Abstract
Ischemia-modified albumin (IMA) levels have been advocated as a biomarker for evaluating the oxidative stress status. No data are showed on the potential role of IMA in type 1 diabetes (T1D). We aimed to establish the correlation among serum levels of IMA, C-reactive protein (CRP), and diabetic ketoacidosis (DKA) in patients with T1D. Fifty-seven patients with T1D, 27 patients with DKA, and 40 controls were enrolled. Serum IMA and CRP levels were measured and evaluated to distinguish from DKA. CRP and IMA levels were significantly elevated in patients with DKA at admission to the hospital compared to non-DKA and control subjects. CRP and IMA levels were higher in non-DKA patients than in controls. CRP, plasma glucose, and IMA levels were reduced after insulin treatment. Serum IMA levels were an independent risk marker for DKA (OR = 1.225, p = 0.002, 95 % CI: 1.076–1.394). Receiver operating characteristic curve analyses showed no difference in the areas under curve for serum IMA and CRP values. This study indicates that IMA and CRP levels were significantly correlated with DKA diagnosis. IMA can act as a biomarker that reflects the presence of DKA.
Similar content being viewed by others
References
A. Gunduz, S. Turedi, A. Mentese, V. Altunayoglu, I. Turan, S.C. Karahan, M. Topbas, M. Aydin, I. Eraydin, B. Akcan, Ischemia-modified albumin levels in cerebrovascular accidents. Am. J. Emerg. Med. 26, 874–878 (2008)
S.G. Ma, W. Xu, C.L. Wei, X.J. Wu, B. Hong, Z.J. Wang, H.R. Hao, H.Q. Guo, Role of ischemia-modified albumin and total homocysteine in estimating symptomatic lacunar infarction in type 2 diabetic patients. Clin. Biochem. 44, 1299–1303 (2011)
S. Turedi, O. Cinar, I. Yavuz, A. Mentese, A. Gunduz, S.C. Karahan, M. Topbas, E. Cevik, A.O. Yildirim, A. Uzun, U. Kaldirim, Differences in ischemia-modified albumin levels between end stage renal disease patients and the normal population. J. Nephrol. 23, 335–340 (2010)
C.Y. Chen, W.L. Tsai, P.J. Lin, S.C. Shiesh, The value of serum ischemia-modified albumin for assessing liver function in patients with chronic liver disease. Clin. Chem. Lab. Med. 49, 1817–1821 (2011)
S.G. Ma, C.L. Wei, B. Hong, W.N. Yu, Ischemia-modified albumin in type 2 diabetic patients with and without peripheral arterial disease. Clinics (Sao Paulo). 66, 1677–1680 (2011)
Y. Iwasaki, Y. Hamamoto, Y. Kawasaki, H. Ikeda, S. Honjo, Y. Wada, H. Koshiyama, Japanese cases of acute onset diabetic ketosis without acidosis in the absence of glutamic acid decarboxylase autoantibody. Endocrine 37, 286–288 (2010)
J. Wolfsdorf, M.E. Craig, D. Daneman, D. Dunger, J. Edge, W.R. Lee, A. Rosenbloom, M.A. Sperling, R. Hanas, International society for pediatric and adolescent diabetes. Diabetic ketoacidosis. Pediatr. Diabetes. 8, 28–43 (2007)
R.R. Dalton, W.H. Hoffman, G.G. Passmore, S.L. Martin, Plasma C-reactive protein levels in severe diabetic ketoacidosis. Ann. Clin. Lab. Sci. 33, 435–442 (2003)
W.H. Hoffman, C.L. Burek, J.L. Waller, L.E. Fisher, M. Khichi, L.B. Mellick, Cytokine response to diabetic ketoacidosis and its treatment. Clin. Immunol. 108, 175–181 (2003)
C. Gabay, I. Kushner, Acute-phase proteins and other systemic responses to inflammation. N. Engl. J. Med. 340, 448–454 (1999)
K. Ukinc, S. Eminagaoglu, H.O. Ersoz, C. Erem, C. Karahan, A.B. Hacihasanoglu, M. Kocak, A novel indicator of widespread endothelial damage and ischemia in diabetic patients: ischemia-modified albumin. Endocrine 36, 425–432 (2009)
A. Piwowar, M. Knapik-Kordecka, M. Warwas, Comparison of the usefulness of plasma levels of oxidatively modified forms of albumin in estimating kidney dysfunction in diabetic patients. Clin. Invest. Med. 33, E109 (2010)
A. Turk, I. Nuhoglu, A. Mentese, S.C. Karahan, H. Erdol, C. Erem, The relationship between diabetic retinopathy and serum levels of ischemia-modified albumin and malondialdehyde. Retina 31, 602–608 (2011)
W. Wei, Q. Liu, Y. Tan, L. Liu, X. Li, L. Cai, Oxidative stress, diabetes, and diabetic complications. Hemoglobin 33, 370–377 (2009)
M.C. Vantyghem, M. Balduyck, F. Zerimech, A. Martin, C. Douillard, S. Bans, P.M. Degand, J. Lefebvre, Oxidative markers in diabetic ketoacidosis. J. Endocrinol. Invest. 23, 732–736 (2000)
F.B. Stentz, G.E. Umpierrez, R. Cuervo, A.E. Kitabchi, Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Diabetes 53, 2079–2086 (2004)
A. Piwowar, M. Knapik-Kordecka, M. Warwas, Ischemia-modified albumin level in type 2 diabetes mellitus—Preliminary report. Dis. Markers 24, 311–317 (2008)
A.B. Erbagci, M. Tarakcioglu, Y. Coskun, E. Sivasli, E. Sibel Namiduru, Mediators of inflammation in children with type I diabetes mellitus: cytokines in type I diabetic children. Clin. Biochem. 34, 645–650 (2001)
A. Viardot, S.T. Grey, F. Mackay, D. Chisholm, Potential antiinflammatory role of insulin via the preferential polarization of effector T cells toward a T helper 2 phenotype. Endocrinology 148, 346–353 (2007)
M. Firoozrai, M. Nourbakhsh, M. Razzaghy-Azar, Erythrocyte susceptibility to oxidative stress and antioxidant status in patients with type 1 diabetes. Diabetes Res. Clin. Pract. 77, 427–432 (2007)
M. Krzystek-Korpacka, B. Salmonowicz, D. Boehm, I. Berdowska, B. Zielinski, E. Patryn, A. Noczynska, A. Gamian, Diagnostic potential of oxidative stress markers in children and adolescents with type 1 diabetes. Clin. Biochem. 41, 48–55 (2008)
Z. Rasheed, H.A. Al-Shobaili, A.A. Alzolibani, M. Ismail Khan, M. Tariq Ayub, M.I. Khan et al., Immunological functions of oxidized human immunoglobulin G in type 1 diabetes mellitus: its potential role in diabetic smokers as a biomarker of elevated oxidative stress. Dis. Markers 31, 47–54 (2011)
A. Ceriello, K. Esposito, M. Ihnat, J. Thorpe, D. Giugliano, Effect of acute hyperglycaemia, long-term glycaemic control and insulin on endothelial dysfunction and inflammation in Type 1 diabetic patients with different characteristics. Diabet. Med. 27, 911–917 (2010)
A.E. Kitabchi, F.B. Stentz, G.E. Umpierrez, Diabetic ketoacidosis induces in vivo activation of human T-lymphocytes. Biochem. Biophys. Res. Commun. 315, 404–407 (2004)
N.S. Glaser, S.L. Wootton-Gorges, M.H. Buonocore, J.P. Marcin, A. Rewers, J. Strain, J. DiCarlo, E.K. Neely, P. Barnes, N. Kuppermann, Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatr. Diabetes 7, 75–80 (2006)
R. Hanas, F. Lindgren, B. Lindblad, Diabetic ketoacidosis and cerebral oedema in Sweden–a 2-year paediatric population study. Diabet. Med. 24, 1080–1085 (2007)
A.L. Rosenbloom, The management of diabetic ketoacidosis in children. Diabetes Ther. 1, 103–120 (2010)
X. Zhang, C. Chen, A new insight of mechanisms, diagnosis and treatment of diabetic cardiomyopathy. Endocrine. 2012 Feb 10. [Epub ahead of print]
L. Weiss, S. Bernstein, R. Jones, R. Amunugama, D. Krizman, L. Jebailey, O. Almogi-Hazan, Z. Yekhtin, R. Shiner, I. Reibstein, E. Triche, S. Slavin, R. Or, E.R. Barnea, Preimplantation factor (PIF) analog prevents type I diabetes mellitus (TIDM) development by preserving pancreatic function in NOD mice. Endocrine 40, 41–54 (2011)
S. Sivanandan, A. Sinha, V. Jain, R. Lodha, Management of diabetic ketoacidosis. Indian J. Pediatr. 78, 576–584 (2011)
Conflict of interest
The authors have no competing interests to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ma, Sg., Jin, Y., Xu, W. et al. Increased serum levels of ischemia-modified albumin and C-reactive protein in type 1 diabetes patients with ketoacidosis. Endocrine 42, 570–576 (2012). https://doi.org/10.1007/s12020-012-9652-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-012-9652-9