Association of inflammatory marker glycosylated haemoglobin circulating lipids with microvascular complications and glycemic control of type 2 diabetes mellitus in south Indian population

Abstract

Background: Inflammatory processes provoke synthesis of various acute newlinephase proteins like C- reactive protein (CRP) in the liver and orchestrate a newlinepredominant role in the development of insulin resistance. Elevated level of CRP was newlineobserved in patients with type-2 diabetes mellitus (type 2DM). In this backdrop the newlinepresent study was undertaken to evaluate the association of inflammatory Markers newline(CRP), glycated haemoglobin, and circulating lipids with microvascular newlinecomplications in type 2 DM patients with strict glycaemic control among the South newlineIndian population. newlineMethods: Prospective hospital based longitudinal study was conducted newlineamong the type 2 DM patients. In this 450 patients were enrolled and finally 384 newlinepatients completed the study. The patient s demographic details were recorded. The newlinemetabolic profiles like fasting and post prandial plasma glucose, HbA1C were newlinemeasured at baseline, 3rd month (Review I), 6th month (Review II) and at 12th month newline(Review III). Triglyceride, total cholesterol, LDL-C, and HDL-C were measured at newlinebaseline. CRP was measured at baseline, 6th month (Review II) and at 12th month newline(Review III). Descriptive statistics will be presented either as mean ± S.D or median. newlineThe statistical significance of the difference between repeated measures was assessed newlineby one-way ANOVA. Strength of association between the CRP and other metabolic newlinevariables were assessed by Pearson s correlation coefficient. newlineResults newlineThe baseline HbA1C, Fasting blood sugar and Post prandial blood sugar newlinevalues were found to be 8.5± 2.1 %, 155.1±54.1mg/dl, 205.5±74.1mg/dl. The newlinebaseline lipid parameters such as total cholesterol, Triglycerides, LDL, HDL, and newlineVLDL were found to be 170.6 ± 19.3 mg/dl, 142.6 ± 60.6 mg/dl, 83.5 ± 19.9 mg/dl, newline35.8± 8.5mg/dl and 83.5 ± 19.9 mg/dl. C reactive protein measured at baseline found newlineto be 3.5 ± 0.76 mg/L. Baseline value of Serum creatinine was found to be 1.0 ± 0.3 newlinemg/dl and microalbuminuria was 28.2 ± 9.4 mg/day. Nerve conduction velocity, newlineAnkle Brachial Index and Vibration Perception Threshold was found to be 32± newlinevii newline14.17%, 1.0 ± 0.1 and 14.0 ± 16.6 Volts respectively. Further, the recruited patients newlinewere followed for three reviews i.e. Review 1 (3months), Review II (6 months) and newlineReview III (12 months) and blood sugar level, HbA1C and CRP were significantly newlinedecreased when compared to baseline. Further in this study baseline CRP showed newlinesignificant positive correlation with baseline FBG, PPBG and HbA1C levels. newlineHowever, Review II and III CRP values showed significant weak correlation with newlineReview II and III FBG, PPBG and HbA1C levels. Meanwhile, in this study CRP newlinebaseline showed significant strong positive correlation with baseline total cholesterol newlineand strong negative correlation with baseline HDL. CRP displayed significant newlinecorrelation with urine for microalbumin. CRP displayed significant negative newlinecorrelation with Ankle brachial Index , but no significant correlation was observed newlinewith cardiac autonomic neuropathy and vibration perception threshold. Further in this newlinestudy, CRP values were higher in patients with diabetic complications. newlineConclusion newlineInflammation is a major risk factor in the development of diabetes. CRP is a newlineimportant inflmmatory for the progresion of various diabetic complications. In this newlinestudy, due to effective pharamcotherapy the CRP level and the metabolic profiels was newlinereduced after 12months follow up. newlineKeywords: Inflammation, CRP, HbA1C, lipid profiles, microalbuminuria and newlinecardiac autonomic neuropathy, peripheral neuropathy newline