Decoding the role of serum cholinesterase among type 2 diabetes mellitus patients at RIMS, Ranchi - A hospital-based study.

Abstract

Introduction: Diabetes mellitus (DM) type 2 is a group of conditions which is defined by persistent hyperglycemia along with various metabolic disturbances in carbohydrate, protein, and lipid metabolism. This condition is characterized by variable levels of insulin resistance, impaired insulin secretion, and elevated glucose production. There are various complications like cardiovascular diseases, neuropathy, nephropathy, and retinopathy which are associated with type 2 DM (T2DM). Serum cholinesterase (ChE) is an alpha glycoprotein enzyme which is formed in the liver and associated with various chronic inflammatory conditions like diabetes, hypertension, and cardiovascular diseases. So, we want to evaluate the correlation between serum cholinesterase concentrations in T2DM and also to evaluate the utility of serum cholinesterase as a diagnostic and prognostic marker in T2DM.

Material and methods: A cross-sectional study was conducted involving 176 participants, divided into two groups: 88 patients diagnosed with T2DM and 88 nondiabetic individuals matched for age and sex who attended at OPD and IPD of Medicine department of RIMS, Ranchi. The height and weight are taken, BMIs are calculated, and blood pressures are recorded. Blood samples are collected from all participants to measure serum cholinesterase levels; FBS, PPBS, HbA1c, serum urea, creatinine, lipid profile, thyroid profile, liver function tests (total bilirubin, direct bilirubin, AST, ALT, alkaline phosphatase), and urine protein creatinine ratio are assessed.

Results and discussion: The activity of serum cholinesterase raised in T2DM compared to the nondiabetic group. The cholinesterase levels in the diabetic group revealed 9272.18 ± 3062.92, median 9661.65, and in nondiabetics, it was 3504.93 ± 1520.74, median 3267.50, with a P value of < 0.001, which is statistically significant. Our study showed a positive correlation between serum cholinesterase and HbA1c with a correlation coefficient of 0.357 and a P value of 0.001, which is statistically significant. There is also a statistically significant correlation found between serum cholinesterase and serum triglyceride and also between serum cholinesterase and very low-density lipoprotein. But in our study, we have found that there is no statistical significant correlation between serum cholinesterase and overweight (BMI ≥ 25.0). The ROC plot analysis in this study demonstrates the higher diagnostic accuracy, 89.77, of serum cholinesterase with a sensitivity of 96.59 and a specificity of 82.95.

Conclusion: So, serum cholinesterase concentrations are significantly increased in patients with T2DM and are also associated with poor glycemic control with increased insulin resistance. These study findings demonstrate the potential of serum cholinesterase as a biomarker to monitor the disease progression and its therapeutic effectiveness for interventions in T2DM.