Title: Study of Highly Sensitive C - Reactive Protein (hs-CRP) In Type 2 Diabetes Mellitus and Its Correlation with Glycosylated Hemoglobin

Authors: Shyam Murari Garg, Sudhir Maan, PD Gupta, Himanshu Devender Kumar,  Kshitiz D Vashista, Anish Gupta, Neeraj Gupta

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.69

Abstract

Background: Diabetes mellitus is one of the leading causes of morbidity and mortality. Studies have shown that hs-CRP is associated with insulin resistance, type 2 diabetes and higher HbA1c levels. This study was done to evaluate the correlation of hs-CRP with HbA1C.

Objectives: The aim of this study is to determine the serum high sensitive C- Reactive Protein (hs-CRP) in patients with type 2 diabetes mellitus and to correlate with HbA1C levels.

Materials and Methods: In this study 50 patients aged above 18 years with type 2 diabetes mellitus were enrolled and subjected to detailed history and examination. In all patients hs-CRP with HbA1C were measured.

Results: In our study population 79% had hs-CRP levels ≥3.0 and 21% had hs-CRP levels <3.0. It concludes that higher prevalence of increase of hs-CRP in subjects with Type 2 diabetes. We found no statistically significant correlation among them except with duration of DM.

Conclusion: This study strongly warrants future investigations that probe the role of genetic variants and other environmental factors that influence the elevation of hsCRP levels in this high-risk group.

Keywords: HbA1C, hs-CRP, Type 2 diabetes mellitus.

References

  1. Brownlee M and Cerami A. Biochemistry of the complications of diabetes mellitus. Annu rev. Biochem, 1981; 50:385-432.
  2. Luscher TF, Creager MA, Bckman JA, Cosentino F. Diabetes and vascular disease: Pathophysiology, Clinical conse-quences, and medical therapy: Part II. Circulation, 2003; 108 (13): 1655-1661. 
  3. Sarinnapakorn V and Wanicagool W. Association between hs-CRP and Hba1c in overweight type 2 diabetic female patients. J Med Assoc Thai. 2013 Mar;96(3):54-8.
  4. SHI CH, WANG C, BAI R, ZHANG XY, MEN LL, DU JL. Associations among glycemic excursions, glycated hemoglobin and high-sensitivity C-reactive protein in patients with poorly controlled type 2 diabetes mellitus. Experimental and Therapeutic Medicine. 2015;10(5):1937-1942.
  5. Bahceci M, Tuzcu A, Ogun C, Canoruc N, Iltimur K, Aslan C.Is serum C-reactive protein concentration correlated with HbA1c and insulin resistance in Type 2 diabetic men with or without coronary heart disease? J Endocrinol Invest. 2005 Feb;28(2):145-50.
  6. Dong Q, Wright JR. Expression of C-reactive protein by alveolar macrophages. J Immunol 1996;56:4815-20
  7. Wang AY. Prognostic value of C-reactive protein for heart disease in dialysis patients.CurrOpinInvestig Drugs. 2005 Sep;6(9):879-86.
  8. Aronson D. Hyperglycemia and the pathobiology of diabetic complications. Adv Cardiol 2008;45:1-16.
  9. Doggen CJ, Berckmans RJ, Sturk A, Cats VM, Rosendaal FR. C-reactive protein, cardiovascular risk factors and the association with myocardial infarction in men. J Intern Med 2000; 248:406-14
  10. Kang ES, Kim HJ, Ahn CW. Relationship of serum high sensitivity C-reactive protein to metabolic syndrome and microvascular complications in type 2 diabetes. Diabetes Res Clin Pract 2005;69:151-9.
  11. Yan SF, Ramasamy R, Naka Y, Schmidt AM. Glycation, Inflammation, and RAGE. A Scaffold for the Macrovascular Complications of Diabetes and Beyond. Circ Res 2003;93:1159– 69.
  12. Chowdhury TA, Hitman GA. Type 2 diabetes in people of South Asian origin: potential strategies for prevention. Br J Diabetes Vasc Dis, 2007;7:279–282.
  13. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes, estimates for the year 2000 and projections for 2030. Diabetes Care, 2004; 27:1047–1053.
  14. Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care, 2008; 31:893–898.
  15. Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet, 2000;356:279–284.
  16. Chandalia M, Cabo-Chan Jr AV, Devaraj S, Jialal I, Grundy SM, Abate N. Elevated plasma high-sensitivity C-reactive protein concentrations in Asian Indians living in the United States. J Clin Endocrinol Metab, 2003;88:3773–3776.
  17. Vikram NK, Misra A, Pandey RM, Dwivedi M, Luthra K, Dhingra V, et al. Association between subclinical inflammation & fasting insulin in urban young adult north Indian males. Indian J Med Res, 2006;124:677–682.
  18. Amanullah S, Jarari A, Govindan MK, Basha MI, khatheeja S. Association of hs-CRP with Diabetic and Non-diabetic individuals.  Jordan Journal of Biological Sciences.2010;3(1):7-12.
  19. Sasidharan A, Krishnamurthy A, Tagore S, Nagaraj T, Santosh HN, Nigam H. C-reactive protein and glycemic control in adults with type 2 diabetes mellitus. J Med Radiol Pathol Surg 2016;2:10-13.
  20. Ni Mhurchu C, Parag V, Nakamara M, Patel A, Rodgers A, Lam TH. Body Mass index and risk of diabetes mellitus in the Asia-Pacific region. Asia Pac. J. Clin. Nutr. 2006;15(2): 127-133.
  21. Eric J B and John HF. The relation between blood glucose and coronary mortality over 33 years in the Whitehall study. Diabetes Care. 2006 Jan;29(1):26-31.
  22. Prevalence of overweight and Obesity among adults with diagnosed diabetes – US, 1988-1994 and 1999- 2002. JAMA, 2005; 293: 546-547.
  23. Cosin AJ, Hernandiz MA, Masramon MX. Overweight and obesity in hypersensitive Spanish patients. (The coronary study. Med Clin ( Barc), 2007;10:129.
  24. Chambers JC, Eda S, Bassett P, Karim Y, Thompson SG, Gallimore JR, Pepys MB, Kooner JS 2001 C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation 104:145–150
  25. Forouhi NG, Sattar N, McKeigue PM 2001 Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int J Obes Relat Metab Disord 25:1327–1331
  26. Pradhan AD, Manson JE, Rifai. N, Burning JE, Ridker PM. 2001.C-reactive protein, interleukin 6 and risk development type 2 diabetes mellitus. JAMA. 286: 327-334.
  27. Pfutzner A, Forst T.2006. High-sensitivity C-reactive protein as a cardiovascular risk marker in patients with diabetes mellitus. Diabetes Technol Ther 8(1):28-36.
  28. Mohan V, Shanthirani CS. Deepa R. 2003. Glucose intolerance (diabetes and IGT) in the selected south Indian population with special reference to family history, obesity and lifestyle factors. The Chennai Urban Population Study (CUPS 14 ). J. Assoc. Physicians India. 51: 771-777.
  29. Mohan V, Shanthi Rani S, Deepa R, Premalatha G and Sastry NG. 2001. Introduction Urban difference in the prevalence of metabolic syndrome in South India. The Chennai Urban Population Study (CUPS 14 ). Diabet . Med. 18: 280-287.
  30. Patel B, Taviad D, Malapati B, Gokani R, Shaikh N, Shah R. Association of hs-CRP levels with Obesity & Metabolic syndrome in patients with Type-2 Diabetes Mellitus: a link between inflammation, adiposity & insulin resistance. Int J Biol Med Res.2015;6(3):5104-5108
  31. Geetha Bhaktha, Manjula Shantaram, Shivananda Nayak, Nagendra S. Relationship of hs-CRP level in diabetic persons free from micro and macrovascular disease. International Journal of Research and Development in Pharmacy and Life Sciences 2014, Vol. 3, No.4, pp 1070-1073.
  32. Wu T, Dorn JP, Donahue RP, Sempos CT, Trevisan M. Associations of serum C-reactive protein with fasting insulin, glucose, and glycosylated hemoglobin: The Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol 2002;155:65-71.
  33. King DE, Mainous AG 3rd, Buchanan TA, Pearson WS. C-reactive protein and glycemic control in adults with diabetes. Diabetes Care 2003;26:1535-9.
  34. Anubha Mahajan, Rubina Tabassum, Sreenivas Chavali, Om Prakash Dwivedi, Mausumi Bharadwaj, Nikhil Tandon, Dwaipayan Bharadwaj. High-Sensitivity C-Reactive Protein Levels and Type 2 Diabetes in Urban North Indians. J Clin Endocrinol Metab (2009) 94 (6): 2123-2127.
  35. Roopakala M S, Pawan H R, Krishnamurthy U, Wilma Delphine Silvia C R, Eshwarappa M, Prasanna Kumar K M. Evaluation of high sensitivity C-reactive protein and glycated hemoglobin levels in diabetic nephropathy. Saudi J Kidney Dis Transpl 2012;23:286-9.
  36. Ajay Meshram, Udit Agrawal, Archana Dhok, Prashant Adole, Komal Meshram, Ruchir Khare. HbA1c, hs-CRP and anthropometric parameters evaluation in the patients of diabetes Mellitus of Central Rural India. International Journal of Medical Science and Public Health 2013; 2(2):291-294.
  37. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith Jr SC, Taubert K, Tracy RP, Vinicor F; Centers for Disease Control and Prevention; American Heart Association 2003 Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107:499–51

Corresponding Author

Himanshu Devender Kumar

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