A Parametric approach to Correlate the HOMA-IR, glycosylated HbA1c, Insulin and Estrogen with Diabetic Pre and Post-Menopausal women of Hyderabad, Sindh, Pakistan

Abstract

A metabolic disorder called diabetes mellitus (DM) is characterized by persistently high blood sugar, and menopause is the natural termination of the fertile phase after 12 consecutive months without a menstrual cycle. In terms of blood lipoproteins and anthropometric measurements, the risk of cardiovascular disease increases for women at menopause and approaches that of males. The purpose of the current study was to compare Type-II diabetic and non-diabetic women in the pre-and post-menopausal phases in terms of haematological parameters, anthropometric indices, and hepatic parameters.

A comparative cross-sectional study was carried out in association with Liaquat University Hospital Jamshoro, Hyderabad, at the University of Sindh's physiology department in Jamshoro. Group-A (Menstruating Normal), Group-B (Menstruating Diabetic), Group-C (Menopausal Normal), and Group-D (Menopausal Diabetic) were the four groups from a total of 400 recruited ladies. In accordance with the inclusion and exclusion criteria, a convenient random sampling was used to obtain the sample. A pre-structured proforma was used to record information on age, blood pressure, parity, glycemic parameters, serum oestrogen, haematological parameters, liver function tests, and anthropometric parameters. Verbal and written informed consent was obtained if they wished to take part in the study. The haematological parameters were analysed on Celltac Alpha MEK-6500K by Nihon Kohden Germany. A measuring tape and weight machine were used for Anthropometric parameters. LFT and FSG were analysed on a Spectrophotometer (Microlab, Merck) and kit purchased from sigma company. The HbA1C on clover analyser. The oestrogen and insulin were analysed on ELISA assay kits (Fortress Diagnostics). The statistical Package for Social Sciences (SPSS,21.0) was used to analyse the data (IBM, USA). The ANOVA was used to evaluate continuous data, and the findings were provided as mean and standard deviation (SD). Pearson's correlation and Spearman's correlation were used to detecting statistical correlation. The 95% Confidential Interval (CI) cutoff for statistical significance was used (i.e., p 0.05).

In the present research Groups, A, B, C, and D, the mean ages were 44.48 years, 45.02 years, 55.36 years, and 54.89 years, respectively (P<0.001). Compared to menopause and regular menstruating, diabetics have higher systolic and diastolic blood pressure levels. Groups A, B, C, and D's glycated haemoglobin A1 (HbA1c) levels were 4.59(±0.37), 10.62(±2.32), 4.75(±0.37), and 12.70(2.04) %, respectively, with a significant difference of (p=0.0001). Mean HbA1c values ranged from 10.62% in group B, diabetic menstruation women, to 12.07% in group D, diabetic menopausal women. B and D diabetic groups showed higher systolic blood pressure (SBP). Diabetes groups B and D have significantly high mean insulin levels (F value 149.74, P<0.0001). Insulin resistance was observed in diabetes groups B and D. (HOMA-IR). In the diabetic groups B and D, homeostatic insulin resistance (HOMA-IR) was identified. Insulin Resistance (HOMA-IR) was found in group B and group D, which had HOMA-IR values of 1.72 and 1.90 and correspondingly, respectively and group-A and C's HOMA-IR values were 0.61 and 0.19 and 0.72 and 0.26 (F value 120.8, P<0.0001). Mean serum oestrogen levels were reported to be 131.3(±79.75) mg, 103.1(±36.12) mg, 25.48(±18.57) mg, and 15.69(±12.02) mg in Groups A, B, C, and D, respectively (F value 159.35, P=0.0001). In menopause groups C and D, reduced haemoglobin, haematocrit, and red blood cell (RBC) levels are common.

In contrast to the non-diabetic groups A and C, diabetes groups B and D had serum levels of γ-glutamyl transferase (GGT), alkaline phosphatase (ALP), and alanine transaminase (ALT) that were all in the higher range. The mean body weight, BMI, waist-height ratio (WHtR) and waist-hip ratio (WHiR), thigh circumference (TC) and mid-upper arm circumference (MUAC) in Groups A, B, C, and D were found to be significant (P<0.001), whereas neck circumference (NC) was found to be insignificant. A significant correlation was found between Age, glycemic index and insulin resistance.

In present study we concluded that, it was revealed that there was elevated blood pressure, poor glycaemic management, increased insulin resistance, low serum oestrogen, anaemia, and changed liver aminotransferase levels. Body mass index, waist and hip circumferences, waist height to hip circumference ratios, neck and thigh circumferences, mid-upper arm and thigh circumferences, and waist-hip ratios all showed that women in menopause were obese. Menopause and diabetes mellitus, in comparison to women who are in the menstruation phase, have a negative effect on a woman's cardiovascular health, according to the current study.