prediabetes, T2DM and healthy (non-T2DM).
Data Collection
• Data was collected using self-administrated pre-tested
questionnaire.
Blood Sample Collection
• A venous blood sample of ten milliliter (ml) was taken from
each participant, the blood sample was collected by vein
puncture with and without anticoagulant.
Biochemical Measurements:
• Whole blood was used for measuring HbA1c using
cobas c 111, serum sample was used for measuring
Fasting blood glucose (FBG, total cholesterol (TC),
triglycerides (TG) and high-density lipoprotein
cholesterol (HDL-C) concentrations, low-density
lipoprotein cholesterol (LDL-C), Fe, Zn and CRP
using (Mindray BS-240).
• Data was analyzed by using statistical package for social
science (SPSS) (version25). The continuous normal variables
are presented as mean ± standard deviations (SD).
• A multivariate analysis (ANOVA) was used to show the
mean difference between the study groups.
• The Shapiro test was used to analyze the normal
distribution of the variables. Frequencies and percentages
were done for the categorical variables.
Statistical Analysis
• Pearson correlation test was performed with CRP, Zn, Fe, as
the dependent variables.
• Partial correlation test was performed with CRP, Zn,
Fe, as the dependent variables adjusted for BMI.
• The association of healthy subjects, prediabetes
and diabetic patients with high risk factors was
analyzed using Chi-square test.
• The statistical analysis was conducted at a 95%
confidence level. P value<0.05 was considered
statistically significant.
Statistical Analysis
•
Ethical approval was granted by the Ethics Committee of
College of Medicine and Health Sciences, Hadramout
University.
•
Written consent was obtained from each Participant.
•
All date research was kept in secure computers.
•
In addition, the name and any other information that could
directly identify the patients and the materials was
removed.
Ethical Approval
The Association between serum Zinc and Iron Levels with study groups
Zinc
Iron
Zinc P=<0.001
Iron P=<0.001
Results
HEALTHY SUBJECTS
PREDIABETES
T2DM
Anthropometric and biochemical data of the study groups
ALL
Healthy
Prediabetes
T2DM
P-value
Age (years)
44.8±12.9
36.5±8.5
43.4±12.3*
54.8±10.6*$
<0.001
Weight (kg)
71.8±11.5
71.6±12.7
74.9±10.5*#
69.1±10.8
0.024
BMI (kg/m2)
26.9±4.4
26.2±3.8
28.2±4.9*#
26.3±4.2
0.023
FBG (mg/dl)
137.4±61.3
86.6±6.1
115.3±5.6*
Variable
210.4±5.9*$
There was significant difference among study groups for Age, weight,
BMI, FBG, HbA1c, CRP, Fe, Zn.
<0.001
Results
Anthropometric and biochemical data of the study groups
Variable
ALL
Healthy
Prediabetes
T2DM
P-value
HbA1c (%)
7±2.7
4.9±0.31
6.7±0.21**
10.3±2.4*$
<0.001
CRP (mg/L)
2.4±1.9
1.69±1.5
1.95±1.4
3.45±0.86*$
0.039
Iron (mcg/dl)
125.3±35.7
104±27.3
122.4±31.8*
149.6±32.4*$
<0.001
Zinc (ug/dl)
72.2±15.2
85.9±10.2*
72.8±9.4#
57.9±10.6*$
<0.001
On the other hand, no significant difference among study groups for
height, SBP, DBP, TC, TG, HDL-C, and LDL-C found.
Results
Pearson correlation using CRP, iron and zinc as
dependent variables in the combined groups studied:
CRP
Iron
Zinc
P
r
P
r
P
BMI (kg/m2) -0.175*
0.021
-0.054
0.481
-0.023
0.761
SBP (mmHg)
0.159*
0.036
0.083
0.278
-0.013
0.860
FBG (mg/dl)
0.152*
0.045
0.543**
<0.001
-0.735**
<0.001
HbA1c (%)
0.097
0.204
0.553**
<0.001
-0.725
<0.001
TC (mg/dl)
0.182*
0.016
0.072
0.346
-0.013
0.867
TG (mg/dl)
0.216**
0.004
0.104
0.172
-0.106
0.163
Iron (mcg/dl)
0.089
0.242
Zinc (ug/dl)
0.001
0.985
r
-0.455** <0.001
-0.455** <0.001
Results
• Using Pearson correlation analysis, Serum CRP was positively associated with SBP,
FBG, TC, TG and negatively associated with BMI.
• Serum Fe concentration was positively associated with FBG, HbA1c and negatively
associated with Zn
• Serum Zn concentration was negatively associated with FBG and Fe.
• At the same time, no significant difference was found between CRP, iron and
zinc with DBP, HDL-C and LDL-C.
Results
The association of healthy subjects, prediabetes and diabetic patients with high risk factors.
Age as
risk factor
Healthy
Prediabetes
T2DM
χ2
P-vlaue
≤35
29 (61.7%)
16 (34.0%)
2 (4.3%)
73.87
<0.001
36-44
19 (47.5%)
15 (37.5%)
6 (15.0%)
45-55
10 (20.0%)
20 (40.0%)
20 (40.0%)
≥56
0 (0.00%)
7 (18.9%)
30 (81.1%)
Participants ≥56 years significantly had a risk factor for developing T2DM
Results
The association of healthy subjects, prediabetes and diabetic patients with high risk factors.
Healthy
Prediabetes
T2DM
χ2
P-vlaue
Low
0 (0.00%)
3 (27.3%)
8 (72.7%)
15.49
0.017
Moderate
8 (28.6%)
8 (28.6%)
12 (42.9%)
High
21 (42.9%)
12 (24.5%)
16 (32.7%)
Never
29 (33.7%)
35 (40.7%)
Physical activity
as risk factor
22 (25.6%)
Also, participants who did not do any physical activity (never)
significantly had a risk factor to be prediabetes and T2DM
Results
The association of healthy subjects, prediabetes and diabetic patients with high risk factors.
Prediabetes
T2DM
χ2
P-vlaue
Normal weight 24 (42.1%)
9 (15.8%)
24 (42.1%)
12.04
0.017
Overweight
27 (30.3%)
37 (41.6%)
25 (28.1%)
Obese
7 (25.0%)
12 (42.9%)
9 (32.1%)
BMI
as risk factor
Healthy
Furthermore, participants with overweight overweight had
significantly a risk factor to be prediabetes T2DM.
Results
Low Zn level and high Fe contribute increased levels of FBG
and HbA1c in T2DM and prediabetes individuals. However, the
correlation between low Zn level and high Fe requires further
investigations to confirm these finding.
Conclusion
o Further investigations are needed to validate the correlation between low Zn
level and high Fe in prediabetes and T2DM individuals.
o Monitoring prediabetes patients with elevated Fe and low Zn levels is the
crucial step for the reduction incidence of diabetes.
o Do exercise help to lower blood glucose levels.
o Overweight individuals should do exercise to reduce higher
weight and prevent incidence of diabetes.
o Use Zn supplements for patients with prediabetes as
anti-inflammatory agents to reduce risk incidence of diabetes.
Recommendatio
n
Praise Allah who bestowing us with wisdom, power, health,
strength and patience to carry out this study.
We would like to thank our faculty for their encouragement
and facilities which gives us opportunity to achieve this study
especially the dean:
Prof Dr. Samir Yaslam Ba-Othman,
Dr. Lotfi Saeed Bin Dahman.
Our warmest thanks to Diabetic Clinic of Ibn-Sina
Education Hospital, Burj Al-nuwr Laboratories, AlHuda Medical Agency for their help.
Acknowledgment
Thank You