Background: Diabetes Mellitus, a hyperglycemic state, leads to inflammatory reaction and oxidant injury with progression to vascular complications. High sensitivity C-Reactive protein (Hs-CRP), a marker of inflammation; gamma glutamyl transferase (GGT), a marker of oxidant injury; glycosylated hemoglobin (HbA1C), a marker of glycemic control and urine albuminuria (qualitative) as an assessment of diabetic microvascular complications can be easily studied.

Aim: To study interrelationship among Hs-CRP, HbA1C, GGT and microvascular complications in type 2 diabetes mellitus patients and to establish role of GGT and Hs-CRP as early markers for development of diabetic microvascular complications. These markers together have not been studied in past.

Method: It was a hospital based cross-sectional case-control study conducted in tertiary care hospital on 75 type 2 diabetic patients selected by inclusion and exclusion criteria with 50 age and sex matched healthy controls. Quantitative assessment of Hs-CRP, GGT, HbA1C and urine albuminuria(qualitative) was done.

Results: Mean value of  Hs-CRP, GGT and HbA1C in diabetic cases was 8.94 ± 2.54 mg/L, 101.61 ± 36.84 U/L, 9.24 ± 1.97 % respectively in comparison to controls (1.52 ± 0.98 mg/L, 19.06 ±8.77 U/L, 4.35 ± 0.94 % respectively). All three values were significantly elevated in 48 (64 %) cases who had urine albuminuria measured qualitatively. There was positive co-relation of HbA1C with Hs-CRP (r= 0.713, p = <0.0005), HbA1C with GGT (r=0.479, p= <0.00001) and Hs-CRP with GGT (r= 0.622, p = <0.0005).

Conclusion: All three values were significantly positively correlated and elevated in diabetics, elevatedin those who had urine albuminuria (qualitative). This suggests possible role of inflammation, oxidant injury and glycemic control in the pathogenesis and progression of diabetic microvascular complications. GGT and Hs-CRP can be routinely used as early markers of diabetes microvascular complications.

Keywords: Diabetes Mellitus, Hs-CRP, GGT, HbA1C, Inflammation, Oxidant injury, Albuminuria.

1. Farsani SF, Van-der-Aa MP, Van-der-Vorst MMJ, Knibbe CAJ, de Boer A. Global trends in the incidence and prevalence of type 2 diabetes in children and adolescents: a systematic review and evaluation of methodological approaches. Diabetologia.2013;56:1471–1488.
2. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature.2001; 414:813-820.
3. Clyne B, Olshaker J. The C-reactive protein. J Emerg Med.1999;17(6):1019–1025.
4. Giugliano D, Marfella R, Coppola L. Vascular effects of acute hyperglycemia in humans reversed by l-Arginine. Evidence for reduced availability of nitric oxide during hyperglycemia.Circulation.1997;95(7):1783-1790.
5. Karp DR, Shimooku K, Lipsky PE. Expression of gamma-glutamyl transpeptidase protects ramos B cells from oxidation induced cell death. J Biol Chem.2001;276:3798-3804.
6. Nathan DM, Balkau B, Bonara E. International expert committee report on the role of A1C assay in diagnosis of diabetes. Diabetes Care.2009;32(7):1327-1334.
7. Gohel MG, Chakho AN. Serum GGT activity and hsCRP level in patients with type 2 diabetes mellitus with good and poor glycemic control: An evidence linking oxidative stress, inflammation and glycemic control. Journal of Diabetesand Metabolic Disorders.2013;12(56):1-8.
8. Mahajan A, Tabassum R, Chaval S, Dwivedi OP, Bharadwaj M, Tandon N, Bharadwaj D. J Clin Endocrin Metab. 2009;94(6):2123-2127.
9. Meshram A, Agrawal U, Dhok A, Adole P, Meshram K, Khare R. HbA1c, hs-CRP and anthropometric parameters evaluation in the patients of Diabetes Mellitus of Central Rural India. Int J Med Sci Public Health.2013;2(2):293-296.
10. Mohan V, Deepa R, Velmurugan K, Premalatha G. Association of C-Reactive Protein with body fat, diabetes and coronary artery disease in Asian Indians: The Chennai Urban Rural Epidemiology Study (CURES-6). J Clin Endocrin Metab.2009;94(6):2123-2127.
11. Amanullah S, Jarari A, Govindan M, Basha MI, Khatheeja S. Association of hs-CRP with Diabetic and Non-diabetic individuals. Jordan Journal of Biological Sciences.2010;3:7-12.
12. Sabanayagm C, Shankar A, Li J, Pollard C, Ducatman A. Serum gamma-glutamyl transferase level and diabetes among US adults. EUR J of Epidimiol. 2009; 24(7):369-373.
13. Nannipieri M, Gonzales C, Baldi S. Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study. Diabetes Care.2005;28(7):1757-1762.
14. Lee DH, Jacobs DR Jr. Association between serum Gamma-glutamyl transferase and C-reactiveprotein. Atherosclerosis.2005;178(2):327-330.
15. Holman R, Paul S, Bethel A, Matthews D, Neil A. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. N Engl J Med.2008;359(15):1577-1589.

Shivani Sharma

Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India