Diabetes & Metabolism Journal

Original Article

The Association between Serum GGT Concentration and Diabetic Peripheral Polyneuropathy in Type 2 Diabetic Patients: Ho Chan Cho; Korean Diabetes J. 2010;34(2):111-118. Published online April 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.2.111

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Background

Diabetic peripheral polyneuropathy (DPP) is one of the common complications of diabetes mellitus (DM) and can lead to foot ulcers or amputation. The pathophysiology of DPP includes several factors such as metabolic, vascular, autoimmune, oxidative stress and neurohormonal growth-factor deficiency and recent studies have suggested the use of serum gamma-glutamyl transferase (GGT) as an early marker of oxidative stress. Therefore, we investigated whether serum GGT may be useful in predicting DPP.

Methods

We assessed 90 patients with type 2 DM who were evaluated for the presence of DPP using clnical neurologic examinations including nerve conduction velocity studies. We evaluated the association between serum GGT and the presence of DPP.

Results

The prevalence of DPP was 40% (36 cases) according to clinical neurological examinations. The serum GGT concentration was significantly elevated in type 2 diabetic patients with DPP compared to patients without DPP (P < 0.01). There were other factors significantly associated with DPP including smoking (P = 0.019), retinopathy (P = 0.014), blood pressure (P < 0.05), aspartate aminotransferase (P = 0.022), C-reactive protein (P = 0.036) and urine microalbumin/creatinine ratio (P = 0.004). Serum GGT was independently related with DPP according to multiple logistic analysis (P < 0.01).

Conclusion

This study shows that increased levels of serum GGT may have important clinical implications in the presence of DPP in patients with type 2 diabetes.

Citations

Citations to this article as recorded by

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Joonhyoung Kim, Kyungdo Han, Juhwan Yoo, Kyung-Ah Park, Sei Yeul Oh
Neurological Sciences.2022; 43(5): 3395. CrossRef
Validity of the diagnosis of diabetic microvascular complications in Korean national health insurance claim data
Hyung Jun Kim, Moo-Seok Park, Jee-Eun Kim, Tae-Jin Song
Annals of Clinical Neurophysiology.2022; 24(1): 7. CrossRef
The association of liver enzymes with diabetes mellitus risk in different obesity subgroups: A population-based study
Dinghao Zheng, Xiaoyun Zhang, Lili You, Feng Li, Diaozhu Lin, Kan Sun, Meng Ren, Li Yan, Wei Wang
Frontiers in Endocrinology.2022;[Epub] CrossRef
Early Biomarkers of Neurodegenerative and Neurovascular Disorders in Diabetes
Aleksandra Gasecka, Dominika Siwik, Magdalena Gajewska, Miłosz J. Jaguszewski, Tomasz Mazurek, Krzysztof J. Filipiak, Marek Postuła, Ceren Eyileten
Journal of Clinical Medicine.2020; 9(9): 2807. CrossRef
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Natalie M. Zahr, Kilian M. Pohl, Adolf Pfefferbaum, Edith V. Sullivan
Journal of Neuroimmune Pharmacology.2019; 14(3): 436. CrossRef
Evaluation of Serum Gamma Glutamyl Transferase Levels in Diabetic Patients With and Without Retinopathy
Neda Valizadeh, Rasoul Mohammadi, Alireza Mehdizadeh, Qader Motarjemizadeh, Hamid Reza Khalkhali
Shiraz E-Medical Journal.2018;[Epub] CrossRef
The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis
Carole Clair, Marya J. Cohen, Florian Eichler, Kevin J. Selby, Nancy A. Rigotti
Journal of General Internal Medicine.2015; 30(8): 1193. CrossRef
Evaluation of oxidative stress markers and vascular risk factors in patients with diabetic peripheral neuropathy
Noha Ahmed El Boghdady, Gamal Ali Badr
Cell Biochemistry and Function.2012; 30(4): 328. CrossRef
Angiotensin-converting enzyme gene single polymorphism as a genetic biomarker of diabetic peripheral neuropathy: longitudinal prospective study
J. Jurado, J. Ybarra, J.H. Romeo, M. Garcia, E. Zabaleta-del-Olmo
Journal of Diabetes and its Complications.2012; 26(2): 77. CrossRef
Routine enzymes in the monitoring of type 2 diabetes mellitus
Osman Evliyaoğlu, Erkan Kibrisli, Yaşar Yildirim, Osman Gökalp, Leyla Çolpan
Cell Biochemistry and Function.2011; 29(6): 506. CrossRef
Antioxidant Effects of Fermented Red Ginseng Extracts in Streptozotocin-Induced Diabetic Rats
Hyun-Jeong Kim, Sung-Gyu Lee, In-Gyeong Chae, Mi-Jin Kim, Nam-Kyung Im, Mi-Hee Yu, Eun-Ju Lee, In-Seon Lee
Journal of Ginseng Research.2011; 35(2): 129. CrossRef
Serum γ‐glutamyltransferase and associated damage among a She Chinese population
Y. Lin, Y. Xu, G. Chen, B. Huang, J. Yao, Z. Chen, L. Yao, F. Lin, Y. Qiao, Z. Chen, S. Zhu, H. Huang, J. Wen
Diabetic Medicine.2011; 28(8): 924. CrossRef

Case Report

A Case of Chronic Inflammatory Demyelinating Polyneuropathy in a Girl with Type 1 DM .: Yi Sun Jang, Hye Soo Kim, Jong Min Lee; Korean Diabetes J. 2006;30(2):130-135. Published online March 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.2.130

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Abstract PDF: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated disorder characterized by the symmetrical weakness in both proximal and distal muscles for at least 2 months, hyporeflexia or areflexia, nerve conduction abnormalities, and high CSF protein level. Diabetes mellitus, monoclonal gammopathy, hepatitis C infection, HIV infection, SLE, Sjogren syndrome and lymphoma have been associated with CIDP. The incidence of CIDP in diabetes is not known exactly, but occur more common among diabetic than nondiabetic patients. There is sometimes a difficulty in distinguishing between diabetic polyneuropathy and CIDP, but differential diagnosis is important because CIDP is treatable with immune-modulating therapy. We report a case of CIDP in 22-year-old girl with type 1 DM who presented with generalized motor weakness and walking disturbance which were treated with iv immunoglobulin

Original Articles

Peripheral Polyneruopathy and Hypoinsulinemia in Patients with Type 2 Diabetes.: Y S Jung, K Y Lee, S K Lee, H K Kim, H Y Park, M H Kang; Korean Diabetes J. 2000;24(2):256-266. Published online January 1, 2001

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Abstract PDF: BACKGROUND
There is little information on the risk factors for diabetic polyneuro-pathy other than glycemic control and duration of diabetes. The relation between diabetic polyneuropathy and hypoinsulinemia is controversial. This study is to determine whether hypoinsulinemia is an additional factor influencing the development of polyneuropathy in patients with type 2 diabetes. METHODS: We performed an oral glucose tolerance test with C-peptide measure-ment in 1'P2 patients with type 2 diabetes. Peripheral polyneuropathy was diagnosed when the patients had both typical symptoms of polyneuropathy and abnormal physical findings or NCV. We analysed the relation between metabolic variables including fasting and postprandial C-peptide levels and diabetic polyneuropathy. RESULTS: In addition to retinopathy and nephropathy, duration of diabetes, low C-peptide level (fasting and postprandial), insulin use, and high HDL-cholesterol level were associated with diabetic polyneuropathy. Multivariate logistic regression model revealed that an independent assoclation of diabetes duration and postprandial 2-hour C-peptide concentration with polyneuropathy. When we stratified the patients into the two groups according to the median duration of diabetes (8 years), the association of low postprandial C-peptide concentration with polyneuro-pathy was significant only in the shorter duration group(< 8 years). However, significant association of HbA(1c) level was shown in the longar duration group. CONCLUSION: Decreased insulin secretory function of the pancreas as well as increased duration of diabetes was indepandently associated with diabetic polyneuropathy in patients with type 2 diabetes. Hypoinsulinemia might be an additional risk factor for the development of diabetic polyneuropathy in type 2 diabetic patients, particularly with short duration, To confirm these relationship further longitudinal study in a large cohort is necessary.

Simple Diagnostic Method of Diabetic Distal Polyneuropathy in Type 2 Diabetics.: Chi Hak Kim, Kyung Il Lee, Sang Gil Han, Jeong Ho Heo, Kwang Jae Lee; Korean Diabetes J. 1998;22(4):561-567. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Early diagnosis of diabetic distal polyneuropathy, a common chronic complication of diabetes mellitus, is important in the management of diabetes mellitus. Michigan Diabetic Neuropathy Score(MDNS) is a good method for diagnosis of this complication but requires many check lists witb nerve conduction study, which may be troublesome in outpatients. This study was performed to investigate simple and convenient diagnostic means which can be substituted with MDNS. METHODS: 41 patients with type 2 diabetes mellitus were assessed with MDNS which include toe 128 Hz tuning fork test, 10 g filament test, pin wheel test and nerve conduction velocity(NCV). Additionally, l28 Hz tuning fork test, l0 g filament test, pin wheel test on fingers and Tacticon and vibration perception test with Bio-thesiometer on toes and fingers were performed. RESULTS: Toe and finger 128 Hz tuning fork, Tacticon and Bio-thesiometer tests were highly concordant with MDNS(kappa>0.40). Also combined tests such as toe and finger 128Hz tuning fork- Tacticon test and Tacticon-Bio-thesiometer test were highly concordant with MDNS(kappa > 0.40) and more sensitive than single tests. CONCLUSION: The results indicate that finger 128 Hz tuning fork - Tacticon combined test is good, simple and convenient in the diagnosis of diabetic distal polyneurapathy.

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