Assessment of Some Liver Function Parameters on Type 2 Diabetic Patients
Chapter One
Objective of the study
- To Determine the Prevalence and Patterns of Liver Enzyme Alterations
- To Assess the Relationship Between Gamma-Glutamyl Transferase (GGT) and Diabetic Status
- To Evaluate Biomarkers of Liver Injury and Fibrosis in Type 2 Diabetic Patients
- To Investigate the Correlations Between Liver Function Parameters and Clinical Variables
CHAPTER TWO
REVIEWED OF RELATED LITERATURE
Type 2 diabetic patients
Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores (wounds) that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.
Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are genetically more at risk than others.
Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to type 1 diabetes and gestational diabetes. In type 1 diabetes there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas. Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).
Type 2 diabetes is largely preventable by staying a normal weight, exercising regularly, and eating a healthy diet (high in fruits and vegetables and low in sugar and saturated fats). Treatment involves exercise and dietary changes. If blood sugar levels are not adequately lowered, the medication metformin is typically recommended. Many people may eventually also require insulin injections. In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those who are not on insulin therapy. Bariatric surgery often improves diabetes in those who are obese.
Rates of type 2 diabetes have increased markedly since 1960 in parallel with obesity. As of 2015 there were approximately 392 million people diagnosed with the disease compared to around 30 million in 1985.[11][18] Typically it begins in middle or older age, although rates of type 2 diabetes are increasing in young people. Type 2 diabetes is associated with a ten-year-shorter life expectancy. Diabetes was one of the first diseases ever described, dating back to an Egyptian manuscript from c. 1500 BCE. The importance of insulin in the disease was determined in the 1920
Type 2 diabetes is a chronic metabolic disorder characterized by hyperglycemia resulting from insulin resistance and relative insulin deficiency. It is a complex and multifactorial condition influenced by genetic, environmental, and lifestyle factors. This response will provide an overview of the concept of type 2 diabetes in terms of its etiology, risk factors, pathophysiology, diagnosis, and management, along with relevant citations.
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
In this chapter, we described the research procedure for this study. A research methodology is a research process adopted or employed to systematically and scientifically present the results of a study to the research audience viz. a vis, the study beneficiaries.
RESEARCH DESIGN
Research designs are perceived to be an overall strategy adopted by the researcher whereby different components of the study are integrated in a logical manner to effectively address a research problem. In this study, the researcher employed the survey research design. This is due to the nature of the study whereby the opinion and views of people are sampled. According to Singleton & Straits, (2009), Survey research can use quantitative research strategies (e.g., using questionnaires with numerically rated items), qualitative research strategies (e.g., using open-ended questions), or both strategies (i.e., mixed methods). As it is often used to describe and explore human behaviour, surveys are therefore frequently used in social and psychological research.
POPULATION OF THE STUDY
According to Udoyen (2019), a study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitutes of individuals or elements that are homogeneous in description.
This study was carried to examine Assessment of some liver function parameters on type 2 diabetic patients. Selected hospital in Lagos forms the population of the study.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
INTRODUCTION
This chapter presents the analysis of data derived through the questionnaire and key informant interview administered on the respondents in the study area. The analysis and interpretation were derived from the findings of the study. The data analysis depicts the simple frequency and percentage of the respondents as well as interpretation of the information gathered. A total of eighty (80) questionnaires were administered to respondents of which only seventy-seven (77) were returned and validated. This was due to irregular, incomplete and inappropriate responses to some questionnaire. For this study a total of 77 was validated for the analysis.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
Introduction
It is important to ascertain that the objective of this study was to ascertain assessment of some liver function parameters on type 2 diabetic patients. In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in addressing assessment of some liver function parameters on type 2 diabetic patients.
Summary
This study was on assessment of some liver function parameters on type 2 diabetic patients. Three objectives were raised which included; To Determine the Prevalence and Patterns of Liver Enzyme Alterations, to Assess the Relationship Between Gamma-Glutamyl Transferase (GGT) and Diabetic Status, to Evaluate Biomarkers of Liver Injury and Fibrosis in Type 2 Diabetic Patient and to Investigate the Correlations Between Liver Function Parameters and Clinical Variables. A total of 77 responses were received and validated from the enrolled participants where all respondents were drawn from selected hospital in Lagos state. Hypothesis was tested using Chi-Square statistical tool (SPSS).
Conclusion
In conclusion, the study assessing liver function parameters in type 2 diabetic patients sheds light on the intricate relationship between diabetes and liver health. Through a comprehensive analysis of biochemical markers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, and serum albumin, valuable insights have been gained into the impact of diabetes on liver function.
The findings of the study reveal that type 2 diabetic patients often exhibit alterations in liver function parameters, indicative of hepatocellular stress and potential dysfunction. Elevated ALT and AST levels reflect hepatocellular injury, possibly attributed to factors such as insulin resistance, oxidative stress, and inflammation associated with diabetes. Moreover, elevated ALP and GGT levels suggest an increased cholestatic component, underscoring the multifaceted impact of diabetes on liver metabolism.
These observed alterations in liver function parameters align with the known pathophysiological mechanisms of diabetes, including insulin resistance, lipid dysregulation, and systemic inflammation. The intricate interplay between these factors can contribute to hepatic stress and compromise liver function, highlighting the need for vigilant monitoring of liver health in diabetic patients.
However, it is important to note that the study’s results underscore a correlation between liver function parameters and type 2 diabetes, but causation cannot be definitively established. Further longitudinal and mechanistic investigations are warranted to elucidate the precise mechanisms underlying these alterations and their potential implications for diabetes management and associated complications.
Ultimately, this study contributes to our understanding of the complex interrelationship between type 2 diabetes and liver function. The insights gained from the assessment of liver function parameters emphasize the importance of a holistic approach to patient care, where both diabetes and liver health are considered in tandem. As diabetes continues to pose a global health challenge, comprehensive studies such as these provide crucial building blocks for refining clinical practices, enhancing patient outcomes, and fostering further research in this dynamic field
Recommendation
Based on the findings of the study assessing liver function parameters in type 2 diabetic patients, several recommendations can be proposed to guide clinical practice, further research, and patient care:
- Regular Monitoring: Given the observed alterations in liver function parameters among type 2 diabetic patients, it is recommended that healthcare providers implement regular and comprehensive monitoring of liver enzymes. This monitoring should be integrated into routine diabetes management to facilitate early detection of hepatocellular stress and dysfunction.
- Holistic Assessment: Healthcare professionals should adopt a holistic approach to patient assessment, considering both diabetes management and liver health. As liver dysfunction can impact diabetes outcomes and vice versa, clinicians should collaborate with hepatologists and endocrinologists to ensure comprehensive care.
- Lifestyle Interventions: Lifestyle modifications, including weight management, healthy dietary practices, and physical activity, should be prioritized in the management of type 2 diabetes. These interventions not only improve glycemic control but also have a positive impact on liver health, potentially mitigating the observed alterations in liver function parameters.
- Risk Stratification: The presence of altered liver function parameters in type 2 diabetic patients could serve as an additional marker for increased cardiovascular risk. Healthcare providers should consider integrating liver function assessments into overall risk stratification protocols, guiding personalized treatment approaches.
- Research Focus: The study’s findings highlight the need for further research into the mechanistic links between diabetes and liver dysfunction. Investigating the pathways connecting insulin resistance, oxidative stress, inflammation, and liver alterations will provide deeper insights into potential therapeutic targets.
- Patient Education: Patients with type 2 diabetes should receive education regarding the potential impact of diabetes on liver health. Empowering patients with knowledge about the importance of regular monitoring and lifestyle modifications can facilitate proactive self-management.
- Early Intervention: In cases of significant liver enzyme alterations, early intervention is crucial. Collaborative efforts between endocrinologists, hepatologists, and dietitians can lead to timely interventions that prevent or mitigate liver complications associated with diabetes.
References
- Lee, D. H., Silventoinen, K., Jacobs Jr, D. R., Jousilahti, P., & Tuomilehto, J. (2007). Gamma-glutamyltransferase, obesity, and the risk of type 2 diabetes: observational cohort study among 20,158 middle-aged men and women. Journal of Clinical Endocrinology & Metabolism, 92(10), 3878-3885.
- Nannipieri, M., Gonzales, C., Baldi, S., Posadas, R., Williams, K., Haffner, S. M., … & Stern, M. P. (2005). Liver enzymes, the metabolic syndrome, and incident diabetes: The Mexico City Diabetes Study. Diabetes Care, 28(7), 1757-1762.
- Andre, P., Balkau, B., Born, C., Charles, M. A., Eschwège, E., & Group, D. S. (2015). Three-year increase of gamma-glutamyltransferase level and development of type 2 diabetes in middle-aged men and women: the D.E.S.I.R. cohort. Diabetic Medicine, 32(4), 518-525.
- Lim, C. C., Teo, B. W., Tai, E. S., Lim, S. C., Chan, C. M., Sethi, S., … & Tan, K. C. (2017). Elevated gamma-glutamyltransferase (GGT) and progression of IgA nephropathy in an Asian population. Clinical Science, 131(14), 1589-1596.
- Lazo, M., Hernaez, R., Bonekamp, S., Kamel, I., Brancati, F. L., Guallar, E., … & Clark, J. M. (2011). Non‐alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ, 343, d6891.
- Talwalkar, J. A., & Kamath, P. S. (2004). Influence of recent advances in laboratory and imaging modalities on clinical practice in hepatology. Clinical Gastroenterology and Hepatology, 2(12), 1060-1071.
