Glycaemic control and C- reactive protein levels in type 2 diabetes mellitus -how well they co-relate?: a prospective study

Velammal Petchiappan, Nanubala Sivakrishna, Santni Manickam, Sujaya Menon


Background: Poorly controlled diabetes mellitus as indicated by elevated glycated haemoglobin (HbA1c) levels is associated with increased cardiovascular risk. C–reactive protein (CRP), an important cardiovascular risk factor, is elevated in diabetics with poor glycaemic control than those with good control. The present study assessed the correlation between HbA1c and CRP levels.

Methods: A prospective study was conducted in thirty type 2 diabetic patients irrespective of the disease duration and treatment; those with established target organ damage were excluded. HbA1c and hsCRP levels were measured at baseline; sugars were monitored monthly and medications optimised; at the end of six months HbA1c and hsCRP levels were measured.

Results: Mean age of the study subjects was 58.7±8.6 years; At the baseline, all had poor glycaemic control (HbA1c >7%); 15 had hsCRP >3 mg/L. At the end of 6 months, 5 achieved good glycaemic control (HbA1c <7%); 10 had hsCRP >3 mg/L. Baseline median hsCRP was 3.33 mg/L (0.68, 15.9) and at the end of 6 months it was 2.08 mg/L (0.48, 9.12). Mean HbA1c at baseline and end line was 10.6±1.55% and 8.43±1.84% respectively. There was significant reduction in both the mean HbA1c and median hsCRP at the end of 6 months (p <0.001). Positive correlation was observed between HbA1c and CRP at baseline (r=0.32, p=0.10). However, this was not observed at the end of 6 months.

Conclusions: There is positive correlation between the level of glycaemic control (HbA1c) and CRP levels; Better glycaemic control results in significant reduction in the hsCRP levels.


C-reactive protein, Correlation, Glycaemic control, hsCRP, HbA1c

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Saudek CD, Kalyani RR, Derr RL. Assessment of Glycemia in Diabetes Mellitus: Hemoglobin A. JAPI. 2005 Apr; 53.

Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, et alGlycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis. BMJ Open. 2017;7:e015949.

Kamath DY, Xavier D, Sigamani A, Pais P. High sensitivity C-reactive protein (hsCRP) & cardiovascular disease: An Indian perspective. Indian J Med Res. 2015;142:261-8.

Pfützner A, Forst T. High-sensitivity Creactive protein as cardio-vascular risk marker in patients with diabetes mellitus. Diabetes Technol Ther. 2006; 8(1):28-36.

Asegaonkar SB, Marathe A, Tekade ML, Cherekar L, Bavikar J, Bardapurkar J et al.High-sensitivity C-reactive protein: a novel cardiovascular risk predictor in type 2 diabetics with normal lipid profile. J Diab Complications. 2011;25(6):368-70.

Mohieldein AH, Hasan M, El-Habiby MI.High Sensitivity C-Reactive Protein as Atherogenic Marker Among Type 2 Diabetes. Eur Sci J. 2017(13);33:403.

Lin Y, Rajala MW, Berger JP. Hyperglycaemia-induced production of acute phase reactants in adipose tissue. J Biol Chem. 2001; 276(45):42077-83.

Freeman DJ, Norrie J, Caslake MJ, et al. West of Scotland Coronary Prevention Study: C-reactive protein is an independent predictor of riskfor the development of diabetes in the West of Scotland Coronary Prevention Study. Diab. 2002;51:1596-1600.

Tutuncu Y, Satman I, Celik S, Dinccag N, Karsidag K, Telci A, et al. A comparison of hs-CRP levels in new diabetes groups diagnosed based on FPG, 2-hPG, or HbA1c criteria. J Diabe Res. 2016.

Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169-80.

Ridker PM, Buring JE, Cook NR. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14719 initially healthy Am women. Circulation. 2003;107:391-7.

Devaraj S, Xu DY, Jialal I. C-reactive protein increases plasminogen activator inhibitor-1 expression and activity in human aortic endothelial cells: implications for the metabolic syndrome and atherothrombosis. Circulation. 2003;107:398-404.

Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation. 2000;102:2165-8.

King DE, Mainous AG, Buchanan TA, Pearson WS.C-reactive protein and glycemic control in adults with diabetes. Diabe Care. 2003;26(5):1535-9

Gohel MG, Chacko AN. Serum GGT activity and hs-CRP level in patients with type 2 diabetes mellitus with good and poor glycemic control: An evidence linking oxidative stress, inflammation and glycemic control. J Diabe Metabolic Dis. 2013;12:56.

Kashinakunti SV, Rangappa M, Kallaganada GS. International J Biochem Res Rev. 2016;11(4): 1-8

Cardoso CR, Leite NC, Salles GF. Prognostic Importance of C-Reactive Protein in High Cardiovascular Risk Patients with Type 2 Diabetes Mellitus: The Rio de Janeiro Type 2 Diabetes Cohort Study. J Am Heart Assoc. 2016;5(11):e004554.

Fazlul Haque AKM, Saifuddin Ekram ARM, Islam QT, Jahan MS, Haque MZ. Evaluation of serum high sensitivity c -reactive protein (hs-crp) in type-2 diabetic patient. J Med. 2010;11:20-3.

Schillinger M, Exner M, Amighi J, Mlekusch W, Sabeti S, Rumpold H. et al. Joint effects of C-reactive protein and glycated hemoglobin in predicting future cardiovascular events of patients with advanced atherosclerosis. Circulation. 2003; 108(19):2323-8.

Li CZ, Xue YM, Gao F, Wang M. Determination of serum hs-CRP in patientswith type 2 diabetes mellitus. Di Yi Jhun Yi Da Xne Xne Bao. 2004;24(7):791-3.

Dilshad Ahmed K, Shazia Q. Evaluation of cardiac risk by oxidative stress and inflammatory markers in diabetic patients. Pak J Med Sci. 2009;25:5.

Sarinnapakorn V, Wanicagool W: Association between hs-CRP and Hba1c in overweight type 2 diabetic female patients. J Med Assoc Thai. 2013;96(3):S54-8.

Amanullah S, Jarari A, Govindan M, Basha MI, Khatheeja S. Association of hsCRP with diabetic and non-diabetic individuals. Jordan J Biol Sci. 2010;3(1):7-12.

Abdrabo AA. Association between fasting plasma glucose and highly sensitive C-reactive protein in a Sudanese population. Sudan Med J. 2012 August;48(2).

Rodríguez-Morán M, Guerrero-Romero F. Elevated concentrations of C-reactive protein in subjects with type 2 diabetes mellitus are moderately influenced by glycemic control. J Endocrinol Invest. 2003;26(3):216-21.