Volume 9
Medical
lou mal
Number :2
or Ihe
Summer 137-1
Augusl 1995
Islamic Republic of Ir.Ll!
COMPA RISON OF LEVELS OF IgG, IgA, AND IgM IN
DIABETIC PATIENTS WITH DIFFERENT GLYCEMIC
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CONTROLS
GHOLAM REZA PISHDAD, M.D.,
AND
ZAHRA FAGHIRI"
Frolll fIll' Seclion oj Endocrinology, Del'arllJll!nl oj Inlenlal Ml'riicilll!, clnd the 'Section oj11I1I1111f1O/OKY,
DI!J'(lrll1ll'IU (if PallwioRY, Shiraz Univl'tsiry (JJMedical SCit'IU'£'S, Shiraz, Islamic RI!J'llhlic oj lrall.
ABSTRACT
[mmunoglobulins G, A, and M have been reponed to be present in statistically
significant higher levels in diabetic patients compared to healthy comrols. II may
be conceived that the levels of immunoglobulins might be significantly higher in
diabetics with long-lasting (months of) poor control than in peers with an equally
long term period of good control. To assess this possibility, we measured and
compared serum levels of IgG, IgA, and IgM in two diabetic popUlations; one
consisting of 27 patients with mean values of at least monthly-measured fasting
plasma sugars during the 3 months prior to the study of 140 mg/dL or less, and the
second group consisting of 34 diabetics with mean levels of fasting plasma
glucoses for each patient during the same interval in excess of I (iO mg/dL. We
found that, while the mean blood sugars were remarkably different between the
groups (P <0.00 I), the difference between mean values of serum immunoglobulins
were not statistically significant (P-values more dlan 0.3, 0.8, and O.X for IgG, IgA,
and IgM, respectively). We conclude that no relationship exists between long­
lasting glycemic controls and serum immunoglobu[in levels in diabetics.
K(!y Words: Diabetes mdlilus, glyco!ll1ic conlrol. immunoglobulins
M.lIRI, Vol. 9, No.2, 123-125, 1995.
INTRODUCTION
dependent) diahetes mellitus. a chronic hyperglycemic
disorder in which aULOimmunity does not play a role in
III all initi[� investigation, we founu higher levclsofigG.
palhogl!nesis. similar ahnormalities were oemonslralcu...l
I diabetics in comp[u"isoll with those
Our findings ofhyperimmullogiohulinemia hoth in Iype
ohtailled irom he'�thy cOlltrols.' We assumed that possihk
I and Iype 2 diahetes mellitus suggeslt:Ll that the shared
IgA. anu IgM in type
Inelabolic disturb,mce (i,e. chronic Ilyperglycelni,l) was the
immuno-inflammatory abnorrnalitiesJ·-1 were the underlying
cause for the elevated immunoglobulins in our patients with
underlying
IDDM and its complications, mId that these abnoflm�ities
hyperimmunoglobulinemia coul� also he ILlokc� UpOIl as a
cause
for
this
finding
ant.1
Ihal
might have either aralc in the genesis of type I diabetes.md
possible complication of diahctcs mellitus.' With this
its complications or may themselves be a complication
consideration, we found il of interest 10
thereoL'
III a subsequent study in type 2 (non-insulin-
set; if Ihcrc is any
palit;I1IS
difference in immulloglobulin kvels in Lliaht;tic
wilh iong-tenn (months ot) diflcrcllI glyccmic controls.
Currespondence: G.R. Pishdnd, M.D., Section of
PATIENTS ANn METHOUS
EnJocrinolof:y & Metabolism, Department of Internal
Medit,;inc, Shiraz University of Medical Sciences, P.O. Box
71365-577, Shiraz, Islamic Republic of Iran.
Twenty-seven consl!cutive diabetic patients with lll�allS
[23
Glycemic Control and Jg Levels in Diabetics
of at leaSI monlhly-measured 1;lsling plasma sugars during
Ihe preceding 3 months of 140 mg/dL or less. were selecled
as group A. Thirty-fourconsccutive diabetics with lI1can� of
at lenst monthly-measured fasting plasma glucoses for each
patient for 3 successive months prior 10 the stuuy in ext.:cs�
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of 160 mg/dL were selecled as group B. CU'dul clinical as
well as routine paraciinical slUdies had excluded any diahelic
,5
(>--()
Group A
patients with evidence of rccl!nl infections or history of
--..
chronic infectious diseases. Furlhennore. palicnls with a
Group
B
2"
5
history of drug addiction.' any accompanying plilmonmy or
hepatic disease, oranyclinical problems unrelated 10 diaheles
mellitus orils known complications were not included in the
0
A
·15
study. Serum immunoglobulin concentrations were measured
55
by ",dial immunodiffusion lechnique' wilh a modified
�4.5
12.5
165
205
Serum lCVl'ts or 196 (gm/l
32.5
slandard procedure as described elsewhere.'.' Sludent's I
lesl was employed for slatislical analysis.
0--0
Group A
25
RESULTS
,.......,
Group B
In group A, Ihere were 27 palienls, 13 male and 14
fem:de, wilh a mean age al diagnosis of 39.15 ± 16.12 years
(mean ± SD), wilh a nlllge Irom 910 72 years. Tile dU"'tion
of disease (mean ± SD) for Ihe smne group w,,� 5.13 ± 4.21.
wilh a range of 0-13 years.
o
In group B. Ihere were 16 modes and 18 fem:des, making
B
1 05
�05
a 10lal of 34 patienls, wilh a mean age at diagnosis of 40.12
3.05
-1.05
S�rum lev�ls of IQA 19m1
± 12.85 years (mean ± SD), wilh a nlllge from 410 62 years.
605
505
7nS
805
U
The duralion of disease for U,e same group was 6.94 ± 4.67
years (mean ± SD), wilh a range of 0-20 years.
As seen in Table I, while the mean of monthly plasma
&--<l
6rtluu I-
glucoses was rcmarlatbly differenl between Ihe groups
(117.50 ± 24 versus 221.50 ± 42 mg/dL, P < 0.001), Ihe
difference between mean v<duesof serum immunoglobulins
were not slatislic,dly signillcanl. As demonstraled, for IgG,
the mean value for group A was 16.50 ± 4.50 gm/L (mean
o
± SD) as compared with 16 ± 4 gm/L for group B (P> 0.6).
IgA had a v,due of 3.5 ± 1.5 gm/L (me:lll ± SD) in group A
c
c
0.85
165
:;:.35
).25
Serum L('vets (If
and 3.5 ± 5 gm/L in group B (P > 0.9). IgM v<dues were 3 ±
0.5 gm/L and 2.5 ± 3.5 gm/L (mean ± SD) for groups A and
405
-165
5 6S
6 45
l�r'l !!�mfLl
Fig 1. Comparison uf the frcqucm;ics uf serum kvcls til' IgG
(A), IgA (B), and IgM ee) in the Iwo diabctic groups.
B, respectively (P > 0.5). Furlhermore. correlation sludies
did not reveal any relationship bel ween plasma sugars and
immunoglobulin levels in eilher l,'Toup.
DISCUSSION
The comparison of U,e frequencies of serum levels of
IgO in the two diabelic groups is depicled in Fig. I-A; as
seen. the proportions are almost identiciu for both.
Our previous studies un immunoglobulin levels in
Fig. I-B illustrales Ihal. in the "",e of IgA. while group
diabelics have revealed higher levels of IgO. IgA. and IgM
A had higher frcLJuencit!s for levels up LO 3.55 gm/L. group
in patients compareu to healthy cllntrols.I,4
B exceeded ill proportions at higher serum levels.
Thissludy w'L)
' uesigned
The comparison of Ihe frequencies of serum levels of
levt.!ls in two groups of long-lasting well- :Ulu long-Iasting
IgM belween Ihe Iwo groups is demonstraled in Fig. I-C. As
puorly-controlled uiabetics,
seen, both groups share almost similar frequencies.
RotlriguL:z-Segade, et aJ. in their investigation of Ihe
124
G.R. Pishdad, M.D., and Z. Faghiri
Table I. Serum im ll lun ogio hulin nmcl'ntraliuns and mean of
tasting ph.lsrna glul'llsl.'!'. in till' two diahelk pupulations.
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Study Group·
Mean±SD··
Group A
16.50± 4.5
Group B
16±4
IgG
Group A
Range**
1.25
•
3.5± 1.5
similar resuIrs were demonslraled (Pishdad el al.
1.5 - 8
Group B
3.5±5.00
1.50 - 6.50
Group A
3±0.50
1 -6
Group B
25±3.50
1- 4.50
hyperimmunoglobulinemia may be seen in both lypes of
Group A
117.5±24
72 -133.50
idiopathic diabetes mellitus,l,", the magnitude of chronic
(monlhs ot) hyperglycemia probably does nor influence ils
degree.
NS
FRS"
REFERENCES
<0.001
Group B
Group A
**
NS
NS
IgM
Group B
In a subsequenl study on slill a !;rrger group of diabelics,
when means of blood sug,rrs were replaced by'HgA,c levels,
30.5
9 - 30.5
=
=
221.50±42
158.5 - 330.5
1. Pishdad GR, Hosseini JaddaeeH. Ghalambor MA: Detennination
of the immu noglobulin s in the sera of insu lin-depe.ndcnt diabetic
Imrly well-cuntrolled dwhdll; pa[(l!Ots.
patients. Iranian Journal of Medical Sciences 16: 156-161,
diabetic patients in relatively poor control.
Mean of at least monthly fasting pinsmll glur.;oses from 3 months
prior to slur..Iy.
Figures have been rounded to the nearest digits or their fifth tenths.
NS
=
signifiC'Ullly differem in diabelics wilh long-Icrm (momhs
of) poor conlrol when compared \Vitil welI-C<1l1trolied peers.
unpublished). We Iherefore conclude lhal alIhough
IgA
*'
PM yalue
and most direct method for quantitation of total
illlmunoglobulins6) and demonstrated thm, contrary to
L:xpectation, serum levels of immunoglobulins were not
1991.
2. Drell DW, Notkins AL: Multiple illllllunological abnormalities
\
in patients with type 1 (insulin-dependent) dinbetes mellitus.
Diabelologia 30: 132-143. 1987.
not significant.
3. Eisenbarth OS: Type I diabetes mellitus: a chronic autoimmune
discasc. New Eng J Med 314: 1360-7, 1986.
effect
fructosmnine demonstrated signiticiUlt correlations belween
the concentration of fructosmnine and JgG, JgA, (Uld JgM.7
But pmtial cOiTelation studies between fructosamine and
various serum proteins revealed that, concerning the
4. Pishdad G R , H o s s e i n i Jaddaee H, Ohalambor M A :
Hyperimmunogiobulinemia a s a possible consequence o f
hyperglycemia. Iranian Journal of Medical Sciences 1 7 : 3238.1992.
5. Cushman P, Grieco MH: Hyperimmunoglobulinemia associated
with narcotic. Am J Med 54: 320, 1973.
relationship he tween fructosmnine and each of the three
6. Fahey JL, McKelvey EM: Quantitative determination of serum
immunoglobulins, only IgA uemollstrated significant
immunoglobulins in antibody-agar plates. J Immun 94: 84-94.
correlation.7 Singh �md Kulig also demonSlrateu a significant
1965.
correlation between fructosamine and IgA in uiahetic
7. Rodriguez-Segadc S, Lojo S, C3Inina MF, et al: Effects of
patients.M
various serum proteins on quantification of fructosaminc. Clin
While Ihere are numerous siudics in regard 10 Ihe levels
Chem 35: 134-138, 1989.
of glycared immunoglobulins and Iheir relalionships wilh
8. Singh J, Kulig KA: Effects of albumin and immunoglobulin A
either fructosmnine (two week average glycemia'i) or glycated
on fructosmnine assay. Clin Chem 38: 824-830, 1992.
hemoglobin (six to eight week average gIycemialO), to our
9 Armbruster DA: Fructosamine: structure, analysis, and clinical
knowledge there ha.i\. 1L':i of yet, been no investigation
usefulness. Clio Chem 33: 2153-63, 1987.
regarding the levels of total immunoglobulins in diabetic
10. Goldstein DE, Little RR, Wiedmeyer HM, et al: Glycateu
hemoglobin: methodologies and clinical applications. Clin
patients in relation to long-term (months ot) glycemic
control. In this work we measured total immunoglobulinsG,
Chem 32 (Suppl
A. 'Uld M by radial immunodiffusion lechniquc (ihe simplcsi
125
B): 64-70.1986.
of v