Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients at St. Paul’s Hospital Millennium Medical College Addis Ababa, Ethiopia: Comparative based cross-sectional study

Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients at St. Paul’s Hospital Millennium Medical College Addis Ababa, Ethiopia: Comparative based cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients at St. Paul’s Hospital Millennium Medical College Addis Ababa, Ethiopia: Comparative based cross-sectional study Andualem Bayih Tiruneh, Gobena Dedefo, Samuel Kinde, Mekides Alem, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4549335/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Aug, 2024 Read the published version in BMC Endocrine Disorders → Version 1 posted 14 You are reading this latest preprint version Abstract Background: Uncontrolled T2DM and its associated consequences nowadays have been a global health crisis, especially for adults. The problem is linked to body iron storage which is indicated by serum ferritin levels. However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control. This study aimed to assess the level of serum ferritin and associated factors among uncontrolled T2DM patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: A hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups from October-2 to December-29, 2023 at St. Paul’s Hospital Millennium Medical College. Pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p<0.05. Result: The mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p<0.001). It was significantly correlated with HbA1c (r=0.457, p<0.001), FBs (r=0.386, p<0.001), serum iron (r=0.430, p<0.001) and SBP (r=0.195, p=0.047) in T2DM patients. Besides, a multivariate logistic regression model revealed that a rise in HbA1c (AOR=3.67, 95% CI(1.50-8.98), serum iron (AOR=1.02, 95% CI(1.01-1.04), being male (AOR=0.16, 95% CI(0.05-0.57) and having only OHA (AOR=0.26, 95% CI(0.07-0.95) were key associated factors for the elevated serum ferritin among T2DM patients. Conclusion: The present study demonstrated that as far as glycemic control is not maintained, T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycemia and had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients. T2DM Ferritin HbA1c glycemic control Figures Figure 1 Figure 2 Background Uncontrolled Type 2 Diabetes Mellitus (UT2DM) has become a global health crisis contributing to 4.2 million deaths, particularly in adults aged 20–79 years as seen in the International Diabetic Federation (IDF) reports [ 1 ]. It causes various complications by damaging nerves and blood vessels as well as many other diabetic consequences if left untreated [ 2 ]. Of all the diagnosed cases of diabetes, about 90% are T2DM which is characterized by a failure of insulin secretion or action [ 3 , 4 ]. One of the main causes of diabetes and its complications is oxidative stress and the conditions are linked to body iron stores [ 5 ]. Hyperglycemia leads to increased glycated hemoglobin A1c (HbA1c), resulting from a non-enzymatic and irreversible interaction of glucose with the N-terminal residue of hemoglobin-A1 within red blood cells (RBC) [ 6 ]. In contrast, free iron is released from RBC during the glycation process and tends to initiate redox reactions to generate free radicals such as reactive oxygen species (ROS) which damage pancreatic β-cell [ 7 ], intensify inflammatory response, and accelerate oxidative damage of biomolecules [ 8 ]. Likewise, obesity is on the rise in Africa which potentially leads to a risk of iron overload and could impact metabolic impairments [ 9 ]. Iron excess can cause organ dysfunction [ 10 ], particularly in the pancreas, it leads to β-cell failure and impaired insulin secretion as well as it induces insulin resistance to different cells via generation of ROS [ 11 ]. Hepcidin and insulin hormones regulate iron and glucose metabolism respectively [ 12 ], but iron deregulation affects glucose metabolism, and glucose metabolism defect on the other hand disrupts iron metabolic pathways, indicating a bi-directional link between them [ 13 , 14 ]. Ferritin is a key protein regulating iron homeostasis [ 15 ] and serum ferritin is a useful marker for iron storage [ 16 ]. Hyperferritinemia significantly influences the clinical course of T2DM independent of obesity and inflammation [ 17 , 18 ]. Uncontrolled T2DM is a serious health concern that should be prevented, especially in low and middle-income countries like Ethiopia, where it is expected to have the greatest current impact. [ 19 ]. HbA1c is a gold standard test that provides long-term glycemic control over the past two or three months rather than daily fluctuation in blood glucose levels [ 20 ]. The American Diabetic Association (ADA) and Canadian Diabetes Association Clinical Practice Guidelines Expert Committee recommend glycemic goals of HbA1c ≤ 7% for adult diabetic patients to reduce its complications [ 21 , 22 ]. However, different studies in Ethiopia revealed a high proportion of uncontrolled T2DM patients and comorbidities related to the condition [ 23 , 24 ]. Although the deregulation of micronutrients like iron and marker of iron storage (ferritin) were reported to be linked with the pathophysiology of T2DM [ 5 , 25 ], no conclusive evidence existed about the association of serum ferritin with the state of glycemic control, and studies in this regard were inconsistent, some indicating a null association [ 26 , 27 ], while others showed significant positive [ 28 , 29 ] or negative associations [ 30 ]. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups. Studies in this area were limited, especially in Ethiopia. Besides, the investigation could lead to a better understanding of the relationship between serum ferritin and glycemic indicators of T2DM (FBs, HbA1c) as well as might improve the treatment response of uncontrolled T2DM patients transitioning to the controlled T2DM category. Methods Study area, design, and periods A hospital-based comparative cross-sectional study was conducted for three months from October 2 to December 29, 2023 among T2DM patients, who had follow-up appointments at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. It is one of the biggest teaching and public referral hospitals, offering healthcare services and student training programs. Besides, the hospital had endocrine clinics for outpatient follow-up chronic illness patients and the majority of them were diabetics, who were primarily monitored by endocrinologists and a team of nurses working in the clinic. Study populations and the selection criteria Adult T2DM patients from 18–65 years of age, who had at least one-year follow-up appointment and started anti-diabetic medication at the outpatient diabetic clinic of SPHMMC were selected and sub-grouped based on the ADA(2022) [ 21 ] and Canadian Diabetes Association Clinical Practice Guidelines Expert Committee (2018) [ 22 ] criteria as having either Uncontrolled Diabetes with HbA1c > 7% or Controlled Diabetes with HbA1c ≤ 7% were included as cases. Besides, age-sex-matched non-diabetic healthy control groups were selected based on the history, FBs (70–100 mg/dl) and HbA1c (< 5.7%) levels as per the ADA criteria [ 31 ]. While, participants who were pregnant, lactating, heavy drinkers, active smokers, had an acute infection within a week, had a known history of cancer or anemia, had blood transfusion or donation or iron supplements within the previous three months, and had been diagnosed with other types of diabetes were excluded based on their medical history and physical examinations. Description of study variables Serum ferritin level was a dependent variable while socio-demographic factors like age, sex, and educational levels; clinical factors like body mass index (BMI), Blood Pressure (BP), glycemic control status, and duration of diabetes mellitus, as well as biochemical factors like serum iron, HbA1c, and FBs levels, were regarded as an independent variable. Sample size and Sampling technique Sample size was determined using a comparative-based study design for quantitative data by taking the 95% confidence interval and 80% power of the study using the formula n = 2SD 2 (Z α/2 +Z β ) 2 /d 2 [ 32 ]. Where; n is the minimal sample size for each group, SD is the standard deviation from previous studies, Z α/2 is 1.96 from the Z table at 95% CI & 5% type 1 error), Z β is 0.84 from the Z table with 80% power of the study and 20% type II errors, and d is Effect size which is the difference in mean values. As per the authors’ knowledge, no published study was conducted in Ethiopia on serum ferritin levels among uncontrolled and controlled T2DM patients. Thus, data from an Indian study was taken, which showed the mean serum ferritin levels in uncontrolled and controlled diabetes patients were 269.8 and 73.30 ng/ml respectively with a standard deviation of 347.1[ 33 ]. Therefore, n = 2(347.1) 2 x(1.96 + 0.84) 2 /(269.8–73.30) 2 =48.92 = 49. However, it was increased by 5% to eliminate potential outliers to make it up to 52 subjects per group, and 156 total study subjects were enrolled. Measurement and Data collection Data collection procedures After participants provided written informed consent, data was collected via face-to-face interviews, direct measurements, and reviewing medical records by professional data collectors in cooperation with outpatient department nurses and laboratory personnel under close supervision of the principal investigator. Participants’ anthropometric data (height and weight) were measured to calculate body mass index (BMI) and categorized as Obesity (≥ 30kg/m 2 ), overweight (25-29.9 kg/m 2 ), Normal (18.5–24.9 kg/m 2 ) and underweight (< 18.5 kg/m 2 ) based on the WHO guideline [ 34 ]. Besides, blood pressure readings were taken after a 5-minute rest using an automatic digital sphygmomanometer apparatus that recorded the systolic and diastolic blood pressures and classified according to the Seventh Report of the Joint National Committee (JNC7) blood pressure classification criteria as normal (< 120mmHg), pre-hypertension (120–139 mmHg) and hypertension (≥ 140mmHg) for systolic blood pressure (SBP) and < 80 mmHg, 80–89 mmHg and ≥ 90 mmHg for diastolic blood pressure (DBP) [ 35 ]. Laboratory sample collection, analysis, and test principles Participants were oriented to have overnight fasting for about 8–10 hours before sample collection. About 3ml of venous blood was collected in Ethylenediaminetetraacetic acid (EDTA) tubes and 5 ml in Serum Separator Tube (SST) via venipuncture with an evacuated tube method under aseptic precautions, by a competent laboratory technologist. The EDTA tube was used for HbA1c determination using the Cobas c501module of the analyzer with a principle of turbidimetric inhibition immunoassay (TINIA) that standardized against the International Federation of Clinical Chemistry (IFCC) reference method and traceable to the Diabetes Control and Complications Trial (DCCT)/National Glycohemoglobin Standardization Program (NGSP) % HbA1c, while the SST tube was allowed for about 20–30 minutes at room temperature until coagulated and centrifuged for 5 minutes at 3000 RPM to separate serum from whole blood. FBs, ferritin, and iron were determined using a principle of glucose hexokinase (HK) of the c501, electrochemiluminescent immunoassay (ECLIA) of the e601, and colorimetric assay techniques of the c501 modules of the Roche diagnostic technology respectively. Reference range and clinical implications of the laboratory tests The reference range for HbA1c and FBs was based on the ADA criteria as healthy groups (HbA1c < 5.7% and FBs 70-99mg/dl), pre-diabetes (HbA1c 5.7–6.4% and FBs 100-125mg/dl), diabetes mellitus (HbA1c ≥ 6.5% and FBs ≥ 126mg/dl). Furthermore, T2DM patients were categorized into controlled (HbA1c ≤ 7%) and uncontrolled (HbA1c > 7%) diabetes. The WHO guidelines classify serum ferritin levels as iron deficiency ( 200ng/ml) for males and iron deficiency ( 150ng/ml) for females, with low risk of iron overload (≤ 200 ng/ml) and increased risk (> 200 ng/ml) [ 36 ]. Adults’ reference range of serum iron is 59–158 ug/dL for males and 37–145 ug/dL for females. Data quality assurance Before the actual data collection took place, the pre-test was done. To reduce misleading answers, the purpose of the investigation was informed to the study participants and sufficient time was taken to collect the data. To assure the reliability of test results, the SOP format of each analyte was followed throughout the process. The performance verification of the clinical chemistry analyzer was checked daily by using standard controls. Generally, quality assurance was maintained throughout the pre-analytical, analytical, and post-analytical phases. Data analysis and interpretation The IBM-SPSS statistical software package (version 27) was used for data entry and analysis. The data distribution was checked with the help of the Shapiro-Wilk test of normality. Normally distributed data was done via parametric tests and descriptive statistics like frequency, percentage, mean and standard deviation (SD) were computed. One-way analysis of variant (ANOVA) and the corresponding post-hock test was used to evaluate (mean ± SD) of the continuous biochemical and clinical parameters. Similarly, bivariate correlations of those parameters with the levels of serum ferritin were computed via Pearson correlation coefficient (r). Furthermore, bivariate and multivariate logistic regression was done to calculate the crude odds ratio (COR) and adjusted odds ratio (AOR) for estimating factors associated with serum ferritin levels in T2DM patients using a 95% confidence interval (CI). Besides, P-values less than 0.05 were considered statistically significant. Operational definitions Good glycaemic control- adult non-pregnant diabetic patients whose HbA1c ≤ 7% based on the ADA guideline [ 21 ]. Poor glycaemic control – adult non-pregnant diabetic patients whose HbA1c > 7% based on the ADA guideline [ 21 ]. Uncontrolled diabetes – diabetic patients who were unable to achieve the target glycemic control status for the past three months and had poor glycemic control at the time of data collection (HbA1c > 7%) as per ADA criteria of glycemic targets [ 37 ]. Controlled diabetes- diabetic patients who had optimal glycemic control status for the past three months and had good glycemic control at the time of data collection (HbA1c ≤ 7%) as per ADA criteria of glycemic targets [ 37 ]. Adult diabetic patients – diabetic patients who had an age group from 18–65 years based on WHO (2019) guidelines [ 38 ]. Result Descriptive features of the study participants In this study, a total of 156 study subjects were enrolled and sub-grouped into three equal groups based on glycemic control status. Of the total (156) participants, 72(46%) were males. Female participants outnumbered males in each group, accounting 27(52%), 29(56%) and 28(54%) in uncontrolled T2DM, controlled T2DM and control groups respectively. Most of the respondents in uncontrolled and controlled T2DM patients had a BMI between 25-29.9kg/m 2 while 18.5–24.9 kg/m 2 in control groups. There were no blood pressure records of ≥ 140/90 mmHg in control groups. 65.4% of T2DM patients were on an oral OHA while 34.6% were injectable insulin users as a treatment option, as shown in Table 1 . Table 1 Descriptive characteristics of study participants at SPHMMC, Addis Ababa, Ethiopia, 2024 (N = 156) Variables Category Study groups Total Uncontrolled T2DM (n = 52) Controlled T2DM(n = 52) Control groups(n = 52) N (%) N (%) N (%) N (%) Sex Male 25(48) 23(44) 24(46) 72(46) Female 27(52) 29(56) 28(54) 84(54) Age (yrs) 18–33 7(13.5) 8 (15.4) 9(17.3) 24(15.4) 34–49 21(40.4) 23(44.2) 22(42.3) 66(42.3) 50–65 24(46.1) 21(40.4) 21(40.4) 66(42.3) Educational levels No formal 7(13.5) 4(7.7) 3(5.7) 14(8.9) Primary 12(23.1) 17(32.7) 9(17.3) 38(24.4) Secondary 20(38.5) 18(34.6) 20(38.5) 58(37.2) Higher 13(25) 13(25) 20(38.5) 46(29.5) BMI(kg/m 2 ) < 18.5 1(1.9) 5(9.6) 6(11.5) 12(7.7) 18.5–24.9 16(30.8) 21(40.4) 33(63.5) 70(44.9) 25-29.9 25(48.1) 24(46.2) 13(25) 62(39.7) ≥ 30 10(19.2) 2(3.8) - 12(7.7) SBP (mmHg) < 120 6(11.6) 15(28.8) 24(46.1) 45(28.8) 120–139 23(44.2) 25(48.1) 28(53.9) 76(48.7) ≥ 140 23(44.2) 12(23.1) - 35(22.5) DBP (mmHg) < 80 16(30.8) 18(34.6) 30(57.7) 64(41) 80–89 19(36.5) 24(46.2) 22(42.3) 65(41.6) ≥ 90 17(32.7) 10(19.2) - 27(17.4) Duration on DM (yrs) 10 31(59.6) 13(25) - 44(42.3) Treatment option OHA 32(61.5) 36(69.2) - 68(65.4) Insulin 20(38.5) 16(30.8) - 36(34.6) No formal education- have no classroom-based education, Primary school- from grades 1–8, secondary school- from grades 9–12, higher level education- college or university, OHA- oral hypoglycemic agent, DM-diabetes mellitus Comparison of the biochemical and clinical parameters in different study groups A one-way ANOVA results reveal that the mean differences in the age of participants in Uncontrolled T2DM, controlled T2DM, and control groups were not statistically significant (F 2, 153 =0.277, P = 0.759). The corresponding post-hock test results for serum ferritin showed that the mean difference between Uncontrolled and controlled T2DM patients was significant (p < 0.001). However, the mean difference in DBP was not significant (p = 0.665). Additionally, the mean difference of serum iron between controlled T2DM and the non-diabetic control group was not significant (p = 0.055). Except for the age of participants, the mean difference of all the tested variables between uncontrolled T2DM and non-diabetic control groups was statistically significant (p < 0.001), as summarized in Table 2 . Table 2 Comparison of serum ferritin and other tested parameters among study subjects with different glycemic control status at SPHMMC, Addis Ababa, Ethiopia, 2024 (n = 52 per group) Study groups ANOVA results Post hoc analysis Age (yrs) F (p-value) Paired groups P-value UT2DM CT2DM CG 47.54 ± 9.44 46.31 ± 9.36 46.35 ± 9.97 0.277(0.759) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM 0.790 0.993 0.802 BMI (kg/m 2 ) UT2DM CT2DM CG 26.43 ± 3.53 24.67 ± 3.51 22.31 ± 3.06 19.443(< 0.001) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM 0.023 0.001 < 0.001 SBP (mmHg) UT2DM CT2DM CG 136.85 ± 14.04 130.67 ± 11.30 119.77 ± 5.17 33.171(< 0.001) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM 0.045 < 0.001 < 0.001 DBP (mmHg) UT2DM CT2DM CG 85.19 ± 8.70 83.24 ± 7.70 77.62 ± 5.16 15.318(< 0.001) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM 0.665 < 0.001 < 0.001 Duration on DM (yrs) UT2DM CT2DM CG 12.21 ± 6.25 8.35 ± 3.81 - - UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM < 0.001 - - HbA1c (%) UT2DM CT2DM CG 9.31 ± 1.47 6.64 ± 0.27 5.44 ± 0.23 262.205(< 0.001) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM < 0.001 < 0.001 < 0.001 FBs (mg/dl) UT2DM CT2DM CG 201.03 ± 43.38 113.03 ± 19.09 89.81 ± 9.37 230.063(< 0.001) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM < 0.001 < 0.001 < 0.001 Serum ferritin (ng/ml) UT2DM CT2DM CG 243.05 ± 91.77 169.30 ± 89.98 109.60 ± 29.33 40.114(< 0.001) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM < 0.001 < 0.001 < 0.001 Serum iron (ug/dl) UT2DM CT2DM CG 140.17 ± 37.26 117.90 ± 31.48 102.75 ± 30.42 16.726(< 0.001) UT2DM vs CT2DM CT2DM vs CG CG vs UT2DM 0.002 0.055 < 0.001 UT2DM- Uncontrolled T2DM, CT2DM-Controlled T2DM, CG-Control groups, SD-Standard deviation, f 2 , 153= F and the p-value < 0.05 level (2-tailed) showed the existence of a significant difference between the groups. All the variables were expressed in (Mean ± SD) form. The distribution of the data set and the five-number summary of minimum, lower quartile (Q 1 ), median, upper quartile (Q 3 ), and maximum values of serum ferritin levels among the three different study groups were plotted in (Fig. 2 ). The maximum value of serum ferritin level was nearest to 500ng/ml, 400ng/ml, and 200ng/ml for uncontrolled T2DM, controlled T2DM, and control groups respectively. Similarly, the median serum ferritin levels were decreased from uncontrolled T2DM to control groups from left to right. The control groups showed a narrower interquartile range (IQR) compared to uncontrolled and controlled T2DM patients, which showed more consistent data sets seen in the control groups than diabetic groups. However, the minimum values of serum ferritin levels were recorded among the controlled T2DM patients as, as shown in Fig. 1 . The mean differences in age, BMI, SBP, DBP, HbA1c, FBs, serum ferritin and serum iron in T2DM patients with different pharmacological treatment options of OHA and injectable insulin users were analyzed. Accordingly, our study indicated that serum ferritin was increased in OHA users than in patients having injectable insulin as a therapeutic option and the difference was statistically significant (p = 0.048). Similarly, DBP was increased among OHA users as compared to injectable insulin users and the difference was significant (p = 0.034). However, the mean difference of duration on diabetes mellitus was decreased in OHA users than in injectable insulin users and the difference was statistically significant (p = 0.047), as shown in Table 3 . Table 3 Comparison of serum ferritin levels and other tested parameters among OHA and injectable insulin users of T2DM patients at SPHMMC, Addis Ababa, Ethiopia, 2024 (n = 104) Tested parameters Diabetes treatment option p-value OHA Injectable insulin Age (Mean ± SD) yrs 47.13 ± 9.76 46.53 ± 8.73 0.756 BMI (Mean ± SD) kg/m 2 25.59 ± 3.91 25.46 ± 3.03 0.882 SBP (Mean ± SD) mmHg 134.44 ± 13.56 132.47 ± 12.13 0.467 DBP (Mean ± SD) mmHg 85.60 ± 8.77 82.03 ± 6.55 0.034 Duration of DM (Mean ± SD) yrs 9.50 ± 4.91 11.75 ± 6.30 0.047 HbA1c (Mean ± SD) % 8.01 ± 1.79 7.90 ± 1.55 0.749 FBs (Mean ± SD) mg/dl 159.27 ± 58.87 152.81 ± 48.63 0.551 Serum ferritin (Mean ± SD) ng/ml 218.38 ± 107.93 183.12 ± 70.53 0.048 Serum iron (Mean ± SD) ug/dl 133.72 ± 38.06 120.19 ± 30.66 0.069 OHA = oral hypoglycemic agents, p-value is significant at < 0.05 levels (2-tailed) Relation of serum ferritin level with biochemical and clinical parameters Our study demonstrated that there was a positive significant correlation of serum ferritin levels with HbA1c, FBs, serum iron and SBP (r = 0.457, p < 0.001; r = 0.386, p < 0.001, r = 0.430, p < 0.001 and r = 0.195, p = 0.047) respectively in T2DM patients. However, there were no significant correlations found in non-diabetic control groups, as shown in Table 4 . Table 4 Correlation of serum ferritin with some biochemical and clinical parameters among patients with T2DM and non-diabetic control groups at SPHMMC, Addis Ababa, Ethiopia, 2024 Tested parameters Study groups T2DM patients (n = 104) Control groups (n = 52) r p-value r p-value Age (yrs) -0.035 0.722 -0.042 0.766 BMI(kg/m 2 ) 0.182 0.065 0.214 0.127 SBP (mmHg) 0.195 0.047* -0.005 0.971 DBP (mmHg) 0.177 0.072 -0.082 0.564 Duration on DM (yrs) 0.092 0.355 - - HbA1c (%) 0.457 < 0.001** -0.066 0.643 FBs (mg/dl) 0.386 < 0.001** -0.056 0.693 Serum iron (ug/dl) 0.430 < 0.001** -0.023 0.871 r = Pearson correlation coefficient **= p-value significant at 0.01 level (2-tailed) and *= p-value significant at 0.05 level (2-tailed) and all the tested parameters were expressed in terms of (Mean ± SD) The study found a linear relationship between serum ferritin levels and glycemic indicators (HbA1c, FBs) in T2DM patients as the majority of the data set closer to the fit line. The correlation was significantly positive, with an uphill pattern, indicating that serum ferritin rises as HbA1c and FBs increased with a Pearson correlation (r) of 0.386 and 0.457 respectively, as shown in Fig. 2 part A and B. Likewise, a significant positive correlation also existed in uncontrolled T2DM patients (r = 0.363, p = 0.008), as demonstrated in Fig. 2 part C. Factors associated with an increase in serum ferritin level among T2DM patients The bivariate analysis was done to identify the candidate variables for multivariate logistic regression based on the Wald test from logistic regression and a p-value cut of < 0.25 at least one within the group [ 39 ]. As such, tested variables like age group, sex, BMI, SBP, DBP, duration of diabetes, treatment option, HbA1c, FBs and serum iron were all associated with an increase in serum ferritin level in T2DM patients and exported into a multivariate logistic regression model. The result of this study showed that T2DM patients who were taking injectable insulin as a treatment option were 0.26 times less likely to increase serum ferritin level as compared to only OHA users (AOR = 0.26, 95% CI(0.07–0.95), p = 0.042). A 1% increase in HbA1c of T2DM patients was 3.67 ng/ml times more likely to increase serum ferritin level (AOR = 3.67, 95% CI (1.50–8.98), p = 0.004). This study also illustrated that a rise in serum iron was positively associated with elevation of serum ferritin in T2DM patients (AOR = 1.02, 95% CI (1.01–1.04), p = 0.017). Similarly, female T2DM patients were 0.16 times less likely to increase serum ferritin level as compared to males (AOR = 0.16, 95% CI (0.05–0.57), p = 0.004), as shown in Table 5 . Table 5 Bivariate and multivariate logistic regression showing factors associated with elevated serum ferritin levels among T2DM patients at SPHMMC, Addis Ababa, Ethiopia, 2024 (n = 104) Tested parameters Category Serum ferritin > 200 ng/ml Bivariate analysis Multivariate analysis Yes (n = 54) No (n = 50) COR(95% CI) P AOR(95% CI) P Age (yrs) a 18–33 10 5 1 34–49 23 21 0.55(0.16–1.87) 0.336 0.43(0.06–2.94) 0.389 50–65 21 24 0.44(0.13–1.49) 0.185 0.19(0.02–1.50) 0.115 Sex a Male 33 15 1 Female 21 35 0.27(0.12–0.62) 0.002 0.16(0.05–0.57) 0.004 Educational levels b No formal 5 6 1 Primary 15 14 1.29(0.32–5.18) 0.724 Secondary 22 16 1.65(0.43–6.37) 0.467 Higher 12 14 1.03(0.25–4.24) 0.969 BMI(kg/m 2 ) a < 18.5 3 3 1 18.5–24.9 13 24 0.54(0.09–3.08) 0.489 0.12(0.01–1.46) 0.097 25-29.9 28 21 1.33(0.24–7.28) 0.740 0.44(0.04–4.42) 0.485 ≥ 30 10 2 5.0(0.55–45.39) 0.153 2.27(0.09–57.2) 0.618 SBP(mmHg) a < 120 8 13 1 120–139 24 24 1.63(0.57–4.63) 0.363 1.48(0.33–6.73) 0.610 ≥ 140 22 13 2.75(0.90–8.40) 0.076 1.56(0.25–9.81) 0.637 DBP(mmHg) a < 80 15 19 1 80–89 21 22 1.21(0.49–2.98) 0.680 0.50(0.12–2.23) 0.365 ≥ 90 18 9 2.53(0.89–7.23) 0.082 0.48(0.08–2.89) 0.425 Duration on DM (yrs) a 10 25 19 0.88(0.30–2.57) 0.811 0.35(0.05–2.30) 0.276 Mode of therapy a OHA 41 27 1 Insulin 13 23 0.37(0.16–0.86) 0.020 0.26(0.07–0.95) 0.042 HbA1c (%) a M ± SD 8.8 ± 1.9 7.1± 1.0 2.12(1.50–3.01) < 0.001 3.67(1.50–8.98) 0.004 FBs (mg/dl) a M ± SD 176.4 ± 59.2 136.1 ± 42.4 1.02(1.01–1.03) < 0.001 0.99(0.97–1.01) 0.233 Serum iron (ug/dl) a M ± SD 142.8 ± 33.9 114.2 ± 32.6 1.03(1.01–1.04) < 0.001 1.02(1.01–1.04) 0.017 1-indicates the reference group, COR = crude odds ratio, AOR = adjusted odds ratio, CI = confidence interval, M = mean, SD = Standard Deviation, p-value significant at 0.05 level (2-tailed), a =variables exported to multivariate logistic regression, b =variables not exported to multivariate logistic regression model Discussion Despite iron being an essential element used in the body, excess accumulation causes different organ dysfunctions [ 10 ]. Particularly in pancreatic β-cells, it decreases insulin production from the islets of Langerhans and causes insulin resistance to different cells [ 11 ] which is the pathophysiology of T2DM [ 3 ]. Uncontrolled T2DM and its associated consequences nowadays have been a global health concern, accounting for 4.2 million deaths in adults aged 20–79 years [ 1 ]. Different studies conducted in Ethiopia revealed a high percentage of uncontrolled T2DM patients[ 23 , 24 ]. Iron and markers of iron storage were reported to be linked with T2DM [ 5 ]. However, the associations of serum ferritin with glycemic control were not well established. The overall result of the present study showed that the level of serum ferritin was high in uncontrolled T2DM patients as compared to controlled T2DM and control groups. A significant positive correlation of serum ferritin with HbA1c, FBs, serum iron and SBP was found among T2DM patients. However, no significant correlation was found among the control groups. Insulin injection users had significantly decreased ferritin levels compared to those who had been on OHA. A rise in HbA1c and serum iron, being male, and having only OHA were the key associated factors for the elevation of serum ferritin in T2DM patients. According to our research, the mean serum ferritin level was significantly increased in uncontrolled T2DM patients (243.05 ± 91.77 ng/ml) (p < 0.001) as compared to controlled T2DM (169.30 ± 89.98 ng/ml) and non-diabetic control groups (109.60 ± 29.33 ng/ml) as shown in (Table 2 ). The finding of this study was different from a study done in Saudi Arabia that described serum ferritin had no link with glycemic indicators and diabetic complications [ 26 ] as well as contrasted with a study conducted in Ethiopia showing a significant decrease in serum ferritin levels among T2DM patients as compared to non-diabetic control groups [ 30 ]. Even though the exact reasons remained unknown, the variation in dietary intake and follow-up care might have a greater influence on the discrepancies in serum ferritin levels[ 40 ]. However, our study was consistent with a study done in India [ 41 ] and Turkey [ 42 ], which showed a noticeable hyperferritinemia among uncontrolled T2DM patients than controlled T2DM patients. This could be due to hyperferritinemia affecting pancreatic β-cells through oxidative stress, impairing the liver's capacity to extract hepatic insulin, interfering with insulin's ability to reduce hepatic glucose synthesis [ 43 ], and potentially leading to diabetic complications via interaction with vascular endothelial growth factor (VEGF) [ 44 ]. This study demonstrated the existence of a significant positive correlation of serum ferritin with HbA1c, FBs, serum iron and SBP (r = 0.457, p < 0.001, r = 0.386, p < 0.001, r = 0.430, p < 0.001 and 0.195, p = 0.047) respectively in T2DM patients. The current finding was contrasted with a study done in Iran [ 27 ] and Iraq [ 45 ] that showed a null correlation. However, our finding was consistent with a study conducted by Shubham J, et al .[ 29 ], Rajeev C, et al . [ 46 ] and Li S, et al .[ 47 ], who found a significant correlation of serum ferritin with glucose control, serum iron and SBP/DBP respectively. This might be due to hyperglycemia causing a non-enzymatic irreversible interaction of glucose with hemoglobin in RBC [ 6 ] and free iron is released during the glycation process which tends to initiate redox reactions to generate free radicals like ROS, which damage pancreatic β-cell [ 7 ] and intensifies the inflammatory response as well as oxidative damage to biomolecules which results in elevated serum ferritin levels [ 8 ]. The multivariate logistic registration model of the present study suggested that increased HbA1c by 1% in T2DM patients had 3.67ng/ml times more likely to increase serum ferritin levels (AOR = 3.67, 95% CI (1.50–8.98), p = 0.004) and an increase in serum iron was also positively associated with elevation of serum ferritin level (AOR = 1.02, 95% CI (1.01–1.04), p = 0.017) as shown in (Table 5 ). This finding was in line with a study done by Sarin S, et al . that showed for every 1ng/ml increase in serum ferritin levels, patients' average HbA1c raised by 0.01% [ 48 ]. Moreover, this study showed a positive likelihood association of serum ferritin with glycemic control status and was consistent with earlier similar studies [ 49 , 50 , 51 ]. This might be due to the biochemical properties of ferritin and the pathophysiology of T2DM which attributed to the close connection of serum ferritin with glycemic control status [ 11 , 52 , 53 ]. WHO and IDF guidelines recommend metformin as the first-line pharmacological treatment option for T2DM, followed by sulfonylureas and other hypoglycemic agents if metformin monotherapy fails and the last could be the addition of injectable insulin [ 54 ]. This study found that OHA users had significantly higher serum ferritin levels than injectable insulin users (p = 0.048), which was consistent with previous Ethiopian studies [ 30 ]. The multivariate logistic regression of the current study also illustrates that insulin injection users were 0.26 times less likely to increase ferritin levels as compared to only OHA users (AOR = 0.26, 95% CI(0.07–0.95), p = 0.042). Even though we didn’t know the exact mechanism for such a difference, possibly insulin injection made a rapid stimulation of iron uptake by fat cells and hepatocytes [ 55 ]. In this study, OHA users had a significantly higher mean DBP record compared to insulin injection users (p = 0.032). This might be due to insulin stimulating the production of nitric oxide (NO) in endothelium which induces vasodilation by relaxing the inner muscle of the blood vessels and regulates sodium homeostasis by enhancing sodium reabsorption in the kidney. Thereby, contributing to the regulation of blood pressure [ 56 ]. Conversely, the diabetes duration was significantly decreased in OHA users than those who had been on injectable insulin (p = 0.047), possibly due to the management guideline of T2DM, as OHA was used before insulin treatment began. Thereby, diabetes duration possibly increased among insulin users [ 54 ]. In our study, female T2DM patients were 0.16 times less likely to increase serum ferritin level as compared to males (AOR = 0.16, 95% CI (0.05–0.57), p = 0.004). Our finding was consistent with other studies which showed that being male could be a risk factor for iron overload [ 57 , 58 ]. This might be due to the nature of females that may lose iron during the menstrual period as the menstrual cycle affects the iron homeostasis pathway [ 59 ]. This study also suggested the presence of a positive correlation between serum ferritin and BMI even though the association was not significant (r = 0.182, p = 0.065), which inline with a study done by Aregbesola A, et al. that showed the higher the BMI the elevated the levels of serum ferritin [ 60 ]. Even if we didn’t know the exact mechanism, scientific studies showed that males stored more fats in their bellies than females [ 61 ]. Therefore, a variation in body composition and fat deposition among sexes, may contribute to gender-specific serum ferritin disparities. Although diabetes mellitus affects both sexes, epidemiological studies showed that the prevalence of diabetes mellitus was increased in males as compared to females. Worldwide, an estimated 17.7 million more men than women have diabetes mellitus [ 62 ]. Even though we don’t know the exact mechanisms, body iron stores might be one of the risk factors for such differences [ 5 ]. Strengths and limitations of the study The major strengths of the current study were the use of a fully automated clinical chemistry analyzer for investigating each laboratory test and as per the authors' knowledge, this was the first Ethiopian study investigating serum ferritin levels and associated factors among patients with uncontrolled T2DM and compared them to those with controlled T2DM and non-diabetic controls. However, the investigation was constrained by a cross-sectional study unlike a longitudinal design, which did not show a well-established relationship between serum ferritin levels and state of glycemic control. Furthermore, it was conducted only in T2DM patients undergoing follow-up appointments at the outpatient clinics, which might not be reflective of the overall diabetes community. Conclusion and recommendation The study found that uncontrolled T2DM patients had elevated serum ferritin levels as far as glycemic control was not maintained, with a significant positive correlation of biochemical indicators like HbA1c, FBs, and iron levels. Factors such as increased HbA1c, raised serum iron, being male, and having only OHA were all associated with increased ferritin levels in T2DM patients. Thereby, elevated serum ferritin might indicate long-term hyperglycemia in T2DM patients suggesting a potential therapeutic target for iron excess. Future research should use longitudinal design with the addition of hepcidin tests, and incorporation of adolescents and children with T1DM for the representativeness. Abbreviations ADA American Diabetic Association BMI Body Mass Index DBP Diastolic blood pressure FBS Fasting Blood Sugar HbA1c Hemoglobin A1c IDF International Diabetic Federation OHA Oral Hypoglycemic Agent RBC Red blood cell ROS Reactive Oxygen Species SBP Systolic blood pressure SOP Standard operating procedure SPHMMC St. Paul’s Hospital Millennium Medical College T1DM Type 1 diabetes mellitus T2DM Type 2 diabetes mellitus WHO World Health Organization Declarations Ethics approval and consent to participate Written consent was obtained from the Departmental Research and Ethics Review Committee (DRERC) of Addis Ababa University College of Health Science, Department of Medical Laboratory Science, and an official permission letter was submitted to St. Paul’s Hospital Millennium Medical College. Furthermore, the study participants were informed about the purpose of the study, the information obtained in the course investigation was kept confidential using codes, and finally written informed consent was obtained from each study participant before the actual data collection was carried out. Consent for publication Not applicable Availability of data and materials The manuscript contains all pertinent information about the data. Competing interests There were no competing interests that the authors declared. Funding Dilla University provided funding for the study and the study design, data collection, analysis, interpretation as well as manuscript preparation were all done without the Funder's input. Authors' contributions ABT was the principal investigator who participated in the conceptualization of the study, drafted the manuscript, performed the data analysis, and participated in data collection and laboratory tests; MW, GD, SK, AG and MA were advised throughout the process and participated in editing and reviewing the manuscript; GT, AA, AG and BG were participated in data collection; ABM, AB, GG and MT were participated in data analysis and interpretation. Each author reviewed and gave their approval to the final draft. Acknowledgments The authors gratefully acknowledge the support of Dilla University for funding, Addis Ababa University College of Health Science for giving this golden chance and St. Paul's Hospital Millennium Medical College for the permission to conduct the research in the diabetic clinic as well as sincerely thank the study participants and data collectors for their kindly participation and cooperation in this work. References Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. Idf diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183. http://doi:10.1016/j.diabres.2021.109119 . Roglic G. Who global report on diabetes: A summary. Int J Noncommunicable Dis. 2016;1(1):3–8. . Classification and diagnosis of diabetes. Standards of medical care in diabetes-2022. Diabetes Care. 2022;45(1):17–38. https://doi.org/10.2337/dc22-S002 . Hurtado MD, Vella A. What is type 2 diabetes? Medicine. 2019;47(1):10 – 5. https://doi.org/.1016/j.mpmed.2018.10.010 . Shaaban MA, Dawod AEA, Nasr MA. Role of iron in diabetes mellitus and its complications. Menoufia medical journal. 2016;29(1):11. http://DOI:0.4103/1110-2098.178938. Ezegbogu M, Abdulsalam K. Glycated haemoglobin (hba1c): An update on available methods. Bayero Journal of Pure and Applied Sciences. 2018;11(1):8–14. http://dx.doi.org/0.4314/bajopas.v11i1.2. Backe MB, Moen IW, Ellervik C, Hansen JB, Mandrup-Poulsen T. Iron regulation of pancreatic beta-cell functions and oxidative stress. Annu Rev Nutr. 2016;36:241–73. http://doi:10.1146/annurev-nutr-071715-50939 . Shetty JK, Prakash M, Ibrahim MS. Relationship between free iron and glycated hemoglobin in uncontrolled type 2 diabetes patients associated with complications. Indian J Clin Biochem. 2008;23:67–70. Moore Heslin A, O’Donnell A, Buffini M, Nugent AP, Walton J, Flynn A, et al. Risk of iron overload in obesity and implications in metabolic health. Nutrients. 2021;13(5). https://doi.org/10.3390/nu13051539 . Kohgo Y, Ikuta K, Ohtake T, Torimoto Y, Kato J. Body iron metabolism and pathophysiology of iron overload. International journal of hematology. 2008;88:7–15. http://DOI0.1007/s12185-008-0120-5. Marku A, Galli A, Marciani P, Dule N, Perego C, Castagna M. Iron metabolism in pancreatic beta-cell function and dysfunction. Cells. 2021;10(11). https://doi.org/10.3390/cells10112841 . Fillebeen C, Lam NH, Chow S, Botta A, Sweeney G, Pantopoulos K. Regulatory connections between iron and glucose metabolism. Int J Mol Sci. 2020;21(20). http://doi:10.3390/ijms21207773 . Fernández-Real JM, López-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes. 2002;51(8):2348–54. Wang H, Li H, Jiang X, Shi W, Shen Z, Li M. Hepcidin is directly regulated by insulin and plays an important role in iron overload in streptozotocin-induced diabetic rats. Diabetes. 2014;63(5):1506–18. Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95–104. http://doi:10.1016/j.blre.2008.08.001 . Rajpathak SN, Crandall JP, Wylie-Rosett J, Kabat GC, Rohan TE, Hu FB. The role of iron in type 2 diabetes in humans. Biochim et Biophys Acta (BBA)-General Subj. 2009;1790(7):671–81. http://doi:10.1016/j.bbagen.2008.04.005 . Sun L, Franco OH, Hu FB, Cai L, Yu Z, Li H, et al. Ferritin concentrations, metabolic syndrome, and type 2 diabetes in middle-aged and elderly chinese. J Clin Endocrinol Metabolism. 2008;93(12):4690–6. http://doi:10.1210/jc.2008-1159 . Mojiminiyi OA, Marouf R, Abdella NA. Body iron stores in relation to the metabolic syndrome, glycemic control and complications in female patients with type 2 diabetes. Nutr Metabolism Cardiovasc Dis. 2008;18(8):559–66. 10.1016/j.numecd.2007.07.007 . http://doi . Saeedi P, Salpea P, Karuranga S, Petersohn I, Malanda B, Gregg EW, et al. Mortality attributable to diabetes in 20–79 years old adults, 2019 estimates: Results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract. 2020;162. https://doi.org/10.1016/j.diabres.2020.108086 . Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of hba1c test in diagnosis and prognosis of diabetic patients. Biomark insights. 2016;11:38440. http://doi:10.4137/Bmi.s . ADA. Glycemic targets: Standards of medical care in diabetes—2022. Diabetes Care. 2022;45(1):83–96. https://doi.org/10.2337/dc22-S006 . Imran SA, Agarwal G, Bajaj HS, Ross S, Committee DCCPGE. Targets for glycemic control. Can J diabetes. 2018;42:42–6. https://doi.org/10.1016/j.jcjd.2017.10.030 . Tekalegn Y, Addissie A, Kebede T, Ayele W. Magnitude of glycemic control and its associated factors among patients with type 2 diabetes at tikur anbessa specialized hospital, addis ababa, ethiopia. PLoS ONE. 2018;13(3). https://doi.org/10.1371/journal.pone.0193442 . Gebreyohannes EA, Netere AK, Belachew SA. Glycemic control among diabetic patients in ethiopia: A systematic review and meta-analysis. PLoS ONE. 2019;14(8). https://doi.org/10.1371/journal.pone.0221790 . Jung CH, Lee MJ, Hwang JY, Jang JE, Leem J, Park J-Y, et al. Elevated serum ferritin level is associated with the incident type 2 diabetes in healthy korean men: A 4 year longitudinal study. PLoS ONE. 2013;8(9). 10.1371/journal.pone.0075250 . http://doi . Alqahtani N, Ghazwani EY, Al-Qahtani AM, Elmahboub RA. Correlation of iron levels with glycemia and microvascular complications among type ii diabetes mellitus patients in najran university hospital. J Family Med Prim Care. 2022;11(6). 10.4103/jfmpc.jfmpc_545_21 . http://DOI . Sharifi F, Sazandeh S. Serum ferritin in type 2 diabetes mellitus and its relationship with hba1c. 2004. Chen L, Li Y, Zhang F, Zhang S, Zhou X, Ji L. Association of serum ferritin levels with metabolic syndrome and insulin resistance in a chinese population. J Diabetes Complicat. 2017;31(2):364–8. http://dx.doi.org/10.1016/j.jdiacomp.2016.06.018 . Gandhi SJ, Chaudhari AS, Pratinidhi S, Sontakke A. Study of serum ferritin and hba1c in type 2 diabetes mellitus. Int J Clin Biochem Res. 2018;5(4):594–8. http://DOI:10.18231/2394-6377.2018.0126 . Wolide AD, Zawdie B, Alemayehu T, Tadesse S. Evaluation of serum ferritin and some metal elements in type 2 diabetes mellitus patients: Comparative cross-sectional study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2016:417 – 24. http://dx.doi.org/10.2147/DMSO.S120326 . ADA. On diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(1):81–90. http://DOI:10.2337/dc14-S081 . Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121–6. http://DOI:10.4103/0253-7176.116232 . Tummalacharla SC, Pavuluri P, Maram SR, Vadakedath S, Kondu D, Karpay S et al. Serum activities of ferritin among controlled and uncontrolled type 2 diabetes mellitus patients. Cureus. 2022;14(5):http://DOI10.7759/cureus.25155. Jan A, Weir CB. Bmi classification percentile and cut off points. StatPearls: Treasure Island, FL, USA. 2021:1–4. https://www.researchgate.net/publication/337153906 . Himmelmann A, Kjeldsen S, Hedner T. Recent hypertension guidelines: Jnc-7 and 2003 esh/esc. Blood Press. 2003;12(4):196–7. https://doi.org/10.1080/08037050310015854 . WHO. On use of ferritin concentrations to assess iron status in individuals and populations. World Health Organization Geneva; 2020. https://creativecommons.org/licenses/by-nc-sa/3.0/igo . ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Glycemic targets: Standards of care in diabetes—2023. Diabetes Care. 2023;46(1):97–110. https://doi.org/10.2337/dc23-S006 . WHO. Development group for the updating of the 2010 global recommendations on physical activity in youth, adults and older adults. 12–20 June 2019 Geneva, Switzerland. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):1–8. http://doi:10.1186/751-0473-3-17 . Bao W, Rong Y, Rong S, Liu L. Dietary iron intake, body iron stores, and the risk of type 2 diabetes: A systematic review and meta-analysis. BMC Med. 2012;10:1–13. http://www.biomedcentral.com/1741-7015/10/119 . Tummalacharla SC, Pavuluri P, Maram SR, Vadakedath S, Kondu D, Karpay S, et al. Serum activities of ferritin among controlled and uncontrolled type 2 diabetes mellitus patients. Cureus. 2022;14(5). http://DOI:10.7759/cureus.25155 . Canturk Z, Çetinarslan B, Tarkun İ, Zafer Canturk N. Serum ferritin levels in poorly-and well‐controlled diabetes mellitus. Endocr Res. 2003;29(3):299–306. http://DOI:10.1081=ERC-120025037. Raj S, Rajan G. Correlation between elevated serum ferritin and hba1c in type 2 diabetes mellitus. Int J Res Med Sci. 2013;1(1):12 – 5. http://DOI:0.5455/2320-6012.ijrms20130203. Guo L, Jiang F, Tang Y-T, Si M-Y, Jiao X-Y. The association of serum vascular endothelial growth factor and ferritin in diabetic microvascular disease. Diabetes Technol Ther. 2014;16(4):224–34. 10.1089/dia.2013.0181 . http://DOI . Kuba RH, Saheb EJ, Mosa IS. Detection of iron and ferritin in diabetes mellitus type 2 patients. Malaysian J Med Health Sci. 2022;18: https://www.researchgate.net/publication/359048957 . Chawla R, Bhoopathi A, Punyani H. Ferritin and serum iron as surrogate markers of poor glycemic control and microvascular complications in type 2 diabetes mellitus. Int J Diabetes Developing Ctries. 2019;39(2):362–8. https://doi.org/10.1007/s13410-018-0687-1 . Li S, Chen F, Li T, Cheng Y, Huang G, Hou D, et al. Higher serum ferritins are associated with higher blood pressure: A cross-sectional study. Medicine. 2024;103(12). http://dx.doi.org/10.1097/MD.0000000000037485 . Sarin S, KK SK, Bhaskar BV, Valliyot B. Association of serum ferritin in type 2 diabetes mellitus patients-an observational study. Int J Pharm Clin Res 2022.: https://www.researchgate.net/publication/360449123 . Son NE. Influence of ferritin levels and inflammatory markers on hba1c in the type 2 diabetes mellitus patients. Pak J Med Sci. 2019;35(4):1030–5. https://doi.org/10.12669/pjms.35.4.1003 . Al-Miraj A, Khan I. Correlation between serum ferritin and glycated haemoglobin levels in type-2 diabetes mellitus patients. J Diabetes Metab. 2021;12:893. Ahmed HEA, Ali NMA. Evaluation of serum ferritin in type-2 diabetes mellitus sudanese patients. Journal of Bioscience and Applied Research. 2022;8(3):132-7. http://DOI10.21608/jbaar.2022.247840. Pasricha SRS, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, et al. Diagnosis and management of iron deficiency anaemia: A clinical update. Med J Aust. 2010;193(9):525–32. WHO. Nutritional anaemias: Tools for effective prevention and control. 2017. Aschner P. New idf clinical practice recommendations for managing type 2 diabetes in primary care. Diabetes Res Clin Pract. 2017;132:169–70. http://dx.doi.org/10.1016/j.diabres.2017.09.002 . Altunoğlu E, Müderrisoğlu C, Erdenen F, Ülgen E, Ar MC. The impact of obesity and insulin resistance on iron and red blood cell parameters: A single center, cross-sectional study. 2014: http://DOI : 10.4274/Tjh.2012.0187 . Horita S, Seki G, Yamada H, Suzuki M, Koike K, Fujita T. Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens. 2011. http://doi:10.4061/2011/391762 . Iglesias-Vázquez L, Arija V, Aranda N, Aglago EK, Cross AJ, Schulze MB, et al. Factors associated with serum ferritin levels and iron excess: Results from the epic-eurgast study. Eur J Nutr. 2022;61(1):101–14. https://doi.org/10.1007/s00394-021-2625-w . Chaudhari R, Niraula A, Gelal B, Baranwal J, Sarraf D, Maskey R et al. Increased serum ferritin levels in type 2 diabetes mellitus patients: A hospital based cross-sectional study. 2021: https://doi.org/10.3126/jucms.v9i02.42009 . Alfaro-Magallanes VM, Barba-Moreno L, Romero-Parra N, Rael B, Benito PJ, Swinkels DW, et al. Menstrual cycle affects iron homeostasis and hepcidin following interval running exercise in endurance-trained women. Eur J Appl Physiol. 2022;122(12):2683–94. https://doi.org/10.1007/s00421-022-5048-5 . Aregbesola A, Voutilainen S, Virtanen JK, Mursu J, Tuomainen T-P. Body iron stores and the risk of type 2 diabetes in middle-aged men. Eur J Endocrinol. 2013;169(2):247–53. 10.1530/EJE-13-0145 . http://DOI . Nauli AM, Matin S. Why do men accumulate abdominal visceral fat? Front Physiol. 2019;10. http://doi:10.3389/fphys.2019.01486 . Kautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia. 2023;66(6):986–1002. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Aug, 2024 Read the published version in BMC Endocrine Disorders → Version 1 posted Editorial decision: Revision requested 21 Jun, 2024 Reviews received at journal 20 Jun, 2024 Reviews received at journal 18 Jun, 2024 Reviews received at journal 15 Jun, 2024 Reviewers agreed at journal 14 Jun, 2024 Reviewers agreed at journal 14 Jun, 2024 Reviewers agreed at journal 13 Jun, 2024 Reviewers agreed at journal 13 Jun, 2024 Reviewers agreed at journal 12 Jun, 2024 Reviewers invited by journal 12 Jun, 2024 Editor invited by journal 12 Jun, 2024 Editor assigned by journal 11 Jun, 2024 Submission checks completed at journal 11 Jun, 2024 First submitted to journal 08 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4549335","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317130713,"identity":"fabc8104-7610-4d96-b2f5-d5aa62bde31b","order_by":0,"name":"Andualem Bayih Tiruneh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYFACHiA2OCDHxsx88AGIy0esFmN+9rZkAxCXjTgtDAcSZ/acMZMAMQlq4Z/de/AzT8Edxg03cswqv+bYybAxMD98dAOPFok755KleQyeMRvcSCu7LbstGegwNmPjHHzW3MgxAGo5zGZwI3nbbcltzEAtPGzS+LTI38gx/g3UwmNwI8GsWHJbPWEtBkAvgGyRkOw5Ysb4cdthwloMb+SlWc4xOGwACmRpxm3HediYCfhF7kbu4Rtv/hyubwNG5cef26rt+dmbHz7G630gYOKBMpjBDGYCykGA8Qc6YxSMglEwCkYBMgAAgStJlrBSMO4AAAAASUVORK5CYII=","orcid":"","institution":"Dilla University","correspondingAuthor":true,"prefix":"","firstName":"Andualem","middleName":"Bayih","lastName":"Tiruneh","suffix":""},{"id":317130714,"identity":"fbff89f9-a11f-409c-9ced-cf23ae1e5596","order_by":1,"name":"Gobena Dedefo","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Gobena","middleName":"","lastName":"Dedefo","suffix":""},{"id":317130715,"identity":"808eb9b7-3cbe-4487-8718-2197076237eb","order_by":2,"name":"Samuel Kinde","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Kinde","suffix":""},{"id":317130716,"identity":"11163203-03c0-4d4a-be3c-c898939e7cc1","order_by":3,"name":"Mekides Alem","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Mekides","middleName":"","lastName":"Alem","suffix":""},{"id":317130717,"identity":"f97b1289-8feb-4644-9971-f3e8cf5f88e6","order_by":4,"name":"Abebe Edao","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Abebe","middleName":"","lastName":"Edao","suffix":""},{"id":317130718,"identity":"e36eb3f1-5ad8-4868-81c4-0906220d4b1e","order_by":5,"name":"Amanuel Baye Mengistie","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Amanuel","middleName":"Baye","lastName":"Mengistie","suffix":""},{"id":317130719,"identity":"422d8d39-5111-4db5-a3d0-e51d52b5be62","order_by":6,"name":"Abera Abreham","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Abera","middleName":"","lastName":"Abreham","suffix":""},{"id":317130721,"identity":"6f20a447-eb52-4132-8031-90e82c56743b","order_by":7,"name":"Abush Getaneh","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Abush","middleName":"","lastName":"Getaneh","suffix":""},{"id":317130723,"identity":"c7517095-2a62-43d4-893b-bf2e0ce3d2e1","order_by":8,"name":"Gizachew Taddesse","email":"","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Gizachew","middleName":"","lastName":"Taddesse","suffix":""},{"id":317130725,"identity":"c2fade51-4016-4b3e-bb01-a1d0a9482885","order_by":9,"name":"Alem Bayable","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Alem","middleName":"","lastName":"Bayable","suffix":""},{"id":317130726,"identity":"443c4f19-48e1-4c27-88af-6f4cf7daa8ab","order_by":10,"name":"Biriku Gashaw","email":"","orcid":"","institution":"Wolkite University","correspondingAuthor":false,"prefix":"","firstName":"Biriku","middleName":"","lastName":"Gashaw","suffix":""},{"id":317130727,"identity":"36ccf73d-d180-46f0-84f7-f4eccb2359b0","order_by":11,"name":"Melaku Tsegaye","email":"","orcid":"","institution":"Wolaita Sodo University","correspondingAuthor":false,"prefix":"","firstName":"Melaku","middleName":"","lastName":"Tsegaye","suffix":""},{"id":317130728,"identity":"5de31af3-2415-443a-8660-82681ff6560f","order_by":12,"name":"Geleta Gemechu","email":"","orcid":"","institution":"Rehoboth Harme College","correspondingAuthor":false,"prefix":"","firstName":"Geleta","middleName":"","lastName":"Gemechu","suffix":""},{"id":317130729,"identity":"4158ad6a-fe7c-4352-91da-cc29766bcf98","order_by":13,"name":"Mistire Wolde","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Mistire","middleName":"","lastName":"Wolde","suffix":""}],"badges":[],"createdAt":"2024-06-08 07:09:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4549335/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4549335/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12902-024-01665-7","type":"published","date":"2024-08-07T15:57:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59436429,"identity":"6a7e5ae8-0035-49aa-b234-3996a585429d","added_by":"auto","created_at":"2024-07-01 19:15:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20659,"visible":true,"origin":"","legend":"\u003cp\u003eThe box and whisker plot summarized the distribution of serum ferritin levels among different study groups at SPHMMC, Addis Ababa, Ethiopia, 2024\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4549335/v1/4f9ca41bbf69a8efff01df17.png"},{"id":59436430,"identity":"2aa93cc0-3218-4723-900b-bf49acbdc1d3","added_by":"auto","created_at":"2024-07-01 19:15:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":292080,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eScatter plot showing the relationship of serum ferritin with glycemic indicators in T2DM patients at SPHMMC, Addis Ababa, Ethiopia, 2024\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4549335/v1/86c0e29dc9ebd5d14ea035a3.png"},{"id":62298351,"identity":"98512c2f-e9f9-4c64-abf1-5464c4062aa8","added_by":"auto","created_at":"2024-08-12 16:12:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1570254,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4549335/v1/7124f524-7f78-43b1-a959-74c79c59b348.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients at St. Paul’s Hospital Millennium Medical College Addis Ababa, Ethiopia: Comparative based cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eUncontrolled Type 2 Diabetes Mellitus (UT2DM) has become a global health crisis contributing to 4.2\u0026nbsp;million deaths, particularly in adults aged 20\u0026ndash;79 years as seen in the International Diabetic Federation (IDF) reports [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It causes various complications by damaging nerves and blood vessels as well as many other diabetic consequences if left untreated [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Of all the diagnosed cases of diabetes, about 90% are T2DM which is characterized by a failure of insulin secretion or action [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. One of the main causes of diabetes and its complications is oxidative stress and the conditions are linked to body iron stores [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHyperglycemia leads to increased glycated hemoglobin A1c (HbA1c), resulting from a non-enzymatic and irreversible interaction of glucose with the N-terminal residue of hemoglobin-A1 within red blood cells (RBC) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In contrast, free iron is released from RBC during the glycation process and tends to initiate redox reactions to generate free radicals such as reactive oxygen species (ROS) which damage pancreatic β-cell [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], intensify inflammatory response, and accelerate oxidative damage of biomolecules [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Likewise, obesity is on the rise in Africa which potentially leads to a risk of iron overload and could impact metabolic impairments [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIron excess can cause organ dysfunction [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], particularly in the pancreas, it leads to β-cell failure and impaired insulin secretion as well as it induces insulin resistance to different cells via generation of ROS [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Hepcidin and insulin hormones regulate iron and glucose metabolism respectively [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], but iron deregulation affects glucose metabolism, and glucose metabolism defect on the other hand disrupts iron metabolic pathways, indicating a bi-directional link between them [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Ferritin is a key protein regulating iron homeostasis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and serum ferritin is a useful marker for iron storage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Hyperferritinemia significantly influences the clinical course of T2DM independent of obesity and inflammation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUncontrolled T2DM is a serious health concern that should be prevented, especially in low and middle-income countries like Ethiopia, where it is expected to have the greatest current impact. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. HbA1c is a gold standard test that provides long-term glycemic control over the past two or three months rather than daily fluctuation in blood glucose levels [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The American Diabetic Association (ADA) and Canadian Diabetes Association Clinical Practice Guidelines Expert Committee recommend glycemic goals of HbA1c\u0026thinsp;\u0026le;\u0026thinsp;7% for adult diabetic patients to reduce its complications [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, different studies in Ethiopia revealed a high proportion of uncontrolled T2DM patients and comorbidities related to the condition [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the deregulation of micronutrients like iron and marker of iron storage (ferritin) were reported to be linked with the pathophysiology of T2DM [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], no conclusive evidence existed about the association of serum ferritin with the state of glycemic control, and studies in this regard were inconsistent, some indicating a null association [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], while others showed significant positive [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] or negative associations [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups. Studies in this area were limited, especially in Ethiopia. Besides, the investigation could lead to a better understanding of the relationship between serum ferritin and glycemic indicators of T2DM (FBs, HbA1c) as well as might improve the treatment response of uncontrolled T2DM patients transitioning to the controlled T2DM category.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area, design, and periods\u003c/h2\u003e \u003cp\u003eA hospital-based comparative cross-sectional study was conducted for three months from October 2 to December 29, 2023 among T2DM patients, who had follow-up appointments at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. It is one of the biggest teaching and public referral hospitals, offering healthcare services and student training programs. Besides, the hospital had endocrine clinics for outpatient follow-up chronic illness patients and the majority of them were diabetics, who were primarily monitored by endocrinologists and a team of nurses working in the clinic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy populations and the selection criteria\u003c/h2\u003e \u003cp\u003eAdult T2DM patients from 18\u0026ndash;65 years of age, who had at least one-year follow-up appointment and started anti-diabetic medication at the outpatient diabetic clinic of SPHMMC were selected and sub-grouped based on the ADA(2022) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Canadian Diabetes Association Clinical Practice Guidelines Expert Committee (2018) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] criteria as having either Uncontrolled Diabetes with HbA1c\u0026thinsp;\u0026gt;\u0026thinsp;7% or Controlled Diabetes with HbA1c\u0026thinsp;\u0026le;\u0026thinsp;7% were included as cases. Besides, age-sex-matched non-diabetic healthy control groups were selected based on the history, FBs (70\u0026ndash;100 mg/dl) and HbA1c (\u0026lt;\u0026thinsp;5.7%) levels as per the ADA criteria [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. While, participants who were pregnant, lactating, heavy drinkers, active smokers, had an acute infection within a week, had a known history of cancer or anemia, had blood transfusion or donation or iron supplements within the previous three months, and had been diagnosed with other types of diabetes were excluded based on their medical history and physical examinations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDescription of study variables\u003c/h2\u003e \u003cp\u003eSerum ferritin level was a dependent variable while socio-demographic factors like age, sex, and educational levels; clinical factors like body mass index (BMI), Blood Pressure (BP), glycemic control status, and duration of diabetes mellitus, as well as biochemical factors like serum iron, HbA1c, and FBs levels, were regarded as an independent variable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample size and Sampling technique\u003c/h2\u003e \u003cp\u003eSample size was determined using a comparative-based study design for quantitative data by taking the 95% confidence interval and 80% power of the study using the formula n\u0026thinsp;=\u0026thinsp;2SD\u003csup\u003e2\u003c/sup\u003e(Z\u003csub\u003eα/2\u003c/sub\u003e+Z\u003csub\u003eβ\u003c/sub\u003e)\u003csup\u003e2\u003c/sup\u003e/d\u003csup\u003e2\u003c/sup\u003e [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Where; n is the minimal sample size for each group, SD is the standard deviation from previous studies, Z\u003csub\u003eα/2\u003c/sub\u003e is 1.96 from the Z table at 95% CI \u0026amp; 5% type 1 error), Z\u003csub\u003eβ\u003c/sub\u003e is 0.84 from the Z table with 80% power of the study and 20% type II errors, and d is Effect size which is the difference in mean values. As per the authors\u0026rsquo; knowledge, no published study was conducted in Ethiopia on serum ferritin levels among uncontrolled and controlled T2DM patients. Thus, data from an Indian study was taken, which showed the mean serum ferritin levels in uncontrolled and controlled diabetes patients were 269.8 and 73.30 ng/ml respectively with a standard deviation of 347.1[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Therefore, n\u0026thinsp;=\u0026thinsp;2(347.1)\u003csup\u003e2\u003c/sup\u003ex(1.96\u0026thinsp;+\u0026thinsp;0.84)\u003csup\u003e2\u003c/sup\u003e/(269.8\u0026ndash;73.30)\u003csup\u003e2\u003c/sup\u003e=48.92\u0026thinsp;=\u0026thinsp;49. However, it was increased by 5% to eliminate potential outliers to make it up to 52 subjects per group, and 156 total study subjects were enrolled.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement and Data collection\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eData collection procedures\u003c/h2\u003e \u003cp\u003e After participants provided written informed consent, data was collected via face-to-face interviews, direct measurements, and reviewing medical records by professional data collectors in cooperation with outpatient department nurses and laboratory personnel under close supervision of the principal investigator. Participants\u0026rsquo; anthropometric data (height and weight) were measured to calculate body mass index (BMI) and categorized as Obesity (\u0026ge;\u0026thinsp;30kg/m\u003csup\u003e2\u003c/sup\u003e), overweight (25-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e), Normal (18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e) and underweight (\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e) based on the WHO guideline [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Besides, blood pressure readings were taken after a 5-minute rest using an automatic digital sphygmomanometer apparatus that recorded the systolic and diastolic blood pressures and classified according to the Seventh Report of the Joint National Committee (JNC7) blood pressure classification criteria as normal (\u0026lt;\u0026thinsp;120mmHg), pre-hypertension (120\u0026ndash;139 mmHg) and hypertension (\u0026ge;\u0026thinsp;140mmHg) for systolic blood pressure (SBP) and \u0026lt;\u0026thinsp;80 mmHg, 80\u0026ndash;89 mmHg and \u0026ge;\u0026thinsp;90 mmHg for diastolic blood pressure (DBP) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory sample collection, analysis, and test principles\u003c/h2\u003e \u003cp\u003eParticipants were oriented to have overnight fasting for about 8\u0026ndash;10 hours before sample collection. About 3ml of venous blood was collected in Ethylenediaminetetraacetic acid (EDTA) tubes and 5 ml in Serum Separator Tube (SST) via venipuncture with an evacuated tube method under aseptic precautions, by a competent laboratory technologist. The EDTA tube was used for HbA1c determination using the Cobas c501module of the analyzer with a principle of turbidimetric inhibition immunoassay (TINIA) that standardized against the International Federation of Clinical Chemistry (IFCC) reference method and traceable to the Diabetes Control and Complications Trial (DCCT)/National Glycohemoglobin Standardization Program (NGSP) % HbA1c, while the SST tube was allowed for about 20\u0026ndash;30 minutes at room temperature until coagulated and centrifuged for 5 minutes at 3000 RPM to separate serum from whole blood. FBs, ferritin, and iron were determined using a principle of glucose hexokinase (HK) of the c501, electrochemiluminescent immunoassay (ECLIA) of the e601, and colorimetric assay techniques of the c501 modules of the Roche diagnostic technology respectively.\u003c/p\u003e \u003cp\u003e \u003cb\u003eReference range and clinical implications of the laboratory tests\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe reference range for HbA1c and FBs was based on the ADA criteria as healthy groups (HbA1c\u0026thinsp;\u0026lt;\u0026thinsp;5.7% and FBs 70-99mg/dl), pre-diabetes (HbA1c 5.7\u0026ndash;6.4% and FBs 100-125mg/dl), diabetes mellitus (HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;6.5% and FBs\u0026thinsp;\u0026ge;\u0026thinsp;126mg/dl). Furthermore, T2DM patients were categorized into controlled (HbA1c\u0026thinsp;\u0026le;\u0026thinsp;7%) and uncontrolled (HbA1c\u0026thinsp;\u0026gt;\u0026thinsp;7%) diabetes. The WHO guidelines classify serum ferritin levels as iron deficiency (\u0026lt;\u0026thinsp;15ng/ml), sufficiency (15-200ng/ml), and excess (\u0026gt;\u0026thinsp;200ng/ml) for males and iron deficiency (\u0026lt;\u0026thinsp;15ng/ml), sufficiency (15-150ng/ml), and excess (\u0026gt;\u0026thinsp;150ng/ml) for females, with low risk of iron overload (\u0026le;\u0026thinsp;200 ng/ml) and increased risk (\u0026gt;\u0026thinsp;200 ng/ml) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Adults\u0026rsquo; reference range of serum iron is 59\u0026ndash;158 ug/dL for males and 37\u0026ndash;145 ug/dL for females.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData quality assurance\u003c/h2\u003e \u003cp\u003eBefore the actual data collection took place, the pre-test was done. To reduce misleading answers, the purpose of the investigation was informed to the study participants and sufficient time was taken to collect the data. To assure the reliability of test results, the SOP format of each analyte was followed throughout the process. The performance verification of the clinical chemistry analyzer was checked daily by using standard controls. Generally, quality assurance was maintained throughout the pre-analytical, analytical, and post-analytical phases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData analysis and interpretation\u003c/h2\u003e \u003cp\u003eThe IBM-SPSS statistical software package (version 27) was used for data entry and analysis. The data distribution was checked with the help of the Shapiro-Wilk test of normality. Normally distributed data was done via parametric tests and descriptive statistics like frequency, percentage, mean and standard deviation (SD) were computed. One-way analysis of variant (ANOVA) and the corresponding post-hock test was used to evaluate (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) of the continuous biochemical and clinical parameters. Similarly, bivariate correlations of those parameters with the levels of serum ferritin were computed via Pearson correlation coefficient (r). Furthermore, bivariate and multivariate logistic regression was done to calculate the crude odds ratio (COR) and adjusted odds ratio (AOR) for estimating factors associated with serum ferritin levels in T2DM patients using a 95% confidence interval (CI). Besides, P-values less than 0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eOperational definitions\u003c/h2\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGood glycaemic control-\u003c/b\u003e adult non-pregnant diabetic patients whose HbA1c\u0026thinsp;\u0026le;\u0026thinsp;7% based on the ADA guideline [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePoor glycaemic control \u0026ndash;\u003c/b\u003eadult non-pregnant diabetic patients whose HbA1c\u0026thinsp;\u0026gt;\u0026thinsp;7% based on the ADA guideline [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eUncontrolled diabetes \u0026ndash;\u003c/b\u003ediabetic patients who were unable to achieve the target glycemic control status for the past three months and had poor glycemic control at the time of data collection (HbA1c\u0026thinsp;\u0026gt;\u0026thinsp;7%) as per ADA criteria of glycemic targets [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eControlled diabetes-\u003c/b\u003e diabetic patients who had optimal glycemic control status for the past three months and had good glycemic control at the time of data collection (HbA1c\u0026thinsp;\u0026le;\u0026thinsp;7%) as per ADA criteria of glycemic targets [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eAdult diabetic patients \u0026ndash;\u003c/b\u003ediabetic patients who had an age group from 18\u0026ndash;65 years based on WHO (2019) guidelines [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. \u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" type=\"Results\" class=\"Section2\"\u003e \u003ch2\u003eResult\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eDescriptive features of the study participants\u003c/h2\u003e \u003cp\u003eIn this study, a total of 156 study subjects were enrolled and sub-grouped into three equal groups based on glycemic control status. Of the total (156) participants, 72(46%) were males. Female participants outnumbered males in each group, accounting 27(52%), 29(56%) and 28(54%) in uncontrolled T2DM, controlled T2DM and control groups respectively. Most of the respondents in uncontrolled and controlled T2DM patients had a BMI between 25-29.9kg/m\u003csup\u003e2\u003c/sup\u003e while 18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e in control groups. There were no blood pressure records of \u0026ge;\u0026thinsp;140/90 mmHg in control groups. 65.4% of T2DM patients were on an oral OHA while 34.6% were injectable insulin users as a treatment option, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive characteristics of study participants at SPHMMC, Addis Ababa, Ethiopia, 2024 (N\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eStudy groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUncontrolled T2DM (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControlled T2DM(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl groups(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72(46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28(54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84(54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22(42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66(42.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66(42.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14(8.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38(24.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58(37.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46(29.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33(63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70(44.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25-29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62(39.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45(28.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120\u0026ndash;139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28(53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76(48.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35(22.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30(57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64(41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026ndash;89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22(42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65(41.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27(17.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDuration on DM (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20(19.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40(38.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44(42.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTreatment option\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68(65.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsulin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36(34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNo formal education- have no classroom-based education, Primary school- from grades 1\u0026ndash;8, secondary school- from grades 9\u0026ndash;12, higher level education- college or university, OHA- oral hypoglycemic agent, DM-diabetes mellitus\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the biochemical and clinical parameters in different study groups\u003c/h2\u003e \u003cp\u003eA one-way ANOVA results reveal that the mean differences in the age of participants in Uncontrolled T2DM, controlled T2DM, and control groups were not statistically significant (F\u003csub\u003e2, 153\u003c/sub\u003e=0.277, P\u0026thinsp;=\u0026thinsp;0.759). The corresponding post-hock test results for serum ferritin showed that the mean difference between Uncontrolled and controlled T2DM patients was significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the mean difference in DBP was not significant (p\u0026thinsp;=\u0026thinsp;0.665). Additionally, the mean difference of serum iron between controlled T2DM and the non-diabetic control group was not significant (p\u0026thinsp;=\u0026thinsp;0.055). Except for the age of participants, the mean difference of all the tested variables between uncontrolled T2DM and non-diabetic control groups was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of serum ferritin and other tested parameters among study subjects with different glycemic control status at SPHMMC, Addis Ababa, Ethiopia, 2024 (n\u0026thinsp;=\u0026thinsp;52 per group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eANOVA results\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePost hoc analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge (yrs)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF (p-value)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePaired groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.54\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/p\u003e \u003cp\u003e46.31\u0026thinsp;\u0026plusmn;\u0026thinsp;9.36\u003c/p\u003e \u003cp\u003e46.35\u0026thinsp;\u0026plusmn;\u0026thinsp;9.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.277(0.759)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003cp\u003e0.993\u003c/p\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003cp\u003e24.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e \u003cp\u003e22.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.443(\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003cp\u003e0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSBP (mmHg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136.85\u0026thinsp;\u0026plusmn;\u0026thinsp;14.04\u003c/p\u003e \u003cp\u003e130.67\u0026thinsp;\u0026plusmn;\u0026thinsp;11.30\u003c/p\u003e \u003cp\u003e119.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.171(\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDBP (mmHg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.70\u003c/p\u003e \u003cp\u003e83.24\u0026thinsp;\u0026plusmn;\u0026thinsp;7.70\u003c/p\u003e \u003cp\u003e77.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.318(\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDuration on DM (yrs)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e \u003cp\u003e8.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHbA1c (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003cp\u003e6.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003cp\u003e5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262.205(\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFBs (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201.03\u0026thinsp;\u0026plusmn;\u0026thinsp;43.38\u003c/p\u003e \u003cp\u003e113.03\u0026thinsp;\u0026plusmn;\u0026thinsp;19.09\u003c/p\u003e \u003cp\u003e89.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e230.063(\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSerum ferritin (ng/ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e243.05\u0026thinsp;\u0026plusmn;\u0026thinsp;91.77\u003c/p\u003e \u003cp\u003e169.30\u0026thinsp;\u0026plusmn;\u0026thinsp;89.98\u003c/p\u003e \u003cp\u003e109.60\u0026thinsp;\u0026plusmn;\u0026thinsp;29.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.114(\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSerum iron (ug/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUT2DM\u003c/p\u003e \u003cp\u003eCT2DM\u003c/p\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140.17\u0026thinsp;\u0026plusmn;\u0026thinsp;37.26\u003c/p\u003e \u003cp\u003e117.90\u0026thinsp;\u0026plusmn;\u0026thinsp;31.48\u003c/p\u003e \u003cp\u003e102.75\u0026thinsp;\u0026plusmn;\u0026thinsp;30.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.726(\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUT2DM vs CT2DM\u003c/p\u003e \u003cp\u003eCT2DM vs CG\u003c/p\u003e \u003cp\u003eCG vs UT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003cp\u003e0.055\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUT2DM- Uncontrolled T2DM, CT2DM-Controlled T2DM, CG-Control groups, SD-Standard deviation, f\u003csub\u003e2\u003c/sub\u003e,\u003csub\u003e153=\u003c/sub\u003e F and the p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level (2-tailed) showed the existence of a significant difference between the groups. All the variables were expressed in (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) form.\u003c/p\u003e \u003cp\u003eThe distribution of the data set and the five-number summary of minimum, lower quartile (Q\u003csub\u003e1\u003c/sub\u003e), median, upper quartile (Q\u003csub\u003e3\u003c/sub\u003e), and maximum values of serum ferritin levels among the three different study groups were plotted in (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The maximum value of serum ferritin level was nearest to 500ng/ml, 400ng/ml, and 200ng/ml for uncontrolled T2DM, controlled T2DM, and control groups respectively. Similarly, the median serum ferritin levels were decreased from uncontrolled T2DM to control groups from left to right. The control groups showed a narrower interquartile range (IQR) compared to uncontrolled and controlled T2DM patients, which showed more consistent data sets seen in the control groups than diabetic groups. However, the minimum values of serum ferritin levels were recorded among the controlled T2DM patients as, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe mean differences in age, BMI, SBP, DBP, HbA1c, FBs, serum ferritin and serum iron in T2DM patients with different pharmacological treatment options of OHA and injectable insulin users were analyzed. Accordingly, our study indicated that serum ferritin was increased in OHA users than in patients having injectable insulin as a therapeutic option and the difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.048). Similarly, DBP was increased among OHA users as compared to injectable insulin users and the difference was significant (p\u0026thinsp;=\u0026thinsp;0.034). However, the mean difference of duration on diabetes mellitus was decreased in OHA users than in injectable insulin users and the difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.047), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of serum ferritin levels and other tested parameters among OHA and injectable insulin users of T2DM patients at SPHMMC, Addis Ababa, Ethiopia, 2024 (n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTested parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDiabetes treatment option\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOHA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInjectable insulin\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e47.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.53\u0026thinsp;\u0026plusmn;\u0026thinsp;8.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.59\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e134.44\u0026thinsp;\u0026plusmn;\u0026thinsp;13.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e132.47\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e85.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e82.03\u0026thinsp;\u0026plusmn;\u0026thinsp;6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of DM (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBs (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e159.27\u0026thinsp;\u0026plusmn;\u0026thinsp;58.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e152.81\u0026thinsp;\u0026plusmn;\u0026thinsp;48.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum ferritin (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) ng/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e218.38\u0026thinsp;\u0026plusmn;\u0026thinsp;107.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e183.12\u0026thinsp;\u0026plusmn;\u0026thinsp;70.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum iron (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) ug/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e133.72\u0026thinsp;\u0026plusmn;\u0026thinsp;38.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e120.19\u0026thinsp;\u0026plusmn;\u0026thinsp;30.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eOHA\u0026thinsp;=\u0026thinsp;oral hypoglycemic agents, p-value is significant at \u0026lt;\u0026thinsp;0.05 levels (2-tailed)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eRelation of serum ferritin level with biochemical and clinical parameters\u003c/h2\u003e \u003cp\u003eOur study demonstrated that there was a positive significant correlation of serum ferritin levels with HbA1c, FBs, serum iron and SBP (r\u0026thinsp;=\u0026thinsp;0.457, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; r\u0026thinsp;=\u0026thinsp;0.386, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, r\u0026thinsp;=\u0026thinsp;0.430, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and r\u0026thinsp;=\u0026thinsp;0.195, p\u0026thinsp;=\u0026thinsp;0.047) respectively in T2DM patients. However, there were no significant correlations found in non-diabetic control groups, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of serum ferritin with some biochemical and clinical parameters among patients with T2DM and non-diabetic control groups at SPHMMC, Addis Ababa, Ethiopia, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTested parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eStudy groups\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eT2DM patients (n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControl groups (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration on DM (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBs (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum iron (ug/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;Pearson correlation coefficient **= p-value significant at 0.01 level (2-tailed) and *= p-value significant at 0.05 level (2-tailed) and all the tested parameters were expressed in terms of (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003cp\u003eThe study found a linear relationship between serum ferritin levels and glycemic indicators (HbA1c, FBs) in T2DM patients as the majority of the data set closer to the fit line. The correlation was significantly positive, with an uphill pattern, indicating that serum ferritin rises as HbA1c and FBs increased with a Pearson correlation (r) of 0.386 and 0.457 respectively, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e part A and B. Likewise, a significant positive correlation also existed in uncontrolled T2DM patients (r\u0026thinsp;=\u0026thinsp;0.363, p\u0026thinsp;=\u0026thinsp;0.008), as demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e part C.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with an increase in serum ferritin level among T2DM patients\u003c/h2\u003e \u003cp\u003eThe bivariate analysis was done to identify the candidate variables for multivariate logistic regression based on the Wald test from logistic regression and a p-value cut of \u0026lt;\u0026thinsp;0.25 at least one within the group [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. As such, tested variables like age group, sex, BMI, SBP, DBP, duration of diabetes, treatment option, HbA1c, FBs and serum iron were all associated with an increase in serum ferritin level in T2DM patients and exported into a multivariate logistic regression model.\u003c/p\u003e \u003cp\u003eThe result of this study showed that T2DM patients who were taking injectable insulin as a treatment option were 0.26 times less likely to increase serum ferritin level as compared to only OHA users (AOR\u0026thinsp;=\u0026thinsp;0.26, 95% CI(0.07\u0026ndash;0.95), p\u0026thinsp;=\u0026thinsp;0.042). A 1% increase in HbA1c of T2DM patients was 3.67 ng/ml times more likely to increase serum ferritin level (AOR\u0026thinsp;=\u0026thinsp;3.67, 95% CI (1.50\u0026ndash;8.98), p\u0026thinsp;=\u0026thinsp;0.004). This study also illustrated that a rise in serum iron was positively associated with elevation of serum ferritin in T2DM patients (AOR\u0026thinsp;=\u0026thinsp;1.02, 95% CI (1.01\u0026ndash;1.04), p\u0026thinsp;=\u0026thinsp;0.017). Similarly, female T2DM patients were 0.16 times less likely to increase serum ferritin level as compared to males (AOR\u0026thinsp;=\u0026thinsp;0.16, 95% CI (0.05\u0026ndash;0.57), p\u0026thinsp;=\u0026thinsp;0.004), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate and multivariate logistic regression showing factors associated with elevated serum ferritin levels among T2DM patients at SPHMMC, Addis Ababa, Ethiopia, 2024 (n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTested parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSerum ferritin\u0026thinsp;\u0026gt;\u0026thinsp;200 ng/ml\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eBivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAOR(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge (yrs)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55(0.16\u0026ndash;1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.43(0.06\u0026ndash;2.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44(0.13\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.19(0.02\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.27(0.12\u0026ndash;0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.16(0.05\u0026ndash;0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational levels\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.29(0.32\u0026ndash;5.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.65(0.43\u0026ndash;6.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03(0.25\u0026ndash;4.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54(0.09\u0026ndash;3.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.12(0.01\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25-29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.33(0.24\u0026ndash;7.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.44(0.04\u0026ndash;4.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.0(0.55\u0026ndash;45.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.27(0.09\u0026ndash;57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSBP(mmHg)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120\u0026ndash;139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.63(0.57\u0026ndash;4.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.48(0.33\u0026ndash;6.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.75(0.90\u0026ndash;8.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.56(0.25\u0026ndash;9.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDBP(mmHg)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026ndash;89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21(0.49\u0026ndash;2.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50(0.12\u0026ndash;2.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.53(0.89\u0026ndash;7.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.48(0.08\u0026ndash;2.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDuration on DM (yrs)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49(0.17\u0026ndash;1.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.80(0.16\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88(0.30\u0026ndash;2.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.35(0.05\u0026ndash;2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMode of therapy \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsulin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37(0.16\u0026ndash;0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.26(0.07\u0026ndash;0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u0026plusmn;\u003c/p\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.12(1.50\u0026ndash;3.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.67(1.50\u0026ndash;8.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBs (mg/dl)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176.4\u0026thinsp;\u0026plusmn;\u0026thinsp;59.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136.1\u0026thinsp;\u0026plusmn;\u0026thinsp;42.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02(1.01\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.99(0.97\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum iron (ug/dl)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142.8\u0026thinsp;\u0026plusmn;\u0026thinsp;33.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114.2\u0026thinsp;\u0026plusmn;\u0026thinsp;32.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03(1.01\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.02(1.01\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e1-indicates the reference group, COR\u0026thinsp;=\u0026thinsp;crude odds ratio, AOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio, CI\u0026thinsp;=\u0026thinsp;confidence interval, M\u0026thinsp;=\u0026thinsp;mean, SD\u0026thinsp;=\u0026thinsp;Standard Deviation, p-value significant at 0.05 level (2-tailed), \u003csup\u003ea\u003c/sup\u003e=variables exported to multivariate logistic regression, \u003csup\u003eb\u003c/sup\u003e=variables not exported to multivariate logistic regression model\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDespite iron being an essential element used in the body, excess accumulation causes different organ dysfunctions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Particularly in pancreatic β-cells, it decreases insulin production from the islets of Langerhans and causes insulin resistance to different cells [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] which is the pathophysiology of T2DM [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Uncontrolled T2DM and its associated consequences nowadays have been a global health concern, accounting for 4.2\u0026nbsp;million deaths in adults aged 20\u0026ndash;79 years [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Different studies conducted in Ethiopia revealed a high percentage of uncontrolled T2DM patients[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Iron and markers of iron storage were reported to be linked with T2DM [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the associations of serum ferritin with glycemic control were not well established.\u003c/p\u003e \u003cp\u003eThe overall result of the present study showed that the level of serum ferritin was high in uncontrolled T2DM patients as compared to controlled T2DM and control groups. A significant positive correlation of serum ferritin with HbA1c, FBs, serum iron and SBP was found among T2DM patients. However, no significant correlation was found among the control groups. Insulin injection users had significantly decreased ferritin levels compared to those who had been on OHA. A rise in HbA1c and serum iron, being male, and having only OHA were the key associated factors for the elevation of serum ferritin in T2DM patients.\u003c/p\u003e \u003cp\u003eAccording to our research, the mean serum ferritin level was significantly increased in uncontrolled T2DM patients (243.05\u0026thinsp;\u0026plusmn;\u0026thinsp;91.77 ng/ml) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as compared to controlled T2DM (169.30\u0026thinsp;\u0026plusmn;\u0026thinsp;89.98 ng/ml) and non-diabetic control groups (109.60\u0026thinsp;\u0026plusmn;\u0026thinsp;29.33 ng/ml) as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The finding of this study was different from a study done in Saudi Arabia that described serum ferritin had no link with glycemic indicators and diabetic complications [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] as well as contrasted with a study conducted in Ethiopia showing a significant decrease in serum ferritin levels among T2DM patients as compared to non-diabetic control groups [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Even though the exact reasons remained unknown, the variation in dietary intake and follow-up care might have a greater influence on the discrepancies in serum ferritin levels[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, our study was consistent with a study done in India [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and Turkey [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], which showed a noticeable hyperferritinemia among uncontrolled T2DM patients than controlled T2DM patients. This could be due to hyperferritinemia affecting pancreatic β-cells through oxidative stress, impairing the liver's capacity to extract hepatic insulin, interfering with insulin's ability to reduce hepatic glucose synthesis [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], and potentially leading to diabetic complications via interaction with vascular endothelial growth factor (VEGF) [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study demonstrated the existence of a significant positive correlation of serum ferritin with HbA1c, FBs, serum iron and SBP (r\u0026thinsp;=\u0026thinsp;0.457, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, r\u0026thinsp;=\u0026thinsp;0.386, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, r\u0026thinsp;=\u0026thinsp;0.430, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and 0.195, p\u0026thinsp;=\u0026thinsp;0.047) respectively in T2DM patients. The current finding was contrasted with a study done in Iran [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and Iraq [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] that showed a null correlation. However, our finding was consistent with a study conducted by Shubham J, \u003cem\u003eet al\u003c/em\u003e.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Rajeev C, \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] and Li S, \u003cem\u003eet al\u003c/em\u003e.[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], who found a significant correlation of serum ferritin with glucose control, serum iron and SBP/DBP respectively. This might be due to hyperglycemia causing a non-enzymatic irreversible interaction of glucose with hemoglobin in RBC [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and free iron is released during the glycation process which tends to initiate redox reactions to generate free radicals like ROS, which damage pancreatic β-cell [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and intensifies the inflammatory response as well as oxidative damage to biomolecules which results in elevated serum ferritin levels [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe multivariate logistic registration model of the present study suggested that increased HbA1c by 1% in T2DM patients had 3.67ng/ml times more likely to increase serum ferritin levels (AOR\u0026thinsp;=\u0026thinsp;3.67, 95% CI (1.50\u0026ndash;8.98), p\u0026thinsp;=\u0026thinsp;0.004) and an increase in serum iron was also positively associated with elevation of serum ferritin level (AOR\u0026thinsp;=\u0026thinsp;1.02, 95% CI (1.01\u0026ndash;1.04), p\u0026thinsp;=\u0026thinsp;0.017) as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This finding was in line with a study done by Sarin S, \u003cem\u003eet al\u003c/em\u003e. that showed for every 1ng/ml increase in serum ferritin levels, patients' average HbA1c raised by 0.01% [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Moreover, this study showed a positive likelihood association of serum ferritin with glycemic control status and was consistent with earlier similar studies [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. This might be due to the biochemical properties of ferritin and the pathophysiology of T2DM which attributed to the close connection of serum ferritin with glycemic control status [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWHO and IDF guidelines recommend metformin as the first-line pharmacological treatment option for T2DM, followed by sulfonylureas and other hypoglycemic agents if metformin monotherapy fails and the last could be the addition of injectable insulin [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. This study found that OHA users had significantly higher serum ferritin levels than injectable insulin users (p\u0026thinsp;=\u0026thinsp;0.048), which was consistent with previous Ethiopian studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The multivariate logistic regression of the current study also illustrates that insulin injection users were 0.26 times less likely to increase ferritin levels as compared to only OHA users (AOR\u0026thinsp;=\u0026thinsp;0.26, 95% CI(0.07\u0026ndash;0.95), p\u0026thinsp;=\u0026thinsp;0.042). Even though we didn\u0026rsquo;t know the exact mechanism for such a difference, possibly insulin injection made a rapid stimulation of iron uptake by fat cells and hepatocytes [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, OHA users had a significantly higher mean DBP record compared to insulin injection users (p\u0026thinsp;=\u0026thinsp;0.032). This might be due to insulin stimulating the production of nitric oxide (NO) in endothelium which induces vasodilation by relaxing the inner muscle of the blood vessels and regulates sodium homeostasis by enhancing sodium reabsorption in the kidney. Thereby, contributing to the regulation of blood pressure [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Conversely, the diabetes duration was significantly decreased in OHA users than those who had been on injectable insulin (p\u0026thinsp;=\u0026thinsp;0.047), possibly due to the management guideline of T2DM, as OHA was used before insulin treatment began. Thereby, diabetes duration possibly increased among insulin users [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, female T2DM patients were 0.16 times less likely to increase serum ferritin level as compared to males (AOR\u0026thinsp;=\u0026thinsp;0.16, 95% CI (0.05\u0026ndash;0.57), p\u0026thinsp;=\u0026thinsp;0.004). Our finding was consistent with other studies which showed that being male could be a risk factor for iron overload [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. This might be due to the nature of females that may lose iron during the menstrual period as the menstrual cycle affects the iron homeostasis pathway [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study also suggested the presence of a positive correlation between serum ferritin and BMI even though the association was not significant (r\u0026thinsp;=\u0026thinsp;0.182, p\u0026thinsp;=\u0026thinsp;0.065), which inline with a study done by Aregbesola A, \u003cem\u003eet al.\u003c/em\u003e that showed the higher the BMI the elevated the levels of serum ferritin [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Even if we didn\u0026rsquo;t know the exact mechanism, scientific studies showed that males stored more fats in their bellies than females [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Therefore, a variation in body composition and fat deposition among sexes, may contribute to gender-specific serum ferritin disparities.\u003c/p\u003e \u003cp\u003eAlthough diabetes mellitus affects both sexes, epidemiological studies showed that the prevalence of diabetes mellitus was increased in males as compared to females. Worldwide, an estimated 17.7\u0026nbsp;million more men than women have diabetes mellitus [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Even though we don\u0026rsquo;t know the exact mechanisms, body iron stores might be one of the risk factors for such differences [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e \u003cp\u003eThe major strengths of the current study were the use of a fully automated clinical chemistry analyzer for investigating each laboratory test and as per the authors' knowledge, this was the first Ethiopian study investigating serum ferritin levels and associated factors among patients with uncontrolled T2DM and compared them to those with controlled T2DM and non-diabetic controls. However, the investigation was constrained by a cross-sectional study unlike a longitudinal design, which did not show a well-established relationship between serum ferritin levels and state of glycemic control. Furthermore, it was conducted only in T2DM patients undergoing follow-up appointments at the outpatient clinics, which might not be reflective of the overall diabetes community.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eConclusion and recommendation\u003c/h2\u003e \u003cp\u003eThe study found that uncontrolled T2DM patients had elevated serum ferritin levels as far as glycemic control was not maintained, with a significant positive correlation of biochemical indicators like HbA1c, FBs, and iron levels. Factors such as increased HbA1c, raised serum iron, being male, and having only OHA were all associated with increased ferritin levels in T2DM patients. Thereby, elevated serum ferritin might indicate long-term hyperglycemia in T2DM patients suggesting a potential therapeutic target for iron excess. Future research should use longitudinal design with the addition of hepcidin tests, and incorporation of adolescents and children with T1DM for the representativeness.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Diabetic Association\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiastolic blood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFBS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFasting Blood Sugar\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHbA1c\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHemoglobin A1c\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIDF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Diabetic Federation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOral Hypoglycemic Agent\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRed blood cell\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReactive Oxygen Species\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSystolic blood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard operating procedure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPHMMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSt. Paul\u0026rsquo;s Hospital Millennium Medical College\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eT1DM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eType 1 diabetes mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eT2DM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eType 2 diabetes mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten consent was obtained from the Departmental Research and Ethics Review Committee (DRERC) of Addis Ababa University College of Health Science, Department of Medical Laboratory Science, and an official permission letter was submitted to St. Paul\u0026rsquo;s Hospital Millennium Medical College. Furthermore, the study participants were informed about the purpose of the study, the information obtained in the course investigation was kept confidential using codes, and finally written informed consent was obtained from each study participant before the actual data collection was carried out.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript contains all pertinent information about the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no competing interests that the authors declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDilla University provided funding for the study and the study design, data collection, analysis, interpretation as well as manuscript preparation were all done without the Funder\u0026apos;s input.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eABT was the principal investigator who participated in the conceptualization of the study, drafted the manuscript, performed the data analysis, and participated in data collection and laboratory tests; MW, GD, SK, AG and MA were advised throughout the process and participated in editing and reviewing the manuscript; GT, AA, AG and BG were participated in data collection; ABM, AB, GG and MT were participated in data analysis and interpretation. Each author reviewed and gave their approval to the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the support of Dilla University for funding, Addis Ababa University College of Health Science for giving this golden chance and St. Paul\u0026apos;s Hospital Millennium Medical College for the permission to conduct the research in the diabetic clinic as well as sincerely thank the study participants and data collectors for their kindly participation and cooperation in this work.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. Idf diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.1016/j.diabres.2021.109119\u003c/span\u003e\u003cspan address=\"http://doi:10.1016/j.diabres.2021.109119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoglic G. Who global report on diabetes: A summary. Int J Noncommunicable Dis. 2016;1(1):3\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.ijncd.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClassification and diagnosis of diabetes. Standards of medical care in diabetes-2022. Diabetes Care. 2022;45(1):17\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/dc22-S002\u003c/span\u003e\u003cspan address=\"10.2337/dc22-S002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHurtado MD, Vella A. What is type 2 diabetes? Medicine. 2019;47(1):10\u0026thinsp;\u0026ndash;\u0026thinsp;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/.1016/j.mpmed.2018.10.010\u003c/span\u003e\u003cspan address=\"https://doi.org/.1016/j.mpmed.2018.10.010\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaaban MA, Dawod AEA, Nasr MA. Role of iron in diabetes mellitus and its complications. Menoufia medical journal. 2016;29(1):11. http://DOI:0.4103/1110-2098.178938.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEzegbogu M, Abdulsalam K. Glycated haemoglobin (hba1c): An update on available methods. Bayero Journal of Pure and Applied Sciences. 2018;11(1):8\u0026ndash;14. http://dx.doi.org/0.4314/bajopas.v11i1.2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBacke MB, Moen IW, Ellervik C, Hansen JB, Mandrup-Poulsen T. Iron regulation of pancreatic beta-cell functions and oxidative stress. Annu Rev Nutr. 2016;36:241\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.1146/annurev-nutr-071715-50939\u003c/span\u003e\u003cspan address=\"http://doi:10.1146/annurev-nutr-071715-50939\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShetty JK, Prakash M, Ibrahim MS. Relationship between free iron and glycated hemoglobin in uncontrolled type 2 diabetes patients associated with complications. Indian J Clin Biochem. 2008;23:67\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore Heslin A, O\u0026rsquo;Donnell A, Buffini M, Nugent AP, Walton J, Flynn A, et al. Risk of iron overload in obesity and implications in metabolic health. Nutrients. 2021;13(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu13051539\u003c/span\u003e\u003cspan address=\"10.3390/nu13051539\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKohgo Y, Ikuta K, Ohtake T, Torimoto Y, Kato J. Body iron metabolism and pathophysiology of iron overload. International journal of hematology. 2008;88:7\u0026ndash;15. http://DOI0.1007/s12185-008-0120-5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarku A, Galli A, Marciani P, Dule N, Perego C, Castagna M. Iron metabolism in pancreatic beta-cell function and dysfunction. Cells. 2021;10(11). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/cells10112841\u003c/span\u003e\u003cspan address=\"10.3390/cells10112841\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFillebeen C, Lam NH, Chow S, Botta A, Sweeney G, Pantopoulos K. Regulatory connections between iron and glucose metabolism. Int J Mol Sci. 2020;21(20). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.3390/ijms21207773\u003c/span\u003e\u003cspan address=\"http://doi:10.3390/ijms21207773\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez-Real JM, L\u0026oacute;pez-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes. 2002;51(8):2348\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, Li H, Jiang X, Shi W, Shen Z, Li M. Hepcidin is directly regulated by insulin and plays an important role in iron overload in streptozotocin-induced diabetic rats. Diabetes. 2014;63(5):1506\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.1016/j.blre.2008.08.001\u003c/span\u003e\u003cspan address=\"http://doi:10.1016/j.blre.2008.08.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajpathak SN, Crandall JP, Wylie-Rosett J, Kabat GC, Rohan TE, Hu FB. The role of iron in type 2 diabetes in humans. Biochim et Biophys Acta (BBA)-General Subj. 2009;1790(7):671\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.1016/j.bbagen.2008.04.005\u003c/span\u003e\u003cspan address=\"http://doi:10.1016/j.bbagen.2008.04.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun L, Franco OH, Hu FB, Cai L, Yu Z, Li H, et al. Ferritin concentrations, metabolic syndrome, and type 2 diabetes in middle-aged and elderly chinese. J Clin Endocrinol Metabolism. 2008;93(12):4690\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.1210/jc.2008-1159\u003c/span\u003e\u003cspan address=\"http://doi:10.1210/jc.2008-1159\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMojiminiyi OA, Marouf R, Abdella NA. Body iron stores in relation to the metabolic syndrome, glycemic control and complications in female patients with type 2 diabetes. Nutr Metabolism Cardiovasc Dis. 2008;18(8):559\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.numecd.2007.07.007\u003c/span\u003e\u003cspan address=\"10.1016/j.numecd.2007.07.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi\u003c/span\u003e\u003cspan address=\"http://doi\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeedi P, Salpea P, Karuranga S, Petersohn I, Malanda B, Gregg EW, et al. Mortality attributable to diabetes in 20\u0026ndash;79 years old adults, 2019 estimates: Results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract. 2020;162. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.diabres.2020.108086\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2020.108086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of hba1c test in diagnosis and prognosis of diabetic patients. Biomark insights. 2016;11:38440. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.4137/Bmi.s\u003c/span\u003e\u003cspan address=\"http://doi:10.4137/Bmi.s\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eADA. Glycemic targets: Standards of medical care in diabetes\u0026mdash;2022. Diabetes Care. 2022;45(1):83\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/dc22-S006\u003c/span\u003e\u003cspan address=\"10.2337/dc22-S006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImran SA, Agarwal G, Bajaj HS, Ross S, Committee DCCPGE. Targets for glycemic control. Can J diabetes. 2018;42:42\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcjd.2017.10.030\u003c/span\u003e\u003cspan address=\"10.1016/j.jcjd.2017.10.030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTekalegn Y, Addissie A, Kebede T, Ayele W. Magnitude of glycemic control and its associated factors among patients with type 2 diabetes at tikur anbessa specialized hospital, addis ababa, ethiopia. PLoS ONE. 2018;13(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0193442\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0193442\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebreyohannes EA, Netere AK, Belachew SA. Glycemic control among diabetic patients in ethiopia: A systematic review and meta-analysis. PLoS ONE. 2019;14(8). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0221790\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0221790\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung CH, Lee MJ, Hwang JY, Jang JE, Leem J, Park J-Y, et al. Elevated serum ferritin level is associated with the incident type 2 diabetes in healthy korean men: A 4 year longitudinal study. PLoS ONE. 2013;8(9). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0075250\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0075250\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi\u003c/span\u003e\u003cspan address=\"http://doi\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlqahtani N, Ghazwani EY, Al-Qahtani AM, Elmahboub RA. Correlation of iron levels with glycemia and microvascular complications among type ii diabetes mellitus patients in najran university hospital. J Family Med Prim Care. 2022;11(6). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jfmpc.jfmpc_545_21\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_545_21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI\u003c/span\u003e\u003cspan address=\"http://DOI\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharifi F, Sazandeh S. Serum ferritin in type 2 diabetes mellitus and its relationship with hba1c. 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L, Li Y, Zhang F, Zhang S, Zhou X, Ji L. Association of serum ferritin levels with metabolic syndrome and insulin resistance in a chinese population. J Diabetes Complicat. 2017;31(2):364\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.jdiacomp.2016.06.018\u003c/span\u003e\u003cspan address=\"10.1016/j.jdiacomp.2016.06.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGandhi SJ, Chaudhari AS, Pratinidhi S, Sontakke A. Study of serum ferritin and hba1c in type 2 diabetes mellitus. Int J Clin Biochem Res. 2018;5(4):594\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI:10.18231/2394-6377.2018.0126\u003c/span\u003e\u003cspan address=\"http://DOI:10.18231/2394-6377.2018.0126\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolide AD, Zawdie B, Alemayehu T, Tadesse S. Evaluation of serum ferritin and some metal elements in type 2 diabetes mellitus patients: Comparative cross-sectional study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2016:417\u0026thinsp;\u0026ndash;\u0026thinsp;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.2147/DMSO.S120326\u003c/span\u003e\u003cspan address=\"10.2147/DMSO.S120326\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eADA. On diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(1):81\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI:10.2337/dc14-S081\u003c/span\u003e\u003cspan address=\"http://DOI:10.2337/dc14-S081\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI:10.4103/0253-7176.116232\u003c/span\u003e\u003cspan address=\"http://DOI:10.4103/0253-7176.116232\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTummalacharla SC, Pavuluri P, Maram SR, Vadakedath S, Kondu D, Karpay S et al. Serum activities of ferritin among controlled and uncontrolled type 2 diabetes mellitus patients. Cureus. 2022;14(5):http://DOI10.7759/cureus.25155.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJan A, Weir CB. Bmi classification percentile and cut off points. StatPearls: Treasure Island, FL, USA. 2021:1\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/337153906\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/337153906\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHimmelmann A, Kjeldsen S, Hedner T. Recent hypertension guidelines: Jnc-7 and 2003 esh/esc. Blood Press. 2003;12(4):196\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/08037050310015854\u003c/span\u003e\u003cspan address=\"10.1080/08037050310015854\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. On use of ferritin concentrations to assess iron status in individuals and populations. World Health Organization Geneva; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://creativecommons.org/licenses/by-nc-sa/3.0/igo\u003c/span\u003e\u003cspan address=\"https://creativecommons.org/licenses/by-nc-sa/3.0/igo\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Glycemic targets: Standards of care in diabetes\u0026mdash;2023. Diabetes Care. 2023;46(1):97\u0026ndash;110. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/dc23-S006\u003c/span\u003e\u003cspan address=\"10.2337/dc23-S006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Development group for the updating of the 2010 global recommendations on physical activity in youth, adults and older adults. 12\u0026ndash;20 June 2019 Geneva, Switzerland.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.1186/751-0473-3-17\u003c/span\u003e\u003cspan address=\"http://doi:10.1186/751-0473-3-17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBao W, Rong Y, Rong S, Liu L. Dietary iron intake, body iron stores, and the risk of type 2 diabetes: A systematic review and meta-analysis. BMC Med. 2012;10:1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.biomedcentral.com/1741-7015/10/119\u003c/span\u003e\u003cspan address=\"http://www.biomedcentral.com/1741-7015/10/119\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTummalacharla SC, Pavuluri P, Maram SR, Vadakedath S, Kondu D, Karpay S, et al. Serum activities of ferritin among controlled and uncontrolled type 2 diabetes mellitus patients. Cureus. 2022;14(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI:10.7759/cureus.25155\u003c/span\u003e\u003cspan address=\"http://DOI:10.7759/cureus.25155\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanturk Z, \u0026Ccedil;etinarslan B, Tarkun İ, Zafer Canturk N. Serum ferritin levels in poorly-and well‐controlled diabetes mellitus. Endocr Res. 2003;29(3):299\u0026ndash;306. http://DOI:10.1081=ERC-120025037.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaj S, Rajan G. Correlation between elevated serum ferritin and hba1c in type 2 diabetes mellitus. Int J Res Med Sci. 2013;1(1):12\u0026thinsp;\u0026ndash;\u0026thinsp;5. http://DOI:0.5455/2320-6012.ijrms20130203.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo L, Jiang F, Tang Y-T, Si M-Y, Jiao X-Y. The association of serum vascular endothelial growth factor and ferritin in diabetic microvascular disease. Diabetes Technol Ther. 2014;16(4):224\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/dia.2013.0181\u003c/span\u003e\u003cspan address=\"10.1089/dia.2013.0181\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI\u003c/span\u003e\u003cspan address=\"http://DOI\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuba RH, Saheb EJ, Mosa IS. Detection of iron and ferritin in diabetes mellitus type 2 patients. Malaysian J Med Health Sci. 2022;18:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/359048957\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/359048957\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChawla R, Bhoopathi A, Punyani H. Ferritin and serum iron as surrogate markers of poor glycemic control and microvascular complications in type 2 diabetes mellitus. Int J Diabetes Developing Ctries. 2019;39(2):362\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s13410-018-0687-1\u003c/span\u003e\u003cspan address=\"10.1007/s13410-018-0687-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Chen F, Li T, Cheng Y, Huang G, Hou D, et al. Higher serum ferritins are associated with higher blood pressure: A cross-sectional study. Medicine. 2024;103(12). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1097/MD.0000000000037485\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000037485\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarin S, KK SK, Bhaskar BV, Valliyot B. Association of serum ferritin in type 2 diabetes mellitus patients-an observational study. Int J Pharm Clin Res 2022.:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/360449123\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/360449123\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSon NE. Influence of ferritin levels and inflammatory markers on hba1c in the type 2 diabetes mellitus patients. Pak J Med Sci. 2019;35(4):1030\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12669/pjms.35.4.1003\u003c/span\u003e\u003cspan address=\"10.12669/pjms.35.4.1003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Miraj A, Khan I. Correlation between serum ferritin and glycated haemoglobin levels in type-2 diabetes mellitus patients. J Diabetes Metab. 2021;12:893.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed HEA, Ali NMA. Evaluation of serum ferritin in type-2 diabetes mellitus sudanese patients. Journal of Bioscience and Applied Research. 2022;8(3):132-7. http://DOI10.21608/jbaar.2022.247840.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePasricha SRS, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, et al. Diagnosis and management of iron deficiency anaemia: A clinical update. Med J Aust. 2010;193(9):525\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Nutritional anaemias: Tools for effective prevention and control. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAschner P. New idf clinical practice recommendations for managing type 2 diabetes in primary care. Diabetes Res Clin Pract. 2017;132:169\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.diabres.2017.09.002\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2017.09.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltunoğlu E, M\u0026uuml;derrisoğlu C, Erdenen F, \u0026Uuml;lgen E, Ar MC. The impact of obesity and insulin resistance on iron and red blood cell parameters: A single center, cross-sectional study. 2014:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI\u003c/span\u003e\u003cspan address=\"http://DOI\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4274/Tjh.2012.0187\u003c/span\u003e\u003cspan address=\"10.4274/Tjh.2012.0187\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorita S, Seki G, Yamada H, Suzuki M, Koike K, Fujita T. Insulin resistance, obesity, hypertension, and renal sodium transport. Int J Hypertens. 2011. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.4061/2011/391762\u003c/span\u003e\u003cspan address=\"http://doi:10.4061/2011/391762\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIglesias-V\u0026aacute;zquez L, Arija V, Aranda N, Aglago EK, Cross AJ, Schulze MB, et al. Factors associated with serum ferritin levels and iron excess: Results from the epic-eurgast study. Eur J Nutr. 2022;61(1):101\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00394-021-2625-w\u003c/span\u003e\u003cspan address=\"10.1007/s00394-021-2625-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaudhari R, Niraula A, Gelal B, Baranwal J, Sarraf D, Maskey R et al. Increased serum ferritin levels in type 2 diabetes mellitus patients: A hospital based cross-sectional study. 2021:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3126/jucms.v9i02.42009\u003c/span\u003e\u003cspan address=\"10.3126/jucms.v9i02.42009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfaro-Magallanes VM, Barba-Moreno L, Romero-Parra N, Rael B, Benito PJ, Swinkels DW, et al. Menstrual cycle affects iron homeostasis and hepcidin following interval running exercise in endurance-trained women. Eur J Appl Physiol. 2022;122(12):2683\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00421-022-5048-5\u003c/span\u003e\u003cspan address=\"10.1007/s00421-022-5048-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAregbesola A, Voutilainen S, Virtanen JK, Mursu J, Tuomainen T-P. Body iron stores and the risk of type 2 diabetes in middle-aged men. Eur J Endocrinol. 2013;169(2):247\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1530/EJE-13-0145\u003c/span\u003e\u003cspan address=\"10.1530/EJE-13-0145\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://DOI\u003c/span\u003e\u003cspan address=\"http://DOI\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNauli AM, Matin S. Why do men accumulate abdominal visceral fat? Front Physiol. 2019;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.3389/fphys.2019.01486\u003c/span\u003e\u003cspan address=\"http://doi:10.3389/fphys.2019.01486\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia. 2023;66(6):986\u0026ndash;1002.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"T2DM, Ferritin, HbA1c, glycemic control","lastPublishedDoi":"10.21203/rs.3.rs-4549335/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4549335/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eUncontrolled T2DM and its associated consequences nowadays have been a global health crisis, especially for adults. The problem is linked to body iron storage which is indicated by serum ferritin levels. However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control. This study aimed to assess the level of serum ferritin and associated factors among uncontrolled T2DM patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups from October-2 to December-29, 2023 at St. Paul’s Hospital Millennium Medical College. Pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eThe mean\u003cstrong\u003e \u003c/strong\u003eserum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p\u0026lt;0.001). It was significantly correlated with HbA1c (r=0.457, p\u0026lt;0.001), FBs (r=0.386, p\u0026lt;0.001), serum iron (r=0.430, p\u0026lt;0.001) and SBP (r=0.195, p=0.047) in T2DM patients. Besides, a multivariate logistic regression model revealed that a rise in HbA1c (AOR=3.67, 95% CI(1.50-8.98), serum iron (AOR=1.02, 95% CI(1.01-1.04), being male (AOR=0.16, 95% CI(0.05-0.57) and having only OHA (AOR=0.26, 95% CI(0.07-0.95) were key associated factors for the elevated serum ferritin among T2DM patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The present study demonstrated that as far as glycemic control is not maintained, T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycemia and had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients.\u003c/p\u003e","manuscriptTitle":"Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients at St. Paul’s Hospital Millennium Medical College Addis Ababa, Ethiopia: Comparative based cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-01 19:14:55","doi":"10.21203/rs.3.rs-4549335/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-21T04:52:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-20T05:54:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-18T07:01:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-15T14:50:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46230847167225081336530408795320600802","date":"2024-06-14T16:35:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125547511645108843111135968017924910159","date":"2024-06-14T12:18:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232032302923634772615260332551404280579","date":"2024-06-13T19:10:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30585960456314542873668606142727767636","date":"2024-06-13T05:15:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198017901218236035578470903690800904845","date":"2024-06-12T17:21:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-12T08:50:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-12T08:23:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-11T07:40:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-11T07:38:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Endocrine Disorders","date":"2024-06-08T07:08:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9546e0fd-033c-4ab6-9396-d20454f2d9bc","owner":[],"postedDate":"July 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-12T16:02:34+00:00","versionOfRecord":{"articleIdentity":"rs-4549335","link":"https://doi.org/10.1186/s12902-024-01665-7","journal":{"identity":"bmc-endocrine-disorders","isVorOnly":false,"title":"BMC Endocrine Disorders"},"publishedOn":"2024-08-07 15:57:30","publishedOnDateReadable":"August 7th, 2024"},"versionCreatedAt":"2024-07-01 19:14:55","video":"","vorDoi":"10.1186/s12902-024-01665-7","vorDoiUrl":"https://doi.org/10.1186/s12902-024-01665-7","workflowStages":[]},"version":"v1","identity":"rs-4549335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4549335","identity":"rs-4549335","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}