Acta Diabetologica

, Volume 51, Issue 6, pp 991–998 | Cite as

Serum ferritin, diabetes, diabetes control, and insulin resistance

Original Article

Abstract

Aims

The present study aims to investigate the association between serum ferritin and diabetes, diabetes control, and insulin resistance (IR) and examine whether gender is a modifier for these associations in a community-based sample.

Methods

A cross-sectional survey of 8,235 participants was conducted in 2009. Serum ferritin, glucose, hemoglobin A1c (HbA1c), insulin, inflammatory markers, and lipid markers were measured. IR was estimated with a Homeostasis Model Assessment (HOMA-IR) equation. Multiple logistic and linear regression models were applied to evaluate these associations.

Results

The numbers of diabetic patients and non-diabetic participants in the present study were 644 (7.8 %) and 7,591 (92.2 %). After adjusting for multiple confounders, the odds ratios (ORs) and 95 % confidence intervals (CIs) for diabetes were 1.48 (1.31–1.69) in men and 1.43 (1.24–1.65) in women for one-unit increase in log-transformed serum ferritin levels. Likewise, ORs (95 % CIs) for poor diabetes control (HbA1c ≥7.5 %) were 1.58 (1.21–2.05) and 1.37 (1.07–1.77) in men and women, respectively. As for HOMA-IR, the respective betas (P value) for one-unit increase in log-transformed serum ferritin were 0.07 (P < 0.0001) and 0.06 (P < 0.0001) in men and women.

Conclusions

In conclusion, elevated serum ferritin levels were associated with higher risks of diabetes, higher levels of HbA1c, and HOMA-IR independent of several confounders.

Keywords

Ferritin Diabetes Insulin resistance Hemoglobin A1c 

References

  1. 1.
    Wang Y, Mi J, Shan XY, Wang QJ, Ge KY (2007) Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes (Lond) 31:177–188CrossRefGoogle Scholar
  2. 2.
    Xu Y, Wang L, He J, Bi Y, Li M et al (2013) Prevalence and control of diabetes in Chinese adults. JAMA 310:948–959PubMedCrossRefGoogle Scholar
  3. 3.
    Yang W, Lu J, Weng J, Jia W, Ji L et al (2010) Prevalence of diabetes among men and women in China. N Engl J Med 362:1090–1101PubMedCrossRefGoogle Scholar
  4. 4.
    Adams PC (2012) Diabetes: serum ferritin levels and T2DM–are body iron stores elevated? Nat Rev Endocrinol 8:573–575PubMedCrossRefGoogle Scholar
  5. 5.
    Dekker LH, Nicolaou M, van der AD, Busschers WB, Brewster LM et al (2013) Sex differences in the association between serum ferritin and fasting glucose in type 2 diabetes among South Asian Surinamese, African Surinamese, and ethnic Dutch: the population-based SUNSET study. Diabetes Care 36:965–971PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Jung CH, Lee MJ, Hwang JY, Jang JE, Leem J et al (2013) Elevated serum ferritin level is associated with the incident type 2 diabetes in healthy Korean men: a 4 year longitudinal study. PLoS One 8:e75250PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Sun L, Zong G, Pan A, Ye X, Li H et al (2013) Elevated plasma ferritin is associated with increased incidence of type 2 diabetes in middle-aged and elderly Chinese adults. J Nutr 143:1459–1465PubMedCrossRefGoogle Scholar
  8. 8.
    Pham NM, Nanri A, Yi S, Kurotani K, Akter S et al (2013) Serum ferritin is associated with markers of insulin resistance in Japanese men but not in women. Metabolism 62:561–567PubMedCrossRefGoogle Scholar
  9. 9.
    Li J, Wang R, Luo D, Li S, Xiao C (2013) Association between serum ferritin levels and risk of the metabolic syndrome in Chinese adults: a population study. PLoS One 8:e74168PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Park SK, Ryoo JH, Kim MG, Shin JY (2012) Association of serum ferritin and the development of metabolic syndrome in middle-aged Korean men: a 5-year follow-up study. Diabetes Care 35:2521–2526PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Kim MK, Baek KH, Song KH, Kang MI, Choi JH et al (2012) Increased serum ferritin predicts the development of hypertension among middle-aged men. Am J Hypertens 25:492–497PubMedCrossRefGoogle Scholar
  12. 12.
    Bao W, Rong Y, Rong S, Liu L (2012) Dietary iron intake, body iron stores, and the risk of type 2 diabetes: a systematic review and meta-analysis. BMC Med 10:119PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Bd Benoist, Mclean E, Egli I, Cogswell M (eds) (2008) Worldwide prevalence of anaemia 1993–2005. World Health Organization, GenevaGoogle Scholar
  14. 14.
    Mehdi U, Toto RD (2009) Anemia, diabetes, and chronic kidney disease. Diabetes Care 32:1320–1326PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Popkin BM, Du S, Zhai F, Zhang B (2010) Cohort Profile: the China Health and Nutrition Survey–monitoring and understanding socio-economic and health change in China, 1989-2011. Int J Epidemiol 39:1435–1440PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Sun X, Du T, Huo R, Xu L (2014) Hemoglobin A1c as a marker for identifying diabetes and cardiovascular risk factors: the China Health and Nutrition Survey 2009. Acta Diabetol 51:353–360PubMedCrossRefGoogle Scholar
  17. 17.
    Forouhi NG, Harding AH, Allison M, Sandhu MS, Welch A et al (2007) Elevated serum ferritin levels predict new-onset type 2 diabetes: results from the EPIC-Norfolk prospective study. Diabetologia 50:949–956PubMedCrossRefGoogle Scholar
  18. 18.
    Kunutsor SK, Apekey TA, Walley J, Kain K (2013) Ferritin levels and risk of type 2 diabetes mellitus: an updated systematic review and meta-analysis of prospective evidence. Diabetes Metab Res Rev 29:308–318PubMedCrossRefGoogle Scholar
  19. 19.
    Wrede CE, Buettner R, Bollheimer LC, Scholmerich J, Palitzsch KD et al (2006) Association between serum ferritin and the insulin resistance syndrome in a representative population. Eur J Endocrinol 154:333–340PubMedCrossRefGoogle Scholar
  20. 20.
    Jehn ML, Guallar E, Clark JM, Couper D, Duncan BB et al (2007) A prospective study of plasma ferritin level and incident diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Epidemiol 165:1047–1054PubMedCrossRefGoogle Scholar
  21. 21.
    Fumeron F, Pean F, Driss F, Balkau B, Tichet J et al (2006) Ferritin and transferrin are both predictive of the onset of hyperglycemia in men and women over 3 years: the data from an epidemiological study on the Insulin Resistance Syndrome (DESIR) study. Diabetes Care 29:2090–2094PubMedCrossRefGoogle Scholar
  22. 22.
    Gonzalez AS, Guerrero DB, Soto MB, Diaz SP, Martinez-Olmos M et al (2006) Metabolic syndrome, insulin resistance and the inflammation markers C-reactive protein and ferritin. Eur J Clin Nutr 60:802–809PubMedCrossRefGoogle Scholar
  23. 23.
    Sun L, Franco OH, Hu FB, Cai L, Yu Z et al (2008) Ferritin concentrations, metabolic syndrome, and type 2 diabetes in middle-aged and elderly Chinese. J Clin Endocrinol Metab 93:4690–4696PubMedCrossRefGoogle Scholar
  24. 24.
    Chen T, Ren Y, Liu Y, Long Y, Zhang X et al (2010) Serum gamma-glutamyl transferase, ferritin and the risk of type 2 diabetes in women from a Chinese minority. Diabetes Res Clin Pract 90:352–357PubMedCrossRefGoogle Scholar
  25. 25.
    Guo X, Zhou D, An P, Wu Q, Wang H et al (2013) Associations between serum hepcidin, ferritin and Hb concentrations and type 2 diabetes risks in a Han Chinese population. Br J Nutr 110:2180–2185PubMedCrossRefGoogle Scholar
  26. 26.
    Batchuluun B, Matsumata T, Erdenebileg N, Tsagaantsooj G, Boldbaatar K et al (2014) Serum ferritin level is higher in poorly controlled patients with Type 2 diabetes and people without diabetes, aged over 55 years. Diabet Med 31:419–424Google Scholar
  27. 27.
    Kim CH, Kim HK, Bae SJ, Park JY, Lee KU (2011) Association of elevated serum ferritin concentration with insulin resistance and impaired glucose metabolism in Korean men and women. Metabolism 60:414–420PubMedCrossRefGoogle Scholar
  28. 28.
    Yu FJ, Huang MC, Chang WT, Chung HF, Wu CY et al (2012) Increased ferritin concentrations correlate with insulin resistance in female type 2 diabetic patients. Ann Nutr Metab 61:32–40PubMedCrossRefGoogle Scholar
  29. 29.
    Deray G, Heurtier A, Grimaldi A, Launay Vacher V, Isnard Bagnis C (2004) Anemia and diabetes. Am J Nephrol 24:522–526PubMedCrossRefGoogle Scholar
  30. 30.
    Thomas MC, MacIsaac RJ, Tsalamandris C, Power D, Jerums G (2003) Unrecognized anemia in patients with diabetes: a cross-sectional survey. Diabetes Care 26:1164–1169PubMedCrossRefGoogle Scholar
  31. 31.
    Emerit J, Beaumont C, Trivin F (2001) Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother 55:333–339PubMedCrossRefGoogle Scholar
  32. 32.
    Wolff SP (1993) Diabetes mellitus and free radicals. Free radicals, transition metals and oxidative stress in the aetiology of diabetes mellitus and complications. Br Med Bull 49:642–652PubMedGoogle Scholar
  33. 33.
    Messner DJ, Rhieu BH, Kowdley KV (2013) Iron overload causes oxidative stress and impaired insulin signaling in AML-12 hepatocytes. Dig Dis Sci 58:1899–1908PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  1. 1.Institute of Clinical Epidemiology, School of Public HealthFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Key Laboratory of Public Health Safety, School of Public HealthFudan UniversityShanghaiPeople’s Republic of China

Personalised recommendations