Evaluation of total antioxidant status (TAS), total oxidant status (TOS) levels and metabolic parameters in patients with well and poorly controlled type 2 diabetes mellitus

Diabetes is regarded as one of the most important health problems of the century. The fact that the number of people with diabetes increases day by day and that diabetes-related health problems affect public health and country economies seriously supports this idea. The balance between free oxygen radicals and antioxidant system plays an important role in the development of diabetes and its complications. Dr. Erel developed a total antioxidant status (TAS) kit and a total oxidant status (TOS) kit to detect overall antioxidant levels with a new calorimetric measurement technique. In this study, we aimed to compare TAS and TOS levels and metabolic parameters in patients with well-controlled type 2 diabetes with metabolic parameters and TAS and TOS levels in patients with poorly controlled type 2 diabetes. Poorly and well-controlled patients who were admitted to the internal diseases outpatient clinics of our university between March 2019 and September 2019 with diagnosis of type 2 diabetes were included in the study. Demographic data and anthropometric measurements, blood pressure and pulse data, TAS-TOS results, metabolic parameters, kidney and liver function tests, whole blood and anemia parameters, presence of diabetes microvascular and macrovascular complications, treatment compliance, diet and exercise habits were recorded. Data of well and poorly controlled type 2 diabetic patients were compared. A total of 139 patients, 96 poor controlled diabets and 43 well controlled diabets, were included in the study. There was no difference between the two groups in terms of demographic data and anthropometric measurements. In the poorly controlled type 2 diabetes group, the median HbA1c was 9.1% and fasting blood glucose was 169 mg / dL, while in the well-controlled type 2 diabetes group, the median was HbA1c 6.4% and the fasting blood glucose was 113 mg / dL, and there was a significant difference between the groups in terms of glycemia control (p<0.001 for HbA1c; p <0.001 for fasting blood glucose). In our study, TOS levels were found to be significantly higher (p = 0.002) and TAS levels were significantly lower in patients with poorly controlled type 2 diabetes compared to well-controlled type 2 diabetics (p <0.001). Microvascular complications were found in 47.9% of poorly controlled type 2 diabetics and 27.9% of well-controlled type 2 DM patients (p = 0.027). In the subgroup analysis, no significant difference was observed between good and badly controlled diabetics in terms of the frequency of retinopathy, nephropathy and neuropathy. While 17.7% of poorly controlled type 2 diabetes patients had macrovascular complications, this rate was found to be 14% in the well-controlled type 2 diabetes group and there was no statistically significant difference between the groups. Diet compliance was found to be 58.1% and 34.4%, respectively, in well-controlled and poorly controlled diabetics (p = 0.027). In poorly controlled diabetic individuals, the oxidant-antioxidant balance in the oxidative system is impaired in favor of oxidation and it is thought that oxidative stress plays a role in the development of microvascular complications. TOS levels can be used as a predictive test for microvascular complications and morbidity in type 2 DM patients. When TAS level is above 1.37 mmol Trolox Eq / L, it predicts good diabetic control with 74% sensitivity and 53% specificity. When TOS level is above 3.97 μmol H2O2 Eq / L, it predicts bad diabetic control with 60% sensitivity and 53% specificity. Keywords: Antioxidants, Complications of Diabetes Mellitus, HbA1c, Oxidants, Type 2 Diabetes Mellitus