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Available Online at http://www.recentscientific.com International Journal of CODEN: IJRSFP (USA) Recent Scientific

International Journal of Recent Scientific Research Research Vol. 11, Issue, 10 (B), pp. 39863-39872, October 2020 ISSN: 0976-3031 DOI: 10.24327/IJRSR Research Article

A STUDY OF LIVER ENZYME AND PROFILE IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS

Mohmmad Imran1, Dr Saba khan2, Ajit Kumar Yadav3 and 4Dr Roshan Alam

1Tutor, Department of Biochemistry, Al-Falah School of Medical Science and Research Center Dhauj Faridabad Haryana, India 2Assistant Professor, Department of Biochemistry, Integral Institute of Medical Science And Research Center Lucknow, India 3Tutor, Department of Biochemistry, Shri Ramkrishna Institute of Medical Science And Sanaka Hospitals Durgapur West Bengal, India 4Professor and HOD, Department of Biochemistry, Integral Institute of Medical Science and Research Center Lucknow, India

DOI: http://dx.doi.org/10.24327/ijrsr.2020.1110.5577

ARTICLE INFO ABSTRACT

Background and Objectives Article History: DM is a group of metabolic diseases described by conclusion from deficiency in

Received 10th July, 2020 insulin secretion. Type2DM is most common form of the disease. Accumulation of intracellular Received in revised form 2nd glycogen in hepatocytes causes liver injury that shows typical biochemical findings of mild to August, 2020 moderate rise in ALT, AST and normal synthetic function with or without ALP elevation Accepted 26th September, 2020 Methods: A newly diagnosed type 2 DM patients a attending in the medicine OPD Integral hospital. Published online 28th October, 2020 To estimate the level of liver enzymes and lipid profile in newly diagnosed of type 2DM patients. in this case-control study, a total study of 88 subjects & age between 35-65 years were enrolled. The Key Words: liver enzyme & lipid profile are estimated by semi auto analyzer using commercially available kits. For statistical analysis, all the data were compared between the two groups by using unpaired t-test. Type 2DM (Diabetes mellitus), liver Pearson correlation coefficient was calculated among DM. enzymes & lipid profil Results: The mean of FBG, ALT, AST, ALP, TC, TAG, LDL-C, and VLDL which was significantly higher in cases as compared to control except for HDL-C that was lower in cases as compared to controls. Therefore, it showed that elevated AST, ALT, LDL and low HDL may predict certain disturbances in lipoprotein metabolism

Copyright © Mohmmad Imran et al, 2020, this is an open-access article distributed under the terms of the Creative

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INTRODUCTION individuals may develop diabetes by the year 2030 (Fauci, 2008). Diabetes mellitus is a group of metabolic diseases described by hyperglycemia conclusion from deficiency in insulin secretion, AS reported by International Diabetes Federation (IDF2014) insulin action, or both. Type 2 diabetes the most common form 450,000 people (3.35% prevalence) have been diagnosed as of the disease (American Diabetes Association, 2003). having diabetes with a further 330,000 undiagnosed persons in Diabetes mellitus ruling cause of death worldwide is one of the Ghana alone (International Diabetes Federation, 2014). most severe health problems in 21st century (Gurjeet et al., In the range of 85-95% of all diabetes cases in high-income 2011). countries, type2 diabetes is present. In Ethiopia it has been reported as number of cases of diabetes to be estimated about The popularity of Diabetes mellitus has increased completely 1.9 million in 2013 (Berhe KK et al 2014 & Patra T et al 2012). around the world, from an estimated 30million cases in 1985 to 177 million in 2000. It is estimation that, more than 360 million One of the major cardiovascular diseases, dyslipidaemia plays an important role in the growth of atherosclerosis. With respect

*Corresponding author: Dr Saba khan Assistant Professor, Department of Biochemistry, Integral Institute of Medical Science And Research Center Lucknow, India International Journal of Recent Scientific Research Vol. 11, Issue, 10 (B), pp. 39863-39872, October 2020 to the general population, the prevalence of dyslipidaemia in Aim and Objectives of the Study type2 diabetes is double (Haffner, 1998). Aim The aim of the present study is to evaluate liver enzymes One of the most common secondary causes of hyperlipidaemia and lipid profile in newly diagnosed of type 2 diabetes mellitus is type 2 DM. The relationship between lipidemia and vascular patient and controls subjects complication of polygenic disease has long existence of interest as a result of each tend to occur with larger frequency in kind Objectives two DM. hormone resistance and fleshiness mix to cause  To estimate ALT, AST & ALP in newly diagnosed of dyslipidaemia and hyperglycaemia and lipidemia have additive type2 diabetes mellitus patients and controls subjects. vessel risk. it's suggested that patients with DM ought to be treated as if they have already got arterial sickness. Hence  To estimate the lipid profile in newly diagnosed of identification, critical evaluation, and follow-up of serum lipid type 2 diabetes mellitus patients and controls subjects profile in Type 2 DM continue to be important (Chaturvedi N  To correlate the above parameters in newly diagnosed et al2001& Harvey JN2002). of type 2 diabetes mellitus patients and controls subjects if any. Due to increase in liver enzymes the illness age to internal Types of Study Case – Control organ failure, so symptomless people with delicate elevation of ALT, AST reveals the possibilities of disease, chiefly NAFLD Cases Newly diagnosed of type 2 diabetic Patients without any and infectious disease (Harris EH2005). complication

The main cause of DM is unknown, but obesity, racial Control Apparently healthy subjects susceptibility, heredity and autoimmunity may be etiological Place of Study factors (BossakETet al 1956&Scrimshow NS,1980).

Diabetes mellitus is a result of abnormality in the production or Clinical Laboratory, Research Laboratory and Central Research the use of insulin. Abnormality involves beta cells and can be Laboratory, Department of Biochemistry, IIMS&R, Integral University, Lucknow. of two types: Deficient beta cell insulin production, or relatively normal, synthesis but abnormal release. Diabetes may Study Period 6 months, (from January, 2018 - June, 2018) results from extra pancreatic factors such as peripheral tissue Collection of Data cell receptor dysfunction producing resistance to the cellular action of insulin, or abnormalities of non-pancreatic hormones Subjects from rural and sub-urban population will be enrolled that effect insulin secretion or blood glucose metabolism who are attending the Medicine OPD at IIMS& R, Lucknow (Ravel R1995). will be included in the study.A detailed clinical history

Liver related disorders identified in diabetes involve elevated including age, sex, occupation, socio-economic status. Subjects liver enzymes, fatty liver disease, cirrhosis, hepato-cellular will be explained in detail about the study and written informed carcinoma and acute liver failure (Marchesini Get al 2003). consent will be taken. Samples from hypothyroid patients will be collected and processed in the Department of Biochemistry, Accumulation of intracellular glycogen in hepatocytes causes IIMS&R, Lucknow. liver injury that shows typical biochemical findings of mild to Selection of Cases moderate rise in ALT, AST and normal synthetic function with or without ALP elevation (Ahmed RM 2015). Inclusion Criteria for Cases

It is indicated by previous study that circulating concentration  Age group: 30-65 years of both genders. of like ALT and AST are increased in  All the newly diagnosed patients with type 2 diabetes individuals with insulin resistance and the metabolic syndrome mellitus (Wannamethee SG et al 2005, Hanley AJ et al 2004&,  Patients having symptoms less than 1 years. Nakanishi N et al 2004).  Subject who will sign the consent form. Abnormal lipid profile is often seen in diabetes patients Exclusion Criteria for Cases because insulin regulates several steps of lipid metabolism. Increased fasting & postprandial levels of serum ,  History of acute illness total and LDL cholesterol and a significant decrease  History of chronic diseases except type 2 diabetes in the HDL cholesterol levels characterised dyslipidemia in mellitus diabetic patient (Rivellese AA et al 2004). Selection of Control Apparently healthy subjects of age group One of the utmost ways of assessing patients suspected to 30-65 yrs. will be taken as control. having risk of developing CHD in this environment is lipid profile.type2 diabetic mellitus is related with abnormalities of Study Design In this case-control study age and gender matched subjects will both quantity and quality of lipoproteins , among other factors, be enrolled for keen observation and avoiding various might be responsible for the increased incidence of CHD confounding factors. Subjects will be grouped as case and (Assmanet al.1988). control as per inclusion/exclusion criteria. Lipid profile and Type2diabetes is associated with a group of interrelated plasma liver enzymes will be estimated in all subjects and will be lipid and lipoprotein abnormalities, including decreased HDL correlated in case and control group. cholesterol and increase triglycerides (American Diabetes Association2003). Collection of Samples 39864 | P a g e Dr Saba khan., A Study of Liver Enzyme and Lipid Profile in Newly Diagnosed Type 2 Diabetes Mellitus

Lipoprotein hydrolyses triglycerides to glycerol and free Total 5 ml venous blood will be collected from the subjects in fatty acids. The glycerol formed with ATP in presence of plain & fluoride vial 1 ml for plasma glucose & 4 ml of liver glycerol kinase forms glycerol 3phosphate which is oxidized by enzymes & lipid profile estimation after an overnight or 12 the enzyme glycerolphosphate oxidase to form hydrogen hours of fasting under aseptic condition. It will be immediately peroxide. The hydrogen peroxide further reacts with phenolic centrifuged at 3000 rpm for 5 min and serum will be separated compound and 4 amino antipyrene by the catalytic action to and then divided peroxidase to form a red color edquinoneimine dye complex. METHODOLOGY Intensity of the clored formed is directly proportional to the amount of triglycerides present in sample and was measured at Estimation of fasting blood sugar via GOD/POD method 505nm. Colour was stable for 1 hr.

Glucose is oxidized by glucose oxidase (GOD) into gluconic Estimation of HDL cholestrol using the kit coral clinical acid and hydrogen peroxide. Hydrogen peroxide in presence of system, India (Trinder et al.,1969) peroxidase (POD) oxidizes the chromogen 4 amino antipyrene/ phenolic compound to a red colored compound. The intensity When the serum is reacted with polythylene glycol contained in of red colored compound is proportional to glucose precipitating reagent all VLDL and LDL are precipitated. The concentration and was measured at 505nm. Colour is stable for HDL remains in the supernatant and is then assayed as a 2 hr.(Trinder. et al.1969): sample for cholesterol using the cholesterol (CHOD/PAP) reagent and the absorbance was measured 505nm. Estimation of Serum Alanine Aminotransferases (ALT) by IFCC method Calculation for LDL cholesterol (mg/dl)

Serum SGPT catalyzes the transfer of chemical group between Total Cholesterol–(Triglycerides/5)-(HDLcholesterol) L-Alanine and alpha-ketoglutarate to create Pyruvate and (Freidwald et al.,1972) glutamate. The Pyruvate fashioned reacts with NADH within Calculation for VLDL cholesterol (mg/dl) the presence of to create NAD.The rate of reaction of NADH to NAD is measured as a decrease in VLDL-Cholesterol = Triglycerides/5(Freidwald et al.1972) absorbence that is proportional to the SGPT activity within the RESULTS sample. (J. Clin. Chem. Et al 1986). Table1 Association of FBG level in case and control Estimation of Serum Aspartate Aminotransferase (AST) by IFCC method Mean serum concentration of FBG in cases and controls is shown in table1 & figure1 Serum AST catalyzes the transfer of chemical group between L-Aspartate and alpha ketoglutarate to from oxalacetate and The mean of serum FBG in cases (179.34 ± 44.36) was higher glutamate. The oxalacetate fashioned reacts with NADH within than the mean of control subjects (93.52 ± 10.77). This the presence of Malate Dehydrogenase to create NAD.The rate difference was statistically significant (p<0.0001) of oxidization of NADH to NAD is measured as a decrease in FBG absorbance that is proportional to the SGOT (AST) activity Group N Mean Standard Deviation Significance within the sample. (J. Clin. Chem. et al 1986). Control 44 93.52273 10.77138 t-value=12.4701 Case 44 179.3409 44.36054 P<0.0001 Estimation of Alkaline Phosphatase (ALP) by DEA (Pnpp N= Number of cases, *p= probability (exact level of significance) Kinetic) method

Alkaline Phosphatase (ALP) at an alkaline pH hydrolyses p- 250 Nitrophenylphosphate to form p-Nitrophenol and Phosphate. 200 SD

The rate of formation of p-Nitrophenol is measured as a rise in ± 150 absorbance that is proportional to the ALP activity within the 100 sample. (Bowers. et al.1972)

MEAN MEAN 50

Estimation of cholesterolusing the kit coral clinical system, 0 India (Trinder et al.1969) 1 2

Serum total cholesterol was determined by an enzymatic CASE CONTROL (CHOD-PAP) colorimetric method. Cholesterol esterase hydrolyses esterified to free cholesterol. The free Figure 1 Compression of FBG in case and control cholesterol is oxidized to form hydrogen peroxide which Table 2 Association of ALT level in case and control further reacts with phenol and 4 aminoantipyrene by the catalytic action of peroxidase to form a red Mean serum concentration of ALT in cases and controls is coloredquinoneimine dye complex. Intensity of the colour shown in table2 & figure2 formed is directly proportional to the amount of cholesterol The mean of serum ALT in cases (53.09 ± 32.12) was higher present in the sample and was measured at 505nm. Colour is than the mean of control subjects (43.65 ± 11.35). This stable for 1 hr. difference was statistically significant (p<0.0698)

Estimation of Triglycerides (GPO/ PAP method) using the kit ALT coral clinical system, India (Trinder et al.1969) Group N Mean Standard Deviation Significance

39865 | P a g e International Journal of Recent Scientific Research Vol. 11, Issue, 10 (B), pp. 39863-39872, October 2020

Control 44 43.65909 11.35258 t-value=1.8360 Case 44 53.09091 32.12969 P<0.0698

N= Number of cases, *p= probability (exact level of significance)

90 80 70

SD 60

± 50 40 30 Figure 4 Comparison of ALP in case and control MEAN MEAN 20 10 Table5 Association of total cholesterol level in case and 0 control 1 2 Mean serum concentration of total cholesterol in cases and CASE CONTROL controls is shown in table5& figure5

The mean of serum total cholesterol in cases (181.45 ± 44.80) Figure 2 Comparison of ALT in case and control was higher than the mean of control subjects (145.13 ± 24.52). Table3 Association of AST level in case and control This difference was statistically significant (p<0.0001)

Mean serum concentration of AST in cases and controls is Total Cholesterol shown in table3 & figure3 Group N Mean Standard Deviation Significance Control 44 145.1364 24.52392 t-value=4.7167 The mean of serum AST in cases (36.22 ± 23.16) was higher Case 44 181.4545 44.80316 P<0.0001 than the mean of control subjects (25.97 ± 7.01). This N= Number of cases, *p= probability (exact level of significance) difference was very statistically significant (p<0.0061) 250 AST 200 Group N Mean Standard Deviation Significance

SD Control 44 25.97727 7.016554 t value=2.8092 ± 150 Case 44 36.22727 23.16359 P<0.0061 100

* N= Number of cases, p= probability (exact level of significance) MEAN 50

0

1 2 CONTROL CASE

Figure 5 Comparison of Cholesterol in cases and controls

Table 6 Association of TG level in case and control

Mean serum concentration of TG in cases and controls is shown in table 6 & figure 6

The mean of serum TG in cases (189.02 ± 83.51) was higher than the mean of control subjects (94.09 ± 19.60). This

difference was statistically significant (p<0.0001) Figure 3 Comparison of AST in case and control TG Table 4 Association of ALP level in case and control Group N Mean Standard Deviation Significance Control 44 94.09091 19.60994 t-value=7.3406 Mean serum concentration of ALP in cases and controls is Case 44 189.0227 83.51284 P<0.0001 shown in table 4 & figure 4 N= Number of cases, *p= probability (exact level of significance)

The mean of serum ALP in cases (119.20 ± 38.33) was higher 300 than the mean of control subjects (90.5 ± 13.96). This 250 difference was statistically significant (p<0.0001) SD 200 ± 150 ALP 100

Group N Mean Standard Deviation Significance MEAN 50 Control 44 90.5 13.96757 t-value=4.6665 Case 44 119.2045 38.33729 P<0.0001 0 1 2 N= Number of cases, *p= probability (exact level of significance) CASE CONTROL

Figure 6 Comparison of TG in cases and controls Table7 Association of HDL level in case and control

Mean serum concentration of HDL in cases and controls is 180 shown in table 7&figure 7 160 140

SD 120 ± 100 80 60 39866 | P a g e MEAN 40 20 0 1 2 CASE CONTROL Dr Saba khan., A Study of Liver Enzyme and Lipid Profile in Newly Diagnosed Type 2 Diabetes Mellitus

The mean of serum HDL in cases (36.22 ± 8.34) was lower 60 than the mean of control subjects (41.11 ± 4.83). This 50 difference was very statistically significant (p<0.0012)

SD 40 ± HDL 30 Group N Mean Standard Deviation Significance 20

Control 44 41.11364 4.833102 t-value=3.3622 MEAN Case 44 36.22727 8.341166 P<0.0012 10

N= Number of cases, *p= probability (exact level of significance) 0

1 2 50 CONTROL 45 CASE 40 35 SD Figure 9 Comparison of VLDL in case and control

± 30 25 20 Table10 Show correlation coefficient among the study

MEAN 15 parameters in cases 10 5 Pearson correlation coefficient among the study parameters 0 1 2 Correlations FBG ALT AST ALP TC TG HDL LDL VLDL CASE CONTROL Pearson 1 .168 .179 .107 .186 -.017 .251 .192 .016 Correlation FBS Sig. (2- .275 .244 .490 .226 .913 .100 .212 .918 Figure 7 Comparison of HDL in cases and controls tailed) N 44 44 44 44 44 44 44 44 44 Table8 Association of LDL level in case and control Pearson ** .168 1 .451 .193 .205 -.144 .038 .219 -.070 Mean serum concentration of LDL in cases and controls is Correlation ALT Sig. (2- .275 .002 .208 .181 .352 .805 .153 .652 shown in table 8 & figure 8 tailed) N 44 44 44 44 44 44 44 44 44 The mean of serum LDL in cases (108.97 ± 39.27) was higher Pearson .179 .451** 1 .120 .013 -.278 -.038 .099 -.240 than the mean of control subjects (85.15 ± 22.23).This Correlation AST Sig. (2- difference was very statistically significant (p<0.0007) .244 .002 .439 .936 .068 .808 .522 .116 tailed) LDL N 44 44 44 44 44 44 44 44 44 Group N Mean Standard Deviation Significance Pearson .107 .193 .120 1 .160 -.112 .006 .155 -.066 Control 44 85.15909 22.23337 t-value=3.5007 Correlation Case 44 108.9773 39.27511 P<0.0007 ALP Sig. (2- .490 .208 .439 .299 .469 .970 .314 .669 N= Number of cases, *p= probability (exact level of significance) tailed) N 44 44 44 44 44 44 44 44 44 Pearson .186 .205 .013 .160 1 .451** .194 .937** .464** 160 Correlation 140 TC Sig. (2- 120 .226 .181 .936 .299 .002 .206 .000 .002 SD tailed)

± 100 80 N 44 44 44 44 44 44 44 44 44 60 Pearson - - -.144 -.278 .451** 1 -.371* .213 .980**

MEAN 40 Correlation .017 .112 20 TG Sig. (2- .913 .352 .068 .469 .002 .013 .166 .000 0 tailed) 1 2 N 44 44 44 44 44 44 44 44 44 Pearson .251 .038 -.038 .006 .194 -.371* 1 .201 -.385** CASE CONTROL Correlation HDL Sig. (2- .100 .805 .808 .970 .206 .013 .190 .010 Figure 8 Comparison of LDL in case and control tailed) N 44 44 44 44 44 44 44 44 44 Table 9 Association of VLDL level in case and control Pearson ** .192 .219 .099 .155 .937 .213 .201 1 .224 Mean serum concentration of VLDL in cases and controls is Correlation LDL Sig. (2- shown in table 9 &figure 9 .212 .153 .522 .314 .000 .166 .190 .144 tailed) The mean of serum VLDL in cases (37.97 ± 16.68) was higher N 44 44 44 44 44 44 44 44 44 Pearson - - than the mean of control subjects (18.72 ± 3.77).This difference .016 -.070 -.240 .464** .980** .224 1 Correlation .066 .385** was statistically significant (p<0.0001) VLDL Sig. (2- .918 .652 .116 .669 .002 .000 .010 .144 tailed) VLDL N 44 44 44 44 44 44 44 44 44 Group N Mean Standard Deviation Significance **. Correlation is significant at the 0.01 level (2-tailed). Control 44 18.77273 3.771766 t-value=7.4458 *. Correlation is significant at the 0.05 level (2-tailed). Case 44 37.97727 16.68796 P<0.0001 * N= Number of cases, p= probability (exact level of significance)

39867 | P a g e International Journal of Recent Scientific Research Vol. 11, Issue, 10 (B), pp. 39863-39872, October 2020

R² = 0.028 180 400 160 350 140 300 R² = 0.000 120 250 100 200

TG Series1

ALT 80 60 150 40 100 20 50 Linear 0 0 (Series1) 0 50 100 150 200 250 300 350 400 0 100 200 300 400

FBG FBG

Figure 10 Scatter diagram showing correlation between ALT and FBG among Figure 14 Scatter diagram showing correlation between TG and FBG among cases cases

160 60 140 R² = 0.032 50 120 R² = 0.063 100 40

T Series1 80 30 Series1 AS 60 HDL 20 40 Linear 10 Linear 20 (Series1) (Series1) 0 0 0 100 200 300 400 0 100 200 300 400 FBG FBG

Figure 11 Scatter diagram showing correlation between AST and FBG Figure 15 Scatter diagram showing correlation between HDL and FBG among cases 250 R² = 0.011 200 200 180 150 160 140 R² = 0.036

100ALP 120 Series1 100 Series1 50 Linear (Series1) LDL 80 60 0 40 Linear 20 (Series1) 0 100 200 300 400 0 FBS 0 100 200 300 400

FBG Figure 12 Scatter diagram showing correlation between ALP and FBG among cases Figure 16 Scatter diagram showing correlation between LDL and FBG among cases 300 250 80 R² = 0.034 70 200 60 R² = 0.000 150 TC Series1 50 100 40 Series1 50 Linear VLDL 30 (Series1) 20 0 Linear 10 (Series1) 0 100 200 300 400 0 FBG 0 100 200 300 400 FBG

Figure 13 Scatter diagram showing correlation between TC and FBG among

cases Figure17 Scatter diagram showing correlation between VLDL and FBG among cases

39868 | P a g e Dr Saba khan., A Study of Liver Enzyme and Lipid Profile in Newly Diagnosed Type 2 Diabetes Mellitus

DISCUSSION decreased HDL-C due to decrease in hepatic lipase activity resulting in decrease VLDL clearances which are metabolic Liver helps in regulating metabolisms including maintenance of abnormalities characterizing metabolic syndrome (Imamura et normal blood glucose concentration in fasting and postprandial al., 1993). states. With loss of insulin effect on the liver, there is promotion of glycogenolysis leading to increase hepatic SUMMARY & CONCLUSION glucose production and lipolysis leading to abnormal The present study was designed to evaluate liver enzymes and and excess fatty acid production. Abnormalities of lipid profile in newly diagnosed type 2 diabetes mellitus. triglyceride storage and lipolysis in insulin-sensitive tissues The parameters estimated were such as the liver are an early manifestation of conditions characterized by insulin resistance and are detectable earlier FBG, ALT, AST, ALP, Total cholesterol (TC) Triglyceride than fasting hyperglycemia. Our findings on liver enzymes are (TG) High density lipoprotein cholesterol (HDL-C) Low similar to previous studies .Abnormalities of glyceride storage density lipoprotein cholesterol (LDL-C) Very low density and lipolysis in hypoglycaemic agent-sensitive tissues like the lipoprotein (VLDL) were compared with that of normal healthy liver are an early manifestation of conditions characterised by individuals. insulin resistance and are detectable sooner than abstinence The present study finding indicates that all the parameter hyperglycaemia. Our findings on liver enzymes are the same as previous studies (Erbey et al., 2000; Colditz et al.,  Considering incidence of parameters FBG (p<0.0001), 1995).AST, ALT and ALP were all significantly elevated ALT (p<0.0698),AST (p<0.0061), ALP (p<0.0001), compared with controls, this could be due to direct hepatotoxic Total cholesterol (p<0.0001), Triglycerides (0.0001), effect of fatty acid on the liver when it is produced in excess. LDL-C (p<0.0007), VLDL (p<0.0001) which was Mechanisms for this could comprise cytomembrane disruption significantly higher in casesas compared to control at high concentration, mitochondrial disfunction, poisonous except for HDL-C (p<0.0012) that was lower in cases substance formation, and activation and inhibition of key steps as compared to controls. Therefore, it showed that within the regulation of metabolism.It is conjointly elevated AST, ALT, LDL and low HDL may predict hypothesized that the elevated ALT, a gluconeogenic catalyst certain disturbances in lipoprotein metabolism. whose factor transcription is suppressed by hypoglycaemic  The present study thus demonstrates that this agent, may indicate impairment in hypoglycaemic agent association may help to develop future strategies for signalling instead of strictly hepatocyte injury (Chan et al., prevention from type 2 DM and through proper 1994).In the current study there was important rise in every lifestyle modification or medical management or by macromolecule parameters and liver enzymes except ALP, that the combination of both. conjointly raised however it had been not statistically important  The results of this study suggests that the patients with (p=0.236) (Philip R et al 2014). In North India, reportable newly diagnosed type 2 diabetes mellitus are more blood serum levels of AST, ALT, ALP and GGT all were likely to exhibit dyslipidemia and liver disease than important elevation in type II DM patients as compared to healthy subjects. control(p<0.5) ( Deepika G et al 2016). Lipid and compound protein abnormalities are common within the diabetic Bibliography population because of the consequences of hypoglycemic agent 1. AGA Technical Review on the Evaluation of Liver deficiency and hypoglycaemic agent resistance on key Chemistry Tests. Gastroenterology 2002; 123: 1367- metabolic enzymes (Decode study group., 1999).The result o f 1384. this study showed significant increased levels o f total 2. 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Mohmmad Imran et al .2020, A Study of Liver Enzyme and Lipid Profile in Newly Diagnosed Type 2 Diabetes Mellitus. Int J Recent Sci Res. 11(10), pp. 39863-39872. DOI: http://dx.doi.org/10.24327/ijrsr.2020.1110.5577

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