C-REACTIVE PROTEIN (CRP) AS A BIOMARKER OF INFLAMMATION IN OBESE AND NON-OBESE TYPE 2 DIABETES MELLITUS PATIENTS WITH METABOLIC SYNDROME

Abstract

Obesity, particularly abdominal obesity when associated with end-organ resistance to insulin, raised blood sugar, deranged lipid profile and high blood pressure is collectively called “Metabolic Syndrome”. Metabolic Syndrome increases the risk of developing type 2 diabetes mellitus(T2DM). Metabolic syndrome represents a range of disorders related to blood pressure, lipid profile, blood sugar and obesity related inflammation. Screening for Metabolic Syndrome is important because obesity related manifestations are associated with the deranged values of five components of Metabolic Syndrome. C-Reactive Protein (CRP) is a known biomarker associated with many metabolic disorders with underlying acute and chronic inflammation. Its use as a potential biomarker of disease states such as diabetes, hypertension and Metabolic Syndrome need to be investigated. Therefore, association of Type 2 diabetes mellitus patients with metabolic syndrome with a proinflammatory state can be confirmed by higher levels of CRP. To investigate the association of serum CRP levels with obese and non-obese type 2 diabetes mellitus patients with metabolic syndrome. A comparative cross-sectional study was performed in 120 subjects divided into 2 groups (60 obese >30kg/m2 and 60 non-obese <30kg/m2 ) type 2 diabetes mellitus patients with Metabolic Syndrome. The participants were recruited from Medical OPD National Medical Center, Karachi for a duration of six months period. The 2005 revised NCEP-ATP III criteria were used to determine participants with Metabolic Syndrome in type 2 diabetic patients. The conditions included in diagnostic criteria for Metabolic Syndrome are high blood pressure, high blood sugar, abnormal cholesterol levels (low HDL or high triglycerides), and increased fat deposits in the abdominal area. After taking informed consent and an overnight fast, fasting venous samples were sent for Fasting Blood Glucose (FBG), Triglycerides (TG), Total cholesterol (TC), Low density Lipoprotein (LDL-C), High density Lipoprotein (HDL-C) and C Reactive Protein (CRP). 75% of type 2 diabetes mellitus patients had metabolic syndrome. The association of Metabolic Syndrome with Marital status and Education was found statistically significant with p<0.05. Independent sample t test gave significant mean differences for waist circumference, systolic blood pressure, fasting blood sugar, and triglycerides between metabolic syndrome and non-metabolic syndrome samples with viii p<0.05. The Multivariate linear regression analysis, results showed increase in WC giving 0.13-time positive impact on CRP (p<0.01). The difference in median CRP of obese and non-obese samples of metabolic samples was also statistically significant with p=0.01 using Mann Whitney U test. Pearson Chi Square test did give a significant association of metabolic syndrome with SBP, FBS, HbA1C, and TG with p<0.05. The laboratory parameters showed higher SBP, DBP, FBG, TG and low HDL-C levels in subjects. CRP levels were higher in obese than non-obese type 2 diabetic patients with Metabolic Syndrome