A study on the prevalence of hypoalbuminemia in the hospitalized type 2 diabetes mellitus patients with acute hyperglycemia and its correlation with the risk to ketosis in these patients
Keywords:Diabetic ketoacidosis, Hypoalbuminemia, Ketonuria, Type II diabetes mellitus
Background: Diabetes mellitus is a chronic metabolic disorder that diminishes the quality and life expectancy of the patients by impacting a significant morbidity and mortality due to its associated complications. Diabetic ketoacidosis is considered as one such acute life-threatening complication of diabetes that is considered a medical emergency.
Methods: The study was conducted as a retrospective analysis of 65 patients diagnosed as Type 2 diabetes mellitus as per the criteria of American Diabetes Association 2019 were included in the study. After the ethical clearance, the study was conducted at the Employment State Insurance Corporation Hospital and Post Graduate Institute of Medical Science and Research, Chennai over a period of 6 months from October 2019 to March 2020. A statistical analysis was done and all the calculations were based on two-sided hypothesis with p<0.05 interpreted as significant.
Results: The analysis of the study showed there was a significant prevalence of hypoalbuminemia (37%) among the patients with diabetes admitted with acute hyperglycemia. The occurrence of ketonuria among those patients with hypoalbuminemia were 62.5% [odds ratio (OR): 3.15, p value: 0.02].
Conclusions: From the study, serum albumin levels has an inverse correlation in patients with acute hyperglycemia. Furthermore, low serum albumin harbingers the risk to ketosis in patients admitted with acute hyperglycemia thereby mirroring the relative insulin deficiency in these patients. Serum albumin can be used by the treating physician as a cost-effective tool and a marker for insulin reserve of the beta cell in an individual admitted with acute hyperglycemia, it can be used as a reliable indicator to identify those at risk to ketosis thereby to prevent and treat the dreaded diabetes related complications.
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study: methodological details. J Diabetes Sci Technol. 2011;5(4):906-14.
Kao Y, Hsu CC, Weng SF, Lin HJ, Wang JJ, Su SB, Huang CC, Guo HR. Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study. Endocrine. 2016;51(1):72-82.
Karthikeyan J, Rajaragupathy S. Diagnostic Usefulness of Serum Albumin as a Predictor of Diabetic Ketoacidosis. Indian J Crit Care Med. 2018;22(10):733-6.
Bhat S, Jagadeeshaprasad MG, Venkatasubramani V, Kulkarni MJ. Abundance matters: role of albumin in diabetes, a proteomics perspective. Expert Rev Proteomics. 2017;14(8):677-89.
Pickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care. 2004;27(3):813-23.
Sakuma K, Ohyama T, Sogawa K, Fujii KY, Matsumura Y. Low protein-high energy diet induces repressed transcription of albumin mRNA in rat liver. J Nutr. 1987;117(6):1141-8.
Kimball SR, Horetsky RL, Jefferson LS. Hormonal regulation of albumin gene expression in primary cultures of rat hepatocytes. Am J Physiol. 1995;268(1):6-14.
Chen Q, Lu M, Monks BR, Birnbaum MJ. Insulin Is Required to Maintain Albumin Expression by Inhibiting Forkhead Box O1 Protein. J Biol Chem. 2016;291(5):2371-8.
Flaim KE, Hutson SM, Lloyd CE, Taylor JM, Shiman R, Jefferson LS. Direct effect of insulin on albumin gene expression in primary cultures of rat hepatocytes. Am J Physiol. 1985;249(5):447-53.
Vincent JL, Russell JA, Jacob M, Martin G, Guidet B, Wernerman J, et al. Albumin administration in the acutely ill: what is new and where next? Crit Care. 2014;18(4):231.
Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. Br J Anaesth. 2000;85(4):599-610.
Tessari P, Kiwanuka E, Millioni R, Vettore M, Puricelli L, Zanetti M, et al. Albumin and fibrinogen synthesis and insulin effect in type 2 diabetic patients with normoalbuminuria. Diabetes Care. 2006;29(2):323-8.
Cheng PC, Hsu SR, Cheng YC. Association between Serum Albumin Concentration and Ketosis Risk in Hospitalized Individuals with Type 2 Diabetes Mellitus. J Diabetes Res. 2016;1269706.
American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(1):13-28.
Newton CA, Raskin P. Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences. Arch Intern Med. 2004;164(17):1925-31.
Nordstrom A, Hadrevi J, Olsson T, Franks PW, Nordstrom P. Higher Prevalence of Type 2 Diabetes in Men Than in Women Is Associated With Differences in Visceral Fat Mass. J Clin Endocrinol Metab. 2016;101(10):3740-6.
Feo P, Gaisano MG, Haymond MW. Differential effects of insulin deficiency on albumin and fibrinogen synthesis in humans. J Clin Invest. 1991;88(3):833-40.
Leibowitz G, Kaiser N, Cerasi E. β-Cell failure in type 2 diabetes. J Diabetes Investig. 2011;2(2):82-91.
Vetter SW. Glycated Serum Albumin and AGE Receptors. Adv Clin Chem. 2015;72:205-75.
Neelofar K, Ahmad J. An overview of in vitro and in vivo glycation of albumin: a potential disease marker in diabetes mellitus. Glycoconj J. 2017;34(5):575-84.
Bhonsle HS, Korwar AM, Kote SS, Golegaonkar SB, Chougale AD, Shaik ML, et al. Low plasma albumin levels are associated with increased plasma protein glycation and HbA1c in diabetes. J Proteome Res. 2012;11(2):1391-6.