The Association between Elevated Serum Gamma Glutamate Transferase Level and Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus


  • Abdulkareem Mohammed Abdulkareem Alhashimi i ( MBChB, Diploma Internal Medicine, FICMS Internal Medicine )
  • Talib Hussein Kamoona ( MBChB, CABM )


Diabetes mellitus, Gamma-glutamyltransferase, neuropathy


Background: diabetes mellitus is a common disorder worldwide. Type 2 is the
commonest form of this disorder. Patients with DM type 2 have a higher
susceptibility to develop certain complications including diabetic peripheral
neuropathy which often leads to foot ulceration and consequently amputation. One
of the major contributers to the development of this complication is the oxidative
stress. Gamma glutamyl transferase (GGT) is an enzyme that increases in level
with increasing oxidative stress.
Aim of the Study: To determine the strength of association between serum GGT
and the presence of diabetic peripheral neuropathy, and to detect whether elevated
serum GGT can be used as an early marker for the development of diabetic
peripheral neuropathy.
Methodology: This study is a case-control study that included a total of 60
participants: 30 patients of type 2 DM with peripheral neuropathy (cases) and 30
patients of type 2 DM without peripheral neuropathy (controls). Data was collected
from Al-Sadr Medical City and Middle Euphrates Center for Neurological
Sciences (Al-Najaf – Iraq) during the period from November 2017 through January
Results: Statistical analysis of the data shown that there is a strong statistical
significance indicating significant relationship between elevated serum GGT levels
and the presence of peripheral neuropathy in study population (χ2 = 13.07 , d.f =
1 , P < 0.001).
Conclusion: Elevated level of serum GGT is associated with diabetic peripheral
neuropathy in patients with type 2 DM.


Wild S, Roglic G, Green A, Sicree R, King H. Global Prevalence of Diabetes: Estimates for the year 2000

and projections for 2030. Diabetes Care. 2004;27(5):1047-1053.

Cho H. The Association between Serum GGT Concentration and Diabetic Peripheral Polyneuropathy in

Type 2 Diabetic Patients. Korean Diabetes Journal. 2010;34(2):111-118.

Hossain P, Kawar B, El Nahas M. Obesity and Diabetes in the Developing World — A Growing Challenge.

New England Journal of Medicine. 2007;356(3):213-215.

Iraq Family Health Survey 2006/7. Prevalence of non communicable diseases and risk factors in Iraq, A step

wise approach. National survey implemented by Ministry of Health, Directorate of Public Health and Primary

Health Care and Ministry of Planning and Development Cooperation in collaboration with World Health

Organization (WHO)/Iraq-Baghdad, 2006/7.

Olokoba A, Obateru O, Olokoba L. Type 2 Diabetes Mellitus: A Review of Current Trends. Oman Medical

Journal. 2012;27(4):269-273.

Piero M, Nzaro G, Njagi J. Diabetes mellitus – a devastating metabolic disorder. Asian Journal of

Biomedical and Pharmaceutical Sciences. 2014;04 (40):1-7.

Azevedo M, Alla S. Diabetes in sub-saharan Africa: Kenya, Mali, Mozambique, Nigeria, South Africa and

Zambia. International Journal of Diabetes in Developing Countries. 2008 ;28(4):101-8.

M. Wilson N, E. Wright D. Inflammatory Mediators in Diabetic Neuropathy. Journal of Diabetes &

Metabolism. 2012;01(S5).

Bhat M. Diabetic Neuropathy - A Review. European Journal of Biomedical and Pharmaceutical Sciences.


Boulton A, Vinik A, Arezzo J, Bril V, Feldman E, Freeman R et al. Diabetic Neuropathies: A statement by

the American Diabetes Association. Diabetes Care. 2005;28(4):956-962.

Abdullah Q, Omer S, Mohammed M. Diabetic polyneuropathy: role of oxidative stress and inflammation.

World journal of pharmacy and pharmaceutical sciences. 2015;4(2): 88-101.

Al-Ani Y. Predicting Microvascular Complications in Diabetic Patients. Iraqi Journal of Medical Sciences.


de M. Bandeira S, da Fonseca L, da S. Guedes G, Rabelo L, Goulart M, Vasconcelos S. Oxidative Stress as

an Underlying Contributor in the Development of Chronic Complications in Diabetes Mellitus. International

Journal of Molecular Sciences. 2013;14(2):3265-3284.

Jyothirmayi B, Sanjayseth, Kaviarasi S, William E. Study of serum GGT levels and lipid profile in diabetic

peripheral neuropathy, International Journal of Pharma and Bio Sciences. 2012;3(4):(B)995-1000

Whitfield J. Gamma-glutamyl transferase. Critical Reviews in Clinical Laboratory Sciences. 2001;38:263–

Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M et al. Nonalcoholic Fatty Liver

Disease: A Feature of the Metabolic Syndrome. Diabetes. 2001;50(8):1844-1850.

Meisinger C, Löwel H, Heier M, Schneider A, Thorand B. Serum

γ-glutamyltransferase and risk of type 2 diabetes mellitus in men and women from the general population.

Journal of Internal Medicine 2005;258:527-35.

Herder C, Lankisch M, Ziegler D, Rathmann W, Koenig W, Illig T

et al. Subclinical Inflammation and Diabetic Polyneuropathy: MONICA/KORA Survey F3 (Augsburg,

Germany). Diabetes Care. 2009;32(4):680-682.

Boulton A, Malik R, Arezzo J, Sosenko J. Diabetic Somatic Neuropathies. Diabetes Care 2004;27(6):1458-

Lee D, Gross M, Jacobs D. Association of Serum Carotenoids and Tocopherols with γ-Glutamyltransferase:

The Cardiovascular Risk Development in Young Adults (CARDIA) Study. Clinical Chemistry 2004;50(3):582-

Gordis L. Epidemiology. Philadelphia, Pennsylvania: Elsevier Saunders; 2014