Evaluation of Serum Zinc-to-Copper Ratio in Adults with Type 2 Diabetes and Its Association with Microvascular Complications

Magdy H. Megallaa, Department of Internal Medicine (Diabetes, Metabolism & Lipidology Unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt
Shimaa M. Elrahmany, Department of Internal Medicine (Diabetes, Metabolism & Lipidology Unit), Faculty of Medicine, Alexandria University, Alexandria, EgyptFollow
Rehab Safwat, Department of Internal Medicine (Diabetes, Metabolism & Lipidology Unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt
Mohamed Zietoun, Department of Internal Medicine (Diabetes, Metabolism & Lipidology Unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt

Subject Area

Endocrinology

Article Type

Original Study

Abstract

Background Zinc (Zn) and copper (Cu) are indispensable trace metals that contribute fundamentally to insulin biology, antioxidant defense, and vascular health. In this research, we sought to explore the association between the serum zinc-to-copper (Zn/Cu) ratio and microvascular complications among adults diagnosed with type 2 diabetes (T2DM). Methods For this case-control design, a total of 336 participants were selected and divided into two main groups: Group 1, comprising 224 patients with T2DM, and Group 2, consisting of 112 healthy subjects serving as controls. Group 1 was further stratified into two subgroups based on the presence of microvascular complications; Group 1A consisted of 112 patients with T2DM exhibiting microvascular complications, whereas Group 1B included 112 patients with T2DM lacking such complications. Serum concentrations of Zn and Cu were quantified by means of a calorimetric assay. Results In T2DM patients, serum Cu levels were elevated, while a reduction was observed in Zn levels as well as in the Zn/Cu ratio as opposed to controls. Among those with microvascular complications, Cu levels increased further, whereas Zn and the Zn/Cu ratio declined. Moreover, the Zn/Cu ratio correlated positively with eGFR and negatively with uACR and neuropathy scores, showing stronger associations than Zn or Cu alone. Logistic regression identified the Zn/Cu ratio as an independent predictor of microvascular complications (OR = 0.672, p < 0.001), and ROC analysis confirmed good diagnostic accuracy (AUC = 0.865). Conclusion An altered Zn/Cu ratio, reflecting trace element imbalance, independently predicts and effectively identifies microangiopathy associated with T2DM.

Recommended Citation

Megallaa, Magdy H.; Elrahmany, Shimaa M.; Safwat, Rehab; and Zietoun, Mohamed (2025) "Evaluation of Serum Zinc-to-Copper Ratio in Adults with Type 2 Diabetes and Its Association with Microvascular Complications," Mansoura Medical Journal: Vol. 55 : Iss. 1 , Article 13.
Available at: https://doi.org/10.58775/2735-3990.1498