The effects of 2,3-diphosphoglycerate, adenosine triphosphate, and glycosylated hemoglobin on the hemoglobin-oxygen affinity of diabetic patients

Abstract

The position of the oxygen dissociation curve (ODC) is modulated by 2,3-diphosphoglycerate (2,3-DPG). Decreases in 2,3-DPG concentration within the red cell shift the curve to the left, whereas increases in concentration cause a shift to the right of the ODC. Some earlier studies on diabetic patients have reported that insulin treatment may reduce the red cell concentrations of 2,3-DPG, causing a shift of the ODC to the left, but the reports are contradictory. Three groups were compared in the present study: 1) nondiabetic control individuals (N = 19); 2) insulin-dependent diabetes mellitus (IDDM) patients (on insulin treatment) (N = 19); 3) non-insulin-dependent diabetes mellitus (NIDDM) patients using oral hypoglycemic agents and no insulin treatment (N = 22). The overall position of the ODC was the same for the three groups despite an increase of the glycosylated hemoglobin fraction that was expected to shift the ODC to the left in both groups of diabetic patients (HbA 1c : control, 4.6%; IDDM, 10.5%; NIDDM, 9.0%). In IDDM patients, the effect of the glycosylated hemoglobin fraction on the position of the ODC appeared to be counterbalanced by small though statistically significant increases in 2,3-DPG concentration from 2.05 (control) to 2.45 µmol/ml blood (IDDM). Though not statistically significant, an increase of 2,3-DPG also occurred in NIDDM patients, while red cell ATP levels were the same for all groups. The positions of the ODC were the same for control subjects, IDDM and NIDDM patients. Thus, the PO 2 at 50% hemoglobinoxygen saturation was 26.8, 28.2 and 28.5 mmHg for control, IDDM and NIDDM, respectively. In conclusion, our data question the idea of adverse side effects of insulin treatment on oxygen transport. In other words, the shift to the left reported by others to be caused by insulin treatment was not detected.

Elevated serum amylase and lipase in pediatric diabetic ketoacidosis*

“…Hypertriglyceridemia was also associated with lipase elevation in the univariate analysis, but this association was not significant in the multivariate analysis. It is possible that low phosphate concentrations during DKA might contribute to ischemic tissue injury by lowering red blood cell 2,3-diphosphoglycerate levels, which may be associated with decreased tissue oxygen delivery (10). In two adult studies, hypophosphatemia was also found to be correlated with pancreatic enzyme elevation during DKA (11,12).…”

Serum Adipocytokines, Metabolic and Immunological Correlations in Type 1 Diabetes mellitus (T1DM) Children

“…HbA1c determines the fasting glucose concentration in diabetic patients and therefore reflects detrimental diabetic complications [52]. HbAlc levels were elevated in T1DM treated with insulin due to poor glycemic control [53].…”

Correlation of fasting and post meal plasma glucose level to increased HbA1c levels in type-2 diabetes mellitus

“…However, it is important to note that HbA1c is neither considered dysfunctional nor harmful. 3 lifetime of the red blood cell, which is approximately 120 days. 4 HbA 1C expressed as a percentage of total blood hemoglobin concentration gives a good retrospective assessment of the mean plasma glucose concentration during the preceding 6-8 weeks while the recent glycemic level has the highest influence and the preceding 30 days contribute only upto 50%.…”