Namrata Sanjeevi1, Jeanne Freeland-Graves2, S Natasha Beretvas3, Prageet K Sachdev4. 1. Postdoctoral Fellow, Health Behavior Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive Room 3165A, MSC 7004, Bethesda, MD 20817, USA, namratas@utexas.edu. 2. Department of Nutritional Sciences, The University of Texas at Austin, 1 University Station A2703, Austin, TX 78712, USA, jfg@mail.utexas.edu. 3. Department of Educational Psychology, The University of Texas at Austin, 1 University Station D5800, Austin, TX 78712, USA, tberetvas@austin.utexas.edu. 4. Department of Nutritional Sciences, The University of Texas at Austin, 1 University Station A2703, Austin, TX 78712, USA, prageet@utexas.edu.
Abstract
INTRODUCTION: Type 2 diabetes is a chronic metabolic disorder that has been associated with alterations in the status of trace elements, including zinc, copper, iron and manganese. However, clinical studies reporting statuses of these trace elements in type 2 diabetes patients compared to controls have shown conflicting results. OBJECTIVE: This meta-analysis aimed to summarize the existing literature on the statuses of zinc, copper, iron, and manganese in Type 2 diabetes mellitus patients. METHODS: A literature search of Embase, PubMed, EBSCOHost, ScienceDirect, Scopus, Cochrane library and Web of Science electronic databases was conducted to find studies published from 1970 to November 2016 that compared the trace elements of interest between type 2 diabetic patients and healthy controls. Keywords used were type 2 diabetes, diabetes, hyperglycemia, insulin, glucose, HbA1c, trace elements, micronutrients, zinc, manganese, copper, ceruloplasmin, iron and ferritin. The bias corrected Hedges' g, was utilized as the effect sizes. Due to the biological interaction between trace elements, it is important to collectively evaluate the statuses of these minerals in type 2 diabetes. Thus, the robust variance estimation method was chosen to handle dependency between multiple outcomes. RESULTS: A total of 52 studies met the inclusion criteria, amounting to 98 effect sizes. Diabetic patients (n=20183) had significantly lower zinc status when compared to controls (effect size = -1.73, p<0.01); whereas copper (effect size = 1.10, p<0.05) and ferritin levels (effect size = 1.05, p<0.01) were significantly higher. Although not significant, ceruloplasmin (effect size = 1.85, p=0.06) and iron (effect size = 1.42, p=0.06) levels were higher, and manganese (effect size = 0.27, p=0.34) was lower in patients. CONCLUSION: Results from this meta-analysis indicate lower zinc status accompanied by increased copper and ferritin levels in patients with type 2 diabetes when compared to controls.
INTRODUCTION: Type 2 diabetes is a chronic metabolic disorder that has been associated with alterations in the status of trace elements, including zinc, copper, iron and manganese. However, clinical studies reporting statuses of these trace elements in type 2 diabetes patients compared to controls have shown conflicting results. OBJECTIVE: This meta-analysis aimed to summarize the existing literature on the statuses of zinc, copper, iron, and manganese in Type 2 diabetes mellitus patients. METHODS: A literature search of Embase, PubMed, EBSCOHost, ScienceDirect, Scopus, Cochrane library and Web of Science electronic databases was conducted to find studies published from 1970 to November 2016 that compared the trace elements of interest between type 2 diabetic patients and healthy controls. Keywords used were type 2 diabetes, diabetes, hyperglycemia, insulin, glucose, HbA1c, trace elements, micronutrients, zinc, manganese, copper, ceruloplasmin, iron and ferritin. The bias corrected Hedges' g, was utilized as the effect sizes. Due to the biological interaction between trace elements, it is important to collectively evaluate the statuses of these minerals in type 2 diabetes. Thus, the robust variance estimation method was chosen to handle dependency between multiple outcomes. RESULTS: A total of 52 studies met the inclusion criteria, amounting to 98 effect sizes. Diabetic patients (n=20183) had significantly lower zinc status when compared to controls (effect size = -1.73, p<0.01); whereas copper (effect size = 1.10, p<0.05) and ferritin levels (effect size = 1.05, p<0.01) were significantly higher. Although not significant, ceruloplasmin (effect size = 1.85, p=0.06) and iron (effect size = 1.42, p=0.06) levels were higher, and manganese (effect size = 0.27, p=0.34) was lower in patients. CONCLUSION: Results from this meta-analysis indicate lower zinc status accompanied by increased copper and ferritin levels in patients with type 2 diabetes when compared to controls.
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