Measurement Of Serum Cholinesterase Levels In Type 2 Diabetes And Its Possible Role As A Marker For Cardiovascular Risk Assessment In Relation To Lipid Profile- One Year Hospital Based Cross Sectional Study

Abstract

Background and Objectives: Type 2 Diabetes Mellitus is a disease that affects nearly 8.7 percent of the Indian population.[2] T2DM related complications affect many organ systems and are responsible for the majority of the morbidity and mortality associated with the disease including cardiovascular diseases which are responsible for 30-50 percent mortality in DM patients past the age of forty years.[1] The incidence and increase of deaths and disability due to cardiovascular diseases in T2DM patients can be attributed to the coexistence of hyperglycaemia with factors such as dyslipidaemia and obesity.[3] Serum pseudocholiesterase levels are known to be raised in patients with obesity/ patients with normal body weight but having dyslipidaemia.[6] Studies have also been done to show that Serum pseudocholinesterase levels have been raised in case of diabetes but the exact mechanism is not known as the biological function of this enzyme remains an enigma.[5] There is a need to screen diabetic patients for cardiovascular risk in order to prevent further mortality and morbidity and further scope for studies to discover newer ways to screen for cardiovascular risk in T2DM patients with reference to dyslipidaemias and one such method may be through the use of serum cholinesterases. Thus, further studies are needed into identifying cause of raised cholinesterase levels in T2DM and whether this enzyme’s levels can be used as a screening test for cardiovascular risk in diabetics. The objectives of the present study is to study the relation of raised pseudocholinesterase levels with increased risk for cardiovascular complications with reference to raised lipid indices in type 2 diabetes mellitus patients. With a secondary objective to identify the association between variations of Serum Cholinesterase in T2DM patients with Hypertension or changes in BMI. Methods: The present cross sectional study was conducted on diabetic patients admitted in KLES Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi from Jan 2018 to Dec 2018. All known Type Two Diabetic patients were screened by the following tests after physical examination: HbA1c, FBS, PPBS, Serum Cholinesterase, Lipid Profile and Serum creatinine. All the patients fulfilling the inclusion criteria and willing to participate were included in the study after obtaining Informed consent. The relevant investigations were done and the data was collected using a proforma meeting the objectives of the study. The data collected was coded and entered into Microsoft Excel Worksheet. For the continuous quantitative variables, mean and standard deviation were calculated. For the categorical variables, frequency and proportion were calculated. Percentages were used to determine the categorical data. Suitable graphs and tables were used to depict the data. Independent sample t-test/ ANOVA/Paired t- test was used to assess statistical significance. Result A total of 100 subjects of T2DM were involved in the analysis. Higher levels of Serum cholinesterase were observed in T2DM where mean duration of diabetes was 98.22 ± 99.33 months. There was a weak positive relation between cholinesterase and total cholesterol (r: 0.047, p: 0.643). There was a weak negative correlation between cholinesterase and HDL (r: -0.108, p: 0.287). There was a weak positive correlation between cholinesterase and LDL (r: 0.036, p: 0.723). There was a weak positive correlation between cholinesterase and Triglycerides (rs: -0.123, p: 0.223). There was a weak positive correlation between cholinesterase and VLDL (rs: 0.147, p: 0.145). There was a weak positive correlation between cholinesterase and BMI (r: 0.289, p: 0.004). The mean of Cholinesterase (U/ml) was 5.61 ± 0.37 in people with hypertension and it was 5.52 ± 0.32 in people without hypertension, which was not significant. (p value 0.284). Conclusion While there was a positive relation between dyslipidemia and pseudocholinesterase in Type 2 Diabetics it is not possible to declare conclusively that the main cause of raised pseudocholinesterase levels in Type 2 Diabetics is because of Dyslipidemia. Further studies are needed to determine the cause. Thus, raised serum pseudocholinesterase levels cannot be recommended to be used as a tool for cardiovascular risk assessment in T2DM patients. There is also a need to further research the genetic aspects for cause of raised serum pseudocholinesterase in T2DM which was beyond the scope of the current study.