Impact of self-reported family history on some metabolic markers of type 2 diabetic patients

Salisu Babura Muazu; Hauwa Bako; Nnamah Kanayo Nwakasi; Oduola Taofeeq; Kabiru Sada Bello; Usman Dankoly Sani; Ahmad Muhammad Bello

doi:10.4103/njbcs.njbcs_4_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 18 | Issue : 2 | Page : 145-152

Impact of self-reported family history on some metabolic markers of type 2 diabetic patients

Salisu Babura Muazu¹, Hauwa Bako², Nnamah Kanayo Nwakasi³, Oduola Taofeeq⁴, Kabiru Sada Bello⁵, Usman Dankoly Sani⁶, Ahmad Muhammad Bello⁷
¹ Department of Internal Medicine, Rasheed Shekoni Specialist Hospital, Dutse, Jigawa State, Nigeria
² Department of Medical Laboratory Science, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
³ Department of Chemical Pathology, College of Health Sciences, Nnamdi Azikwe University, Nnewi, Nigeria
⁴ Department of Chemical Pathology, School of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
⁵ Department of Medicine, Federal Medical Centre, Gusau, Zamfara State, Nigeria
⁶ Department of Physiotherapy, Dutse General Hospital, Dutse, Jigawa State, Nigeria
⁷ Department of Medical Laboratory Sciences, College of Health Sciences, Bayero University, Kano, Nigeria

Date of Submission	06-Jul-2021
Date of Decision	19-Aug-2021
Date of Acceptance	16-Sep-2021
Date of Web Publication	10-Dec-2021

Correspondence Address:
Dr. Salisu Babura Muazu
Department of Internal Medicine, Rasheed Shekoni Specialist Hospital, Dutse, Jigawa State
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/njbcs.njbcs_4_21

Abstract

Context: Family history of type 2 diabetes mellitus (T2DM), hypertension (HTN) and obesity, are known non-modifiable, independent and easily assessed risk factors for incident type 2 diabetes. Aims: This study was aimed at assessing the effect of self-reported family history on the levels of some metabolic markers (total homocysteine [tHcy], high sensitivity C-reactive protein [hs-CRP] and glycated haemoglobin [HbA1c]) among patients with type 2 diabetes. Settings and Design: Two hundred and forty participants subdivided into Group 1 (T2DM only), Group 2 (T2DM diagnosed with HTN) and Group 3 (controls) were enrolled in a cross-sectional pattern. Subjects and Methods: A structured questionnaire was used to obtain information on self-reported family history. Biochemical parameters were assayed using standard laboratory procedures. Statistical Analysis Used: SPSS version 20.0 was used for statistical analysis with significance at P ≤ 0.05. Results: Group 1: Family history of type 2 diabetes (FHD) (HbA1c, P < 0.001, fasting plasma glucose 145, P = 0.005, triglycerides [TG], P = 0.049), family history of HTN (FHTN) (HbA1c, P < 0.001, FPG P = 0.005), family history of obesity (FHO) (HbA1c, P < 0.001, high-density lipoprotein cholesterol [HDL-C], P = 0.049). Group 2: FHD (tHcy, P = 0.021, HDL-C, P = 0.026), FHTN (tHcy, P = 0.035), FHO (HbA1c, P = 0.003, FPG, P = 0.001, TC, P < 0.001, TG, P = 0.019, LDL-C, P = 0.001). Group 3: FHD (tHcy, P = 0.004, HDL-C, P = 0.035), FHTN (FPG, P < 0.001, tHcy P = 0.010, TC, P = 0.037, TG, P = 0.003), FHO (hs-CRP, P < 0.001, HDL-C, P = 0.007, TG P = 0.001, LDL-C P = 0.019). Conclusions: Self-reported positive family history may provide insights into the biochemical and metabolic profile of patients with type 2 diabetes.

Keywords: Family history, metabolic markers, type 2 diabetes

How to cite this article:
Muazu SB, Bako H, Nwakasi NK, Taofeeq O, Bello KS, Sani UD, Bello AM. Impact of self-reported family history on some metabolic markers of type 2 diabetic patients. Niger J Basic Clin Sci 2021;18:145-52

How to cite this URL:
Muazu SB, Bako H, Nwakasi NK, Taofeeq O, Bello KS, Sani UD, Bello AM. Impact of self-reported family history on some metabolic markers of type 2 diabetic patients. Niger J Basic Clin Sci [serial online] 2021 [cited 2022 Aug 14];18:145-52. Available from: https://www.njbcs.net/text.asp?2021/18/2/145/332194

Introduction

Family history of disease is a useful screening tool and predictor of disease development.^[1] Worldwide, there has been a four-fold increase in the number of people living with diabetes mellitus over the past 30 years,^[2] which has imposed a substantial burden on the universal health-care system.^[3] Family history of diabetes (FHD) is an easily accessible medical record in the clinic, which has been observed to have an important association with diabetes.^[4],[5] Correspondingly, a study showed a four-fold increase in the risk of type 2 diabetes among participants with positive FHD compared with those without FHD.^[5] Particularly, family history of diabetes is meticulously associated with diabetes-related complications, including diabetic neuropathy, retinopathy^{[1],[6],[7],[8],[9]} and foot complications.^[10]

Diabetes, hypertension (HTN) and obesity are diseases which have a genetic component within family clusters.^[5] Lifestyle related and anthropometric risk factors such as waist circumference, physical inactivity and body mass index, are known attributors to the pathogenesis of type 2 diabetes.^[11] The clustering of such traits among families,^[6] may explain in part, the extra risk attributable to family history, although the link between family history-associated risk and common genetic variations is still unclear.^[11]

Family history of diabetes has been reported to account for at least 50% of the probability of being diagnosed with type 2 diabetes mellitus (T2DM)^[1] and is acknowledged to increase 2-4 folds when one or both parents are affected. In most instances, when both parents are affected, there is a 75% increased risk, while if one parent is affected, it increases the risk by only 15%. Notably, having a first-degree relative with type 2 diabetes may amount to 40% increase in the chance of developing diabetes.^[12] A significant relationship has been established between type 1 diabetes and positive family history.^[13]

Familial histories, either paternal or maternal, are associated with an earlier age of disease onset and with poor glycaemic control.^[12] However, in a study by Vassy et al. 2011,^[14] a feeble association was reported between genetic risk scores and the number of parents with diabetes. Understanding the joint, but separate contributions of genetics and environment in the progression of T2DM, remains a significant task towards its prevention and control, given the fact that the onset of and complications from T2DM can be prevented or delayed.^[11]

Establishing the relationship between the levels of metabolic markers and self-reported family history is becoming increasingly important. This study was aimed at assessing the effect of self-reported family history of type 2 diabetes, HTN and obesity on the levels of some metabolic markers among patients with type 2 diabetes.

Subjects and Methods

One hundred and sixty patients with type 2 diabetes attending the Endocrinology Unit, Department of Internal Medicine, Rasheed Shekoni Specialist Hospital, Jigawa State, were enrolled in the study using a cross-sectional design. The participants were grouped into three; 80 patients with type 2 diabetes not diagnosed with HTN served as Group 1, 80 patients with type 2 diabetes diagnosed with HTN served as Group 2 and 80 age-and-sex matched apparently healthy volunteers (controls) served as Group 3.

The study was performed in accordance with the ethical standards of the Research Ethics Committee guidelines of Rasheed Shekoni Specialist, Hospital Dutse Nigeria. Ethical approval was obtained from the Institutional Ethical Committee.

Written informed consent was obtained from all participants before data collection. Information on self-reported family history of type 2 diabetes, obesity, HTN (biparental, paternal, maternal or siblings) and relevant clinical details were obtained using a structured questionnaire. Pregnant women and patients diagnosed with gestational diabetes, type 1 diabetes, other specific forms of diabetes and unclassified diabetes, patients diagnosed with cardiovascular disease or stroke were excluded from the study.

Fasting plasma glucose (FPG) and lipid profile (total cholesterol [TC], triglycerides [TG] and high-density lipoprotein cholesterol [HDL-C]) were assayed using enzymatic methods (Agappe diagnostics, Cham, Switzerland GmbH) whereas low-density lipoprotein cholesterol (LDL-C) was calculated using Friedewald's equation (LDL-C = TC − [HDL-C + TG/5]) for TG values less than 4.56 mmol/l. Enzyme-Linked Immunosorbent Assay method (Monobind Inc., Califonia, USA and Cusabio, Wuhan, Hubei Province, China) was used to assay high sensitivity C-reactive protein (hs-CRP) and total homocysteine (tHcy), immunoturbidimetric method (Centronic GmbH, Wartenberg, Germany) was used to assay glycated haemoglobin (HbA1c). The Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis with significance at P ≤ 0.05.

Results

A total of two hundred and forty (240) participants were enrolled into the study in a cross-sectional pattern. The participants were grouped into three; type 2 diabetes only (Group 1), type 2 diabetes diagnosed with hypertension (Group 2) and apparently healthy volunteers (Group 3). As shown in [Table 1], the self-reported positive family history of obesity, hypertension and diabetes across the groups (1, 2 and 3) were (43.8%, 67.5%, 10.0%), (35.0%, 56.2%, 55%) and (28.8%, 50.0%, 35.0%) respectively.

Table 1: Socio-demographic characteristics of the study participants

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The pattern of biochemical metabolic markers across the group-1 was shown in [Table 2]: Family history of type 2 diabetes (FHD) (HbA1c, P < 0.001, fasting plasma glucose 145, P = 0.005, triglycerides [TG], P = 0.049), family history of HTN (FHTN) (HbA1c, P < 0.001, FPG P = 0.005), family history of obesity (FHO) (HbA1c, P < 0.001, high-density lipoprotein cholesterol [HDL-C], P= 0.049). [Table 3] shows the pattern of biochemical metabolic markers across the group-2. The FHD (tHcy, P= 0.021, HDL-C, P = 0.026), FHTN (tHcy, P = 0.035), FHO (HbA1c, P = 0.003, FPG, P = 0.001, TC, P < 0.001, TG, P = 0.019, LDL-C, P = 0.001). [Table 4] shows variations in biochemical parameters based on self-reported family history of type 2 diabetes, hypertension and obesity in Group 3: FHD (tHcy, P = 0.004, HDL-C, P = 0.035), FHTN (FPG, P < 0.001, tHcy P = 0.010, TC, P = 0.037, TG, P = 0.003), FHO (hs-CRP, P < 0.001, HDL-C, P = 0.007, TGP = 0.001, LDL-C P = 0.019).

Table 2: Variations in biochemical parameters based on self-reported family history of type 2 diabetes, hypertension and obesity in Group 1

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Table 3: Variations in biochemical parameters based on self-reported family history of type 2 diabetes, hypertension and obesity in Group 2

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Table 4: Variations in biochemical parameters based on self-reported family history of type 2 diabetes, hypertension and obesity in Group 3

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Discussion

Family history of diabetes is a strong risk factor for the development of type 2 diabetes^{[2],[15],[16]} though the precise factors accounting for this increase in risk are poorly understood. It is possible that the increased risk of type 2 diabetes is mediated partly by shared environmental and genetic components among family members, hence the association with a range of metabolic abnormalities.^[11] In this study, we observed a significant association between self-reported family history of type 2 diabetes with measures of glycemia and increased levels of TG and tHcy among patients with type 2 diabetes and controls. This may be because persons with a positive family history of diabetes tend to be more prone to the early development of diabetic complications^[12] such as diabetic retinopathy and nephropathy, coronary and peripheral artery diseases, which may be responsible in part for our finding of elevations in the levels of these markers. Our report is similar to that of Unnikrishnan et al. 2016.^[17] The outcome of our study may be used as a criterion for suggesting improved risk-reducing behaviours including lifestyle modification and increasing risk awareness for diabetes mellitus in persons with a positive family history of diabetes.

Self-reported family history of HTN (FHTN) correlated positively with concentrations of cardiometabolic markers in our study. The increase in the concentrations of these markers may be explained in part by the crosslink between the pathogenesis of type 2 diabetes and HTN as reported in the literature.^{[16],[18],[19]} Although, genetic risk factors, anthropometric and lifestyle changes provide a marginal proportion of the excess risk associated with family history,^[11] our findings of elevations in the concentrations of cardiometabolic markers among persons with a positive FHTN, may buttress the significance of documenting a family history of diabetes, HTN and obesity in the prediction of future cardiovascular complications among individuals.

It has been established that family history of type 2 diabetes is associated with increased risk of becoming overweight or obese and with a greater susceptibility to the negative consequences of increasing body fat, probably because of increased propensity to accumulate non-subcutaneous/ectopic fat and increased levels of pro-inflammatory markers,^[20] increased birth weight, gestational diabetes, body mass index, HTN, dyslipidaemia and decreased physical inactivity, contribute to the increased prevalence of type 2 diabetes, particularly in persons with a positive family history.^[1] We observed a significant association between self-reported family history of obesity and elevations in the concentrations of metabolic indicators and biochemical markers of inflammation, glycaemia and dyslipidaemia across the groups. Our finding reinforces the pivotal role obesity plays in the development of type 2 diabetes and its attendant consequences in the progression of co-morbidities. It is unclear from our study how family history imparts the levels of these markers but the indispensable role it plays cannot be overlooked.

The strength of our study lies in its ability to assay biochemical markers of both patients with type 2 diabetes and apparently healthy individuals with or without a self-reported family history of type 2 diabetes, HTN and obesity to permit comparison based on an incidence of family history.

The limitations of our study include the unavailability of documented evidence of family history of chronic diseases from the medical records of patients with type 2 diabetes. As a result, we had to opt for self-reported family history for both patients and controls.

Although genetic studies have proved a link between family history of diabetes and incident type 2 diabetes. Fewer studies have explored the likely differences in the concentrations of biochemical markers based on its presence or absence.

Our study may not give a true representation of the family history of type 2 diabetes, HTN and obesity in the general population which may be attributed to the fact that all reports of family history were based on participants' knowledge not clinical evidence.

Our findings may pave way for more detailed investigations on the likely causes of the variations in concentrations of metabolic biochemical markers in the presence or absence of family history of chronic diseases among patients with type 2 diabetes in Nigeria.

We also recommend the documentation of the family history of diabetes, HTN and obesity as part of the medical record for outpatients. That will no doubt assist in the assessment of patients and prediction of future risk for the development of type 2 diabetes through interpretation of the pattern of biochemical indices.

Conclusion

Self-reported positive family history may provide insights into the biochemical and metabolic profile of patients with type 2 diabetes which will no doubt aid assessment and monitoring in the course of disease progression. Although our scope of search may pose a limitation, our study is the first in northwestern Nigeria on the relationship between metabolic markers and family history of the disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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