Role of immunological and biochemical markers in bone turnover in type I diabetic patients in Karbala province, Iraq


  • Ahmed Abbas Hasan
  • Hams Ahmed Al Jndeel
  • Humam Kasem Hussein



Diabetes mellitus, pro-inflammatory cytokines, HbA1c, vitamin D, sPINP, sCTX


Introduction & Aim: Long-term diabetes mellitus (DM) is known to have a deleterious impact on bone health, resulting in change in bone mineral density, bone turnover, and bone quality, all of which increase the risk of fractures. The aim of. this study was to link immunological and pro-inflammatory cytokine (I.L-6, I.L-1, and TNF-alpha) markers in patients.with type 1 diabetes to Their connection to bones formation (sPINP) and bone resorption parameters (sCTX).


Materials & Methods: This study included 80 patients suffering from T1DM in the age range of 20-45 years. The patients were assayed for their biochemical (Vitamin D and HbA1c), Immunological (IL-6, IL-1 and TNF-alpha) parameters, as well as bone formation and resorption markers.


Results: HbA1c values were observed to be  7.5 in 85% of individuals, while vitamin D levels were 16 ng/mL. Correlation in patients with HbA1c 7.5. The results of a linear regression between I.L-6 and sCTX showed that there was an increase in sCTX for each unit of IL-6.


Conclusion: In patients with HbA1c levels 7.5, there is an association between IL-6, TNFalpha, and the bone resorption. TNF-alpha and IL-6 have been linked to metabolic control loss.

Author Biographies

Ahmed Abbas Hasan

Department of Clinical Laboratory Sciences, College of Pharmacy, University of Karbala, Karbala, Iraq

Hams Ahmed Al Jndeel

College of Pharmacy, University of Karbala, Karbala, Iraq & Department of Laboratory Technologies, College of Al-Zahrawi University ID: 122473929, Iraq

Humam Kasem Hussein

Al-Furat Al-Awsat Technical University/Technical institute of Najaf, Iraq


Eisenbarth, G.S. Type I diabetes mellitus. A chronic autoimmune disease. N. Engl. J. Med. 1986; 314(21): 1360-1368.

Atkinson, M.A., Eisenbarth, G.S., Michels, A.W. Type 1 diabetes. The Lancet, 2014; 383(9911): 69-82.

Foulis, A.K., McGill, M., Farquharson, M.A. Insulitis in type 1 (insulin-dependent) diabetes mellitus in man macrophages, lymphocytes, and interferon-gamma containing cells. J. Pathol. 1991; 165(2): 97-103.

Mathis, D., Vence, L., Benoist, C. Beta Cell death during progression to diabetes. Nature. 2001; 414(6865):792-798.

Walker, L.S., von Herrath, M. CD4 T cell differentiation in type 1 diabetes. Clin. Exp. Immunol. 2016; 183(1):16-29.

Honkanen, J., Nieminen, J.K., Gao, R., Luopajarvi, K., Salo, H.M., Ilonen, J., et al., IL-17 immunity in human type 1 diabetes. J. Immunol. 2010; 185(3):1959-1967.

Lindley, S., Dayan, C.M., Bishop, A., Roep, B.O., Peakman, M., Tree, T.I. Defective suppressor function in CD4(+), CD25(+), T-cells from patients with type 1 diabetes. Diabetes. 2005; 54(1): 92-99.

Brusko, T.M., Wasserfall, C.H., Clare-Salzler, M.J., Schatz, D.A., Atkinson, M.A. Functional defects & the influence of age on the frequency of CD4+ CD25+ T-cells in type 1 diabetes. Diabetes. 2005;54(5):1407-1414.

Haseda, F., Imagawa, A., Murase Mishiba, Y., Terasaki, J., Hanafusa, T. CD4+ CD45RA- FoxP3high activated regulatory T cells are functionally impaired & related to residual insulin-secreting capacity in patients with type 1 diabetes. Clin. Exp. Immunol. 2013;173(2): 207-216.

Paschou, S.A., Papadopoulou-Marketou, N., Chrousos G.P., Kanaka-Gantenbein, C. On type 1 diabetes mellitus pathogenesis. Endocr. Connect. 2018; 7(1): R38-R46.

Frongia, O., Pascutto, C., Sechi, G.M., Soro, M., Angioi, R.M. Genetic and environmental factors for type 1 diabetes: Data from the province of Oristano, Sardinia, Italy. Diabetes Care. 2001; 24(10):1846-1847.

Pociot, F., Lernmark, A. Genetic risk factors for type 1 diabetes. Lancet, 2016; 387:2331-2339.

Rewers, M., Ludvigsson, J. Environmental risk factors for type 1 diabetes. Lancet, 2016; 387:2340-2348.

Harinarayan,C.V. Vitamin D and diabetes mellitus. Hormones. 2014;13:163-181.

Zmijewski, M.A. Vitamin D and human health. Int J Mol Sci. 2019; 20 (1): 145;

Khan, T.S., Frasser, L.A. Type 1 Diabetes and osteoporosis: From molecular pathways to bone phenotype. J Osteoporos. 2015;2015:1-8.

Vestergaard, P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes: A meta-analysis. Osteoporos Int. 2007;18(4):427-444.

Janghorbani, M., Feskanich, D., Willett, W.C., Hu, F. Prospective study of diabetes & risk of hip fracture: the nurses’ health study. Diabetes Care. 2006;29(7):1573-1578.

Livingstone, S. Scottish Diabetes Research Network Epidemiology Group. Life Expectancy in Type 1 Diabetes: A Scottish Registry Linkage Study. University of Dundee, UK: Scottish Diabetes Research Network Epidemiology Group; 2013. Disponible en http://www.easdvirtualmeeting. org/ resources/3906.

Dhaon, P., Shah, V.N. Type 1 diabetes & osteoporosis: A review of literature. Indian J Endocrinol Metab. 2014; 18(2):159-165.




How to Cite

Abbas Hasan A, Ahmed Al Jndeel H, Kasem Hussein H. Role of immunological and biochemical markers in bone turnover in type I diabetic patients in Karbala province, Iraq. Biomedicine [Internet]. 2023 Nov. 9 [cited 2023 Dec. 2];43(5):1599-601. Available from:



Original Research Articles

Plum Analytics