Serum CA 19–9 Level is Correlated to the Clinical Characteristics and Chronic Complications of Patients Newly Diagnosed with Type 2 Diabetes Mellitus

Abstract

Aim This study investigated the relation of serum carbohydrate antigen 199 (CA 19–9) levels to the clinical characteristics and chronic complications of patients newly diagnosed with type 2 diabetes mellitus (T2DM).

Methods A total of 371 patients newly diagnosed with T2DM and 133 healthy people with consecutively matched age were compared. The 371 patients with T2DM were divided into four groups by quartiles based on their serum CA 19–9 levels, in which clinical characteristics and chronic complications, such as diabetic retinopathy (DR), diabetic nephropathy, and macrovascular complications were compared. Logistic regression analysis was used to evaluate the risk factors of DR.

Results Among the 371 patients newly diagnosed with T2DM, 60 had elevated CA 19–9 levels (16.17%). The frequencies of elevated serum CA 19–9 were 24.39% (30 of 123) for females and 12.10% (30 of 248) for males, in which the values for females were higher than those for males (P<0.01).Differences were observed among the serum CA 19–9 levels, hemoglobin A1c (HbA1c), and DR (P<0.05). Logistic regression analysis showed that serum CA 19–9 levels, fasting blood glucose (FBG) and fasting C-peptide (FC-P) were risk factors for DR (P<0.05).

Conclusions Serum CA 19–9 levels were correlated with HbA1c and DR in patients newly diagnosed with T2DM. The elevated serum CA 19–9 levels, high FC-P, and FBG levels were important risk factors for DR in patients newly diagnosed with T2DM.

Key words

type 2 diabetes mellitus - CA 19–9 - hemoglobin A1c - diabetic retinopathy

Publication History

Received: 21 May 2019
Received: 31 July 2019

Accepted: 09 August 2019

Article published online:
28 August 2019

• References

• 1 Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol 2016; 22: 9694-9705 doi: 10.3748/wjg.v22.i44.9694
• 2 Gul K, Nas S, Ozdemir D. et al. CA 19-9 level in patients with type 2 diabetes mellitus and its relation to the metabolic control and microvascular complications. Am J Med Sci 2011; 341: 28-32 doi:10.1097/MAJ.0b013e3181f0e2a0
• 3 Wolfgang CL, Herman JM, Laheru DA. et al. Recent progress in pancreatic cancer. CA Cancer J Clin 2013; 63: 318-348 doi:10.3322/caac.21190
• 4 Choe JW, Kim HJ, Kim JS. et al. Usefulness of CA 19-9 for pancreatic cancer screening in patients with new-onset diabetes. Hepatobiliary Pancreat Dis Int 2018; 17: 263-268 doi:10.1016/j.hbpd.2018.04.001
• 5 Torn C, Landin-Olsson M, Lernmark A. et al. Prognostic factors for the course of beta cell function in autoimmune diabetes. J Clin Endocrinol Metab 2000; 85: 4619-4623 doi:10.1210/jcem.85.12.7065
• 6 Cwik G, Wallner G, Skoczylas T. et al. Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions. Arch Surg 2006; 141: 968-973 Discussion 974. Doi:10.1001/archsurg.141.10.968
• 7 Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol 2007; 33: 266-270 doi:10.1016/j.ejso.2006.10.004
• 8 Benhamou PY, Vuillez JP, Halimi S. et al. Influence of metabolic disturbances of diabetes mellitus on serum CA 19-9 tumor marker. Diabete Metab 1991; 17: 39-43
• 9 Jiang Q, Lei L, Zhang X. et al. The correlated factors of serum CA19-9 levels in diabetic patients. Curr Diabetes Rev 2017; 13: 47-49 doi:10.2174/1573399812666151012115546
• 10 Teng D, Wu K, Sun Y. et al. Significant increased CA199 levels in acute pancreatitis patients predicts the presence of pancreatic cancer. Oncotarget 2018; 9: 12745-12753 doi:10.18632/oncotarget.23993
• 11 Yu H, Li R, Zhang L. et al. Serum CA19-9 level associated with metabolic control and pancreatic beta cell function in diabetic patients. Exp Diabetes Res 2012; 2012: 745189 doi:10.1155/2012/745189
• 12 Shimodaira M, Niwa T, Nakajima K. et al. The relation between CA 19-9 level and early-phase insulin secretion in normoglycemic and prediabetic subjects. Int J Biol Markers 2015; 30: e169-e173 doi:10.5301/jbm.5000130
• 13 Uygur-Bayramicli O, Dabak R, Orbay E. et al. Type 2 diabetes mellitus and CA 19-9 levels. World J Gastroenterol 2007; 13: 5357-5359
• 14 [Anonymous]. Activation of protein kinase C by elevation of glucose concentration: Proposal for a mechanism in the development of diabetic vascular complications. Proc Natl Acad Sci U S A 1991; 88: 9907
• 15 Flyvbjerg A, Thorlacius-Ussing O, Naeraa R. et al. Kidney tissue somatomedin C and initial renal growth in diabetic and uninephrectomized rats. Diabetologia 1988; 31: 310-314
• 16 Dankner R, Freedman LS, Gerstein HC. et al. Newly diagnosed type 2 diabetes may serve as a potential marker for pancreatic cancer. Diabetes Metab Res Rev 2018; 34: e3018 doi:10.1002/dmrr.3018
• 17 Kim SH, Baek CO, Lee KA. et al. Clinical implication of elevated CA 19-9 level and the relationship with glucose control state in patients with type 2 diabetes. Endocrine 2014; 46: 249-255 doi:10.1007/s12020-013-0058-0
• 18 Murai J, Soga S, Saito H. et al. Study on the mechanism causing elevation of serum CA19-9 levels in diabetic patients. Endocr J 2013; 60: 885-891
• 19 Murakami M, Nagai Y, Tenjin A. et al. Proposed cut-off value of CA19-9 for detecting pancreatic cancer in patients with diabetes: A case-control study. Endocr J 2018; 65: 639-643 doi:10.1507/endocrj.EJ17-0380
• 20 Zhang G, Chen H, Chen W. et al. Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study. Brit J Ophthalmol 2017; 101: 1591-1595 doi:10.1136/bjophthalmol-2017-310316
• 21 Xu J, Wei WB, Yuan MX. et al. Prevalence and risk factors for diabetic retinopathy: the Beijing Communities Diabetes Study 6. Retina 2012; 32: 322-329 doi:10.1097/IAE.0b013e31821c4252
• 22 Larsen MB, Henriksen JE, Grauslund J. et al. Prevalence and risk factors for diabetic retinopathy in 17 152 patients from the island of Funen, Denmark. Acta Ophthalmol 2017; 95: 778-786 doi:10.1111/aos.13449
• 23 Voigt M, Schmidt S, Lehmann T. et al. Prevalence and progression rate of diabetic retinopathy in type 2 diabetes patients in correlation with the duration of diabetes. Exp Clin Endocrinol Diabetes. 2018; 126: 570-576 doi:10.1055/s-0043-120570
• 24 Wang SY, Andrews CA, Herman WH. et al. Incidence and Risk Factors For Developing Diabetic Retinopathy Among Youths With Type 1 Or Type 2 Diabetes Throughout The United States. Ophthalmology 2017; 124: 424-430 doi:10.1016/j.ophtha.2016.10.031
• 25 Guo F, Zhou T, Tang J. et al. Related risk factors between subclinical carotid atherosclerosis and diabetic retinopathy in newly diagnosed type 2 diabetes mellitus in china. Exp Clin Endocrinol Diabetes 2019;
• 26 Nakamura N, Aoji O, Yoshikawa T. et al. Elevated serum CA19-9 levels in poorly controlled diabetic patients. Jpn J Med 1986; 25: 278-280
• 27 Ghamdi AHA. Clinical Predictors of diabetic retinopathy progression; A Systematic Review. Curr Diabetes Rev 2019;
• 28 Peng ZH, Wan DS, Li LR. et al. Expression of COX-2, MMP-2 and VEGF in stage II and III colorectal cancer and the clinical significance. Hepatogastroenterology 2011; 58: 369-376
• 29 Horikawa Y, Suzuki A, Enya M. et al. Periodontal disease may be associated with the occurrence of diabetic retinopathy: A subgroup analysis of the survey of the diabetes coordination notebook in gifu. Exp Clin Endocrinol Diabetes 2019;
• 30 Hampton BM, Schwartz SG, Brantley Jr. MA. et al. Update on genetics and diabetic retinopathy. Clin Ophthalmol 2015; 9: 2175-2193 doi:10.2147/OPTH.S94508
• 31 Steffes MW, Sibley S, Jackson M. et al. Beta-cell function and the development of diabetes-related complications in the diabetes control and complications trial. Diabetes Care 2003; 26: 832-836
• 32 Reddy S, Amutha A, Rajalakshmi R. et al. Association of increased levels of MCP-1 and cathepsin-D in young onset type 2 diabetes patients (T2DM-Y) with severity of diabetic retinopathy. J Diabetes Complications 2017; 31: 804-809 doi:10.1016/j.jdiacomp.2017.02.017
• 33 Yang J, Zhou MC, Feng K. et al. Clinical characteristics of 261 cases of hospitalized patients with type 1 diabetes mellitus. Chin Med Sci J 2016; 31: 69-75
• 34 Pikkemaat M, Melander O, Molstad S. et al. C-peptide concentration, mortality and vascular complications in people with type 2 diabetes. The Skaraborg Diabetes Register. Diabet Med 2015; 32: 85-89 doi:10.1111/dme.12608
• 35 Takao T, Inoue K, Suka M. et al. Optimal cutoff values of fasting plasma glucose (FPG) variability for detecting retinopathy and the threshold of FPG levels for predicting the risk of retinopathy in type 2 diabetes: A longitudinal study over 27years. Diabetes Res Clin Pract 2018; 140: 228-235 doi:10.1016/j.diabres.2018.03.051