Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity

  • Meena Verma
  • Sangeeta Paneri
  • Preetha Badi
  • P. G. Raman


Non-insulin dependent diabetes mellitus (NIDDM) is the most rapidly growing chronic metabolic disorder in the world. With advancement in the age and duration of diabetes there is a gradual tendency for the level of blood sugar to rise along with a subsequent increase in the HbA1c as well as in the fasting insulin level. Whether this is an aging process or increased frequency of diabetes is still controversial. The correlation between glucose and insulin sensitivity is consistent with the idea that the degree of chronic hyperglycemia is a cause of excessive insulin resistance in type 2 diabetes, i.e. the insulin resistance which characterizes type 2 diabetes but not nondiabetic subjects matched for age, gender, family history and duration of diabetes. The study comprised a total of 76 subjects out of which 30 were normal, non-diabetic persons and the rest 46 were diabetics with different duration of time in years, after being diagnosed diabetic. Data was analyzed after dividing the subjects into four groups—Group 1 comprised of one year old diabetics, Group 2 was made up of those, who had diabetes, for the past 2–5 years, Group 3 included patients who were diabetic since more than 5 years and Group 4 included non-diabetics as the normal control group. The results obtained indicated that the HbA1c levels showed a significant increase with the duration of diabetes as well as the insulin level showed a significant correlation after adjustment for age, sex and duration of diabetes.

Key words

Glycation HbA1c Insulin Resistance Fasting Blood Glucose Post Prandial Blood Glucose 


  1. 1.
    The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. (1995); 44: 968–983.Google Scholar
  2. 2.
    Stratton, I.M., Adler, A.I., Neil, H.A.et al. (2002). Association of glycemia with macrovascular and microvascular complications of type 2 diabetes, (UKPDS 35) prospective observational study. BMJ 321, 405–412.CrossRefGoogle Scholar
  3. 3.
    Burm, H.F., Haney, D.N., Grabbay, K.H.et al. (1975). Further identification of the nature and the linkage of the carbohydrates in hemoglobin Alc Biochem. Biophys. Res. Comm. 67, 103–109.CrossRefGoogle Scholar
  4. 4.
    Rahbar, S. (1968). An abnormal hemoglobin in red cells of diabetics. Clin. Chim. Acta. 22, 296–298.CrossRefGoogle Scholar
  5. 5.
    Trivelli, L.A., Ranney, H.M. and Lai, H-T. (1971). Hemoglobin components in patients with diabetes mellitus. N. Engl. J. Med. 284, 353–357.PubMedGoogle Scholar
  6. 6.
    Arnetz, B.B., Kallner, A. and Theorell, T. (1982). The influence of aging on HbA1c. J. Gerontol. 37, 648–650.PubMedGoogle Scholar
  7. 7.
    Kilpatrick, E.S., Dominiczak, M.H. and Small, M. (1996). The effects of aging on glycation and the interpretation of glycemic control in type 2 diabetes. Q.J. Med. 89, 307–312.Google Scholar
  8. 8.
    Kabadi, U.M. (1998). Glycosylation of proteins. Lack of influence on aging. Diabetes Care 11, 421–432.Google Scholar
  9. 9.
    Defronzo, R.A., Bonadonna, R.C. and Ferrannini, E. (1992). Pathogenesis of NIDDM: A balanced overview. Diabetes Care, 15 (3), 318–368.PubMedCrossRefGoogle Scholar
  10. 10.
    Mykkanen, L., Zaccaro, D.J., Hales, C.N., Festa, A. and Haffner, S.M. (1999). The relation of proinsulin and insulin to insulin sensitivity and acute insulin response in subjects with newly diagnosed type 2 diabetes: The Insulin Resistance Atherosclerosis Study. Diabetologia 42 (9), 1060–1066.PubMedCrossRefGoogle Scholar
  11. 11.
    The expert committee on the diagnosis and classification of diabetes mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care (1997), 10, 1183–1197.Google Scholar
  12. 12.
    David, M. and Nathan, M.D. (2002). Initial management of glycemia in type 2 diabetes mellitus. NEJM 347 (17), 1342–1349.CrossRefGoogle Scholar
  13. 13.
    Rao, G.M., Morghom, L.O., Abukhris, A.A., Mansori, S.S., Alphgih, F.A. and Ragale, L.Y. (1986). HbA1c and blood glucose levels in Libyan diabetic patients. Trop. Geogr. Med. 38 (4), 391–397.PubMedGoogle Scholar
  14. 14.
    Shera, A.S., Jawad, F., Maqsood, A., Jamal, S., Azfar, M. and Ahmed, U. (2004). Prevalence of chronic complications and associated factors in type 2 diabetes. J. Pak. Med. Assoc. 54 (2), 54–59.PubMedGoogle Scholar
  15. 15.
    Sampson, M.J., Hughes, D.A., Carrier, M.J. and Davies, I.R. (2002). Status of HbA1c during acute hyperglycemia in type 2 diabetes. Diabetes care 25, 537–541.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosetti, L., Giaccari, A. and Defronzo, R. (1990) Glucose toxicity. Diabetes care 13, 610–630.CrossRefGoogle Scholar
  17. 17.
    Yki-Jarvinen, H. (1992). Glucose toxicity. Endocr Rev. 13, 415–431.PubMedCrossRefGoogle Scholar
  18. 18.
    Mandarino, L., Baker, B., Rizza, R., Genest, J. and Gerich, J. (1984). Infusion of insulin repairs human adipocyte, glucose metabolism in vitro without decreasing adipocyte insulin receptor binding. Diabetologia 27, 358–363.PubMedCrossRefGoogle Scholar
  19. 19.
    Mathews, D., Hosker, J. and Naylor, B. (1985). Insulin resistance and beta-cell functioning from fasting plasma glucose and insulin concentration in man. Diabetologia 28, 412–419.CrossRefGoogle Scholar
  20. 20.
    Reaven, G. (1995). Pathophysiology of insulin resistance in human disease. Physiol. Rev. 75, 473–486.PubMedGoogle Scholar
  21. 21.
    Meneilly, G.S. and Tessier, D. (1995). Diabetes in the elderly. Diabet. Med. 12, 949–960.PubMedCrossRefGoogle Scholar
  22. 22.
    Evans, J.L. and Goldfine, I.D. (2002). Glucose Status in Postmenopausal women. Endocr. Rev. 23, 599–622.PubMedCrossRefGoogle Scholar
  23. 23.
    Mayumi, O., Seiji, N., Yoko, I., Eiko, Y.et al. (2003). Effects of Post-menopausal Hormone Replacement Therapy on HbA1c levels. Diabetes care 26, 1088–1092.CrossRefGoogle Scholar
  24. 24.
    Clark, C.M. Jr. and Vinicor, F. (1996). Introduction: Risks of benefits of intensive management in NIDDM. The Fifth Regenstrief. Conference. Ann. Intern. Med. 124, 81–85.Google Scholar
  25. 25.
    Colwell, J.A. (1996). The feasibility of intensive insulin management in NIDDM: Implications of the Veterans Affairs Cooperative Study on Glycemic Control and complications in NIDDM. Ann. Intern. Med. 124, 131–135.PubMedGoogle Scholar
  26. 26.
    Kitabchi, A.E. and Bryer Ash, M. (1997). NIDDM: New aspects of management. Hosp. Pract. 32, 135–164.Google Scholar
  27. 27.
    Gloria-Botthini, F., Antonacci, E., Bottini, N., Ogana, A., Borgiani, P., De Santis, G. and Lucarini, N. (2000). Rh blood groups and diabetic disorders: Is there an effect on glycosylated hemoglobin level? Hum. Biol. 72 (2), 287–294.Google Scholar

Copyright information

© Association of Clinical Biochemists of India 2006

Authors and Affiliations

  • Meena Verma
    • 1
  • Sangeeta Paneri
    • 1
  • Preetha Badi
    • 1
  • P. G. Raman
    • 2
  1. 1.Dept. of BiochemistryM.G.M. Medical CollegeIndoreIndia
  2. 2.Department MedicineM.G.M. Medical CollegeIndore

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