Study of association between C-reactive protein and albuminuria in type 2 diabetes mellitus
DOI:
https://doi.org/10.18203/2320-6012.ijrms20233388Keywords:
Type 2 diabetes mellitus, Diabetic nephropathy, C-reactive protein, Albuminuria, Microvascular complicationAbstract
Background: Inflammatory markers are excessively produced by adipocytes in T2DM due to obesity-induced dysregulation of adipocytes. Inflammation is recognised by elevated level of inflammatory markers like C-reactive protein. It has been reported that patients with nephropathy and those with albuminuria have higher levels of inflammatory markers.
Methods: Study design observational descriptive cross-sectional study. 150 subjects having age more than 30 years and less than 55 years diagnosed with type 2 diabetes mellitus were included. HbA1c, FPG, creatinine, urea, CRP, and albuminuria were analysed.
Results: A strong and statistically significant correlation was seen between serum CRP levels and albuminuria levels with a p value of 0.831 and a p value of 0.00. The study group was divided into two groups with normal CRP (n=40) and elevated CRP (n=110). Average values of all parameters showed a statistically significant increase in the group with abnormal CRP levels. In the ROC analysis, an area of .957 under the curve shows a very high predictive value of 15.5 mg/l of CRP for predicting albuminuria in patients of T2DM.
Conclusions: From our results, we have been able to establish a strong association as well as a predictive relationship between the level of CRP and albuminuria in T2DM. We have shown that serum CRP levels at a cut-off of 15.5 mg/l are a predictor of clinically significant albuminuria. This makes serum CRP level an effective screening tool for albuminuria.
References
Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Ind J Ophthalmol. 2021;69(11):2932-8.
Rais N, Ved A, Ahmad D, Parveen K, Prakash O. Prevalence of diabetes mellitus and socio- demographic survey in the community of Western Uttar Pradesh, India in the Year 2019-2020. Int J Cur Res Rev. 2021;13(1):10-5.
Molehin OR, Adefegha SA, Adeyanju AA. Role of oxidative stress in the pathophysiology of type 2 diabetes and cardiovascular diseases. Role of oxidative stress in pathophysiology of diseases. 2020:277-97.
Roep BO, Thomaidou S, van Tienhoven R, Zaldumbide A. Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nature Revi Endocrinol. 2021;17(3):150-61.
Cree-Green M, Triolo TM, Nadeau KJ. Etiology of insulin resistance in youth with type 2 diabetes. Curr Diab Rep. 2013;13(1):81-8.
Hocking S, Samocha-Bonet D, Milner K-L, Greenfield JR, Chisholm DJ. Adiposity and insulin resistance in humans: the role of the different tissue and cellular lipid depots. Endocrine Reviews. 2013;34(4):463-500.
Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S, et al. The role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol. 2019;14(1):50-9.
Wu Y, Ding Y, Tanaka Y, Zhang W. Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. Int J Med Sci. 2014;11(11):1185-200.
Chawla A, Chawla R, Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum? Indian J Endocrinol Metab. 2016;20(4):546-51.
Márquez DF, Ruiz-Hurtado G, Segura J, Ruilope L. Microalbuminuria and cardiorenal risk: old and new evidence in different populations. F1000Res. 2019;8.
Phosat C, Panprathip P, Chumpathat N, Prangthip P, Chantratita N, Soonthornworasiri N, et al. Elevated C-reactive protein, interleukin 6, tumor necrosis factor alpha and glycemic load associated with type 2 diabetes mellitus in rural Thais: a cross-sectional study. BMC Endocr Disord. 2017;17(1):44.
Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:754.
Jeong H, Baek SY, Kim SW, Park EJ, Lee J, Kim H, et al. C reactive protein level as a marker for dyslipidaemia, diabetes and metabolic syndrome: results from the Korea National Health and Nutrition Examination Survey. BMJ Open. 2019;9(8):e029861.
Mondal K, Mukherjee D. Study to assess association of C-reactive protein with nephropathy in people living with type 2 diabetes mellitus. MedRxiv. 2020:2020-09.
Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, del Cañizo-Gómez FJ. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diab. 2014;5(4):444.
Lambers Heerspink HJ, Brantsma AH, de Zeeuw D, Bakker SJ, de Jong PE, Gansevoort RT, et al. Albuminuria assessed from first-morning-void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidity and mortality. Ame J Epidemiol. 2008;168(8):897-905.
DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nature Reviews Dis Prim. 2015;1(1):1-22.
Galicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, et al. Pathophysiology of type 2 diabetes mellitus. Int J Mol Sci. 2020;21(17).
Fernandes R, Viana SD, Nunes S, Reis F. Diabetic gut microbiota dysbiosis as an inflammaging and immunosenescence condition that fosters progression of retinopathy and nephropathy. Molec Basi Dis. 2019;1865(7):1876-97.
Zargar AH, Khan AK, Masoodi SR, Laway BA, Wani AI, Bashir MI, et al. Prevalence of Type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent. Diab Res Clin Pract. 2000;47(2):135-46.
Al-Baghli NA, Al-Ghamdi AJ, Al-Turki KA, Al Elq AH, El-Zubaier AG, Bahnassy A. Prevalence of diabetes mellitus and impaired fasting glucose levels in the Eastern Province of Saudi Arabia: results of a screening campaign. Singapore Med J. 2010;51(12):923-30.
Jain A, Paranjape S. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility. Indian J Endocrinol Metab. 2013;17(Suppl 1):S318-22.
Sujata, Thakur R. Unequal burden of equal risk factors of diabetes between different gender in India: a cross-sectional analysis. Scient Repo. 2021;11(1):22653.
Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA. 2001;286(3):327-34.
Zbaar SA, Sarhat ER, Khalaf SJ. Association of C-reactive protein with risk of complications of diabetic nephropathy. Egypt J Chem. 2022;65(8):483-7.
Dabla PK. Renal function in diabetic nephropathy. World J Diabetes. 2010;1(2):48-56.
Petchiappan V, Sivakrishna N, Manickam S, Menon S. Glycaemic control and C- reactive protein levels in type 2 diabetes mellitus -how well they co-relate?: a prospective study. Int J Res Med Sci. 2019;7(5):1818-21.
Kahraman C, Kahraman NK, Aras B, Coşgun S, Gülcan E. The relationship between neutrophil-to-lymphocyte ratio and albuminuria in type 2 diabetic patients: a pilot study. Arch Med Sci. 2016;12(3):571-5.
Navarro JF, Mora C, Macıéa M, Garcıéa J. Inflammatory parameters are independently associated with urinary albumin in type 2 diabetes mellitus. Ame J Kid Dis. 2003;42(1):53-61.
Sharma S, Ghalaut VS, Dixit R, Kumar S, George PJ. Microalbuminuria and C-reactive protein as a predictor of coronary artery disease in patients of acute chest pain. J Cardiovasc Dis Res. 2013;4(1):37-9.