A Study of Highly Sensitive C-Reactive Protein (hs-CRP) in Type 2 Diabetes Mellitus and its Correlation with Glycosylated Hemoglobin (HbA1C) at Tertiary Care Centre. A One Year Cross Sectional Study

Abstract

Background and objectives There is a rising prevalence of non –communicable diseases in developing countries like India especially Diabetes Mellitus with more than 50% percent of diabetic patients being unaware of their diabetic status in India. The rise in Diabetes in India can be attributed to genetic predisposition, the sedentary lifestyles and the changing food habits. hs-CRP is a marker of systemic inflammation, is emerging as an independent risk factor for cardiovascular disease. High hs-CRP levels have been linked to an increased risk of thrombotic events including myocardial infarction and stroke. hs-CRP levels are higher in people with diabetes compared with those without diabetes. Less is known about whether hs-CRP in people with diabetes is related to level of HbA1C. According to a previous study done by Dana E. King et al. Where they concluded that a higher HbA1c is significantly associated with a greater likelihood of higher CRP among adults with diabetes. The relation was significant in unadjusted comparisons of the percent of people with elevated CRP according to HbA1c level and in logistic regression models to predict elevation of CRP after controlling for age, race, sex, smoking, BMI, insulin level, and length of time with diabetes. Type II diabetes is disease in which blood sugar level increases the shear stress contributing to inflammation and dysfunction of endothelium. The purpose of this study was to identify the relationship between serum hs-CRP and HbA1c in type II diabetic subjects. Methods: The present cross-sectional study was conducted on patients with T2DMin medicine OPD or admitted in KLE’S Dr.Prabhakar Kore Hospital and Medical Research Centre, Belagavi from Jan 2016 to Dec 2016.Patients were selected who had come for follow up and are known diabetics and other Patients with diabetes were identified using the question, “Has your doctor ever told you that you have diabetes?” patients who answered positively to the question regarding having diabetes were enrolled. Their relevant data was collected by a detailed interview, clinical examination and lab reports. These findings were noted on a predesigned and pretested proforma. These patients were stratified according to their age, gender, BMI, duration of diabetes and HbA1c levels and each of these variables were compared to hs-CRP levels. The comparison of categorical data was done using Chi-square test, probability value (‘p’ value) of less than or equal to 0.05 was considered as statistically significant. Results: In our study we enrolled 100 cases who were diabetic, we observed majority of cases 41% in the age group of 36-50 years. Our study male population was 72% with a male to female ratio of 2.57:1 (male preponderance). None of our cases had any other co-morbidity except for T2DM, co-morbidity were ruled out by normal ECG, CBC, RFT, LFT and URINE EXAMINATION and even any patients taking medication that could influence the level of hs-CRP. Maximum number of patients had poor glycemic control with 47% of cases had HbA1c levels more than 9.6%. We observed most of our patients had hs-CRP levels ≥ 3.0 (82%) and remaining cases had hs-CRP levels < 3.0 (12%). Most number of our cases had duration of T2DM ≤5 years of duration 58%, followed by 27% in the duration of 6-10 years and 15% who had a duration of ≥ 11 years. We also observed most of our cases had a higher BMI according to Indian standardized BMI ≥ 23kg/m² were 93% and BMI < 23 kg/m² were 7%. We observed that hs-CRP levels were affected by duration of Diabetes, BMI and HbA1c levels. We also observed hs-CRP was not influenced by the age and gender of the patient. Conclusion: In our study we could not elicit statistical significance between hs-CRP with AGE of our patients even though patients above 65 years all had hs-CRP levels ≥ 3.0 and gender. But we concluded hs-CRP levels ≥ 3.0 was very significant with BMI ≥ 23.0 kg/m². hs-CRP levels also was affected by duration of diabetes and poor glycemic control (HbA1c).The result we concluded that hs-CRP was affected by longer duration of diabetes, poor glycemic control and high BMI.