Study of highly sensitive C reactive protein with each component of metabolic syndrome in type 2 diabetic patients

Abstract EN

Background : Type 2 diabetes is increasingly common worldwide, almost 90 % of all patients with diabetes show insulin resistance.

Subclinical chronic inflammation may be an important pathogenic factor in the development of insulin resistance in type 2 diabetes.

Chronic mild inflammatory state underlies not only the cardiovascular disease but also is the soil of the metabolic syndrome pathologies and its complications development.

Association between the inflammatory mediators as CRP, Fibrinogen, Alpha-1 glycoprotein, Leptin, TNF alpha and the metabolic syndrome suggest that both atherosclerosis and insulin resistance are the results of chronic activation of the non specific (innate) immune system.

The assessment of markers of chronic inflammation such as CRP and interleukin 6 (IL-6) could be used to identify persons at risk of coronary heart disease.

Objective : The aim of the present study is to determine the association of highly sensitive C Reactive Protein (hs-CRP) with body fat, DM and coronary artery disease in some Egyptian population.

Study Design : The study included 40 patients with type 2 diabetes mellitus and 20 healthy subjects .All were above the age of 35, patients were divided into 2groups 20 of them without coronary heart disease and 20 with coronary heart disease.

For all the subjects , full history taking including type of medications taken by the patient, thorough clinical examination with particular stress on measuring blood pressure in supine position and anthropometric measurements including weight, height, BMI, and waist circumference.

Coronary artery disease diagnosis was based on ECG changes suggestive of ST segment depression and old q ware change.

Laboratory investigations including fasting blood glucose, fasting plasma insulin, HOMA -IR to detect insulin resistance, total cholesterol, triglycerides, high density lipoprotein, carotid intimal thickness by Carotid ultrasonography , HbA1c and highly sensitive CRP.

Results : Comparing all groups with each other there was a high statistical significant difference (p <0.001) regarding waist circumference, duration of diabetes, HbA1c, systolic and diastolic blood pressure, fasting blood glucose and IMT.

A statistical significant difference was found among the groups (p < 0.05) as regards BMI, HOMA-IR, triglycerides, LDL-c and Hs-CRP.

No statistical significant difference was found (p > 0.05) regarding age, sex, total cholesterol, HDL-c and fasting plasma insulin.

The correlation study showed that there is a significant direct correlation between Hs-CRP and BMI, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, fasting insulin, insulin resistance, LDL, low HDL levels, duration of diabetes and IMT, but no significant correlation with age, triglycerides and fasting insulin.

Step-wise- regression-analysis showed that the IMT was the most sensitive predictor variable of Hs-CRP.

Conclusion : -Hs-CRP is a sensitive marker of underlying chronic systemic inflammation therefore it is directly correlated to the components of the metabolic syndrome in type 2 diabetes as the metabolic syndrome itself involves an inflammatory process in its pathogenesis.

- Increased concentration of Hs-CRP represents the start of the inflammatory process of atherosclerosis so it can be used as a marker that predicts future cardiovascular risk in people without overt cardiovascular disease.