Indian Journal of Clinical Biochemistry

, Volume 22, Issue 2, pp 53–59

Glycemic control modifies the association between microalbuminuria and c-reactive protein in Type 2 Diabetes Mellitus

  • Kaushik Bhowmick
  • A. V. M. Kutty
  • H. V. Shetty

Abstract

Microalbuminuria and C-reactive protein reflect closely related components of the same disease process. The present study attempts to evaluate whether any association exists between C-reactive protein and microalbuminuria in Type 2 Diabetes Mellitus patients with poor and adequate glycemic control. It was observed that in diabetics with poor glycemic control, microalbuminuria showed a significant positive correlation with C-reactive protein and the prevalence of microalbuminuria was significantly more at elevated C-reactive protein levels. These parameters were not significant in subjects with adequately controlled disease. Further, there was a significant increase in levels of microalbuminuria in patients with poor glycemic control when compared to well-controlled diabetics at comparative levels of C-reactive protein. This study supports the hypothesis that endothelial dysfunction and inflammatory activity are involved in the pathogenesis of microalbuminuria and underscores the importance of glycemic control in the progression of inflammation in diabetes.

Key words

Microalbuminuria C-reactive protein Glycemic control Diabetes Mellitus 

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References

  1. 1.
    Caramori M, Fioretto P, Mauer M. The need for early predictors of diabetic nephropathy risk: is albumin excretion rate sufficient? Diabetes 2000; 49: 1399–1408.PubMedCrossRefGoogle Scholar
  2. 2.
    Mogensen C. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310: 356–60.PubMedGoogle Scholar
  3. 3.
    Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen M, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Harris M, Klein R, Welborn T, Knuiman M. Onset of NIDDM occurs at least 4–7 years before clinical diagnosis. Diabetes Care 1992; 15: 815–9.PubMedCrossRefGoogle Scholar
  5. 5.
    American Diabetes Association. Diabetic nephropathy. Diabetes Care 2003; 26 (Suppl 1); S94-S98.Google Scholar
  6. 6.
    Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage. The steno hypothesis. Diabetologia 1989; 32: 219–26.PubMedCrossRefGoogle Scholar
  7. 7.
    Haffner S, Stern M, Gruber M, Hazuda H, Mitchell B, Patterson J. Potential marker for increased cardiovascular risk factors in nondiabetic subjects? Arteriosclerosis 1990; 10: 727–31.PubMedGoogle Scholar
  8. 8.
    Yudkin J, Forrest R, Jackson C. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Lancet 1998; 2: 530–33.Google Scholar
  9. 9.
    Meigs J, Jacques P, Selhub J, Singer D, Nathan D, Rifai N, D'Agostino R, Wilson P. Fasting plasma homocysteine levels in the insulin resistance syndrome. The Framiningham Offspring Study. Diabetes Care 2001; 24: 1403–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999; 340: 115–26.PubMedCrossRefGoogle Scholar
  11. 11.
    Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin or leucocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998; 279: 1992–7.CrossRefGoogle Scholar
  12. 12.
    Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet 1997; 349: 462–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Strandberg TE, Vanhanen H, Tikkanen MJ. Effect of statins in C-reactive protein in patients with coronary artery disease. Lancet 1999; 353: 118–19.PubMedCrossRefGoogle Scholar
  14. 14.
    Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Moye LA, Goldman S. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation 1998; 98: 839–44.PubMedGoogle Scholar
  16. 16.
    Report of the expert committee on the diagnosis and classification of Diabetes Mellitus. Diabetes Care 1998; 20: 1183–97.Google Scholar
  17. 17.
    Coen DA Stehouwer, Mari-Anne Gall, Jos WR Twisk, Elisabeth Knudsen, Jeff J Emeis, Hans-Henrik Parving. Increased albumin excretion, endothelial dysfunction and chronic low-grade inflammation in Type 2 Diabetes. The American Diabetes Association Inc 2002.Google Scholar
  18. 18.
    Festa A, D'Agonstino R, Howard G, Mykkanen L, Tracy R, and Haffner S. Inflammation and microalbuminuria in nondiabetic and type 2 diabetic subjects: the Insulin Resistance Atherosclerosis Study. Kidney Int 2000; 58: 1703–10.PubMedCrossRefGoogle Scholar
  19. 19.
    Stehouwer C, Gall M, Twisk J, Knudsen E, Emeis J, Parving H. Increased urinary albumin excretion, endothelial dysfunction, and chronic low grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes 2002; 51: 1157–65.PubMedCrossRefGoogle Scholar
  20. 20.
    Navarro JF, Mora C, Maca M, Garca J. Inflammatory parameters are independently associated with urinary albumin in type 2 diabetes mellitus. Am J Kidney Dis. 2003; 42: 53–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Stuveling E, Hillege H, Bakker S, Gans R, Jong PD, Zeeuw DD. Creactive protein is associated with renal function abnormalities in a non-diabetic population. Kidney Int 2003; 63: 654–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Stehouwer CDA, Lambert J, Donker AJM, van Hinsbergh VWM. Endothelial dysfunction and the pathogenesis of diabetic angiopathy. Cardiovasc Res 1997; 34: 55–68.PubMedCrossRefGoogle Scholar
  23. 23.
    Yudkin JS, Stehouwer CDA, Emeis JJ, Coppack SW. Creactive protein in healthy subjects: associations with obesity, insulin resistance and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler. Thromb Vasc Biol 1999; 19: 972–8.Google Scholar
  24. 24.
    Jager A, van Hinsbergh VWM, Kostense PJ, Emeis JJ, Yudkin JS, Nijpels G, Dekker JM, Heine RJ, Bouter LM, Stehouwer CDA. von Willebrand factor, C-reactive protein and 5-year mortality in diabetic and nondiabetic subjects the Hoorn Study. Arterioscler. Thromb Vasc Biol 1999; 19: 3071–8.Google Scholar
  25. 25.
    Jager A, van Hinsbergh VWM, Kostense PJ, Emeis JJ, Nijpels G, Dekker JM, Heine RJ, Bouter LM, Stehouwer CDA. Increased levels of soluble vascular cell adhesion molecule 1 are associated with risk of cardiovascular mortality in type 2 diabetes. Diabetes 2000; 49: 485–91PubMedCrossRefGoogle Scholar
  26. 26.
    Mykkänen L, Zaccaro DJ, O'Leary DH, Howard G, Robbins DC, Haffner SM. Microalbuminuria and carotid artery intimamedia thickness in nondiabetic and NIDDM subjects: the Insulin Resistance Atherosclerosis Study (IRAS). Stroke 1997; 28: 1710–16.PubMedGoogle Scholar
  27. 27.
    Guerrero-Romero F, Rodriguez-Moran M. Relation of C-reactive protein to features of the metabolic syndrome in normal glucose tolerant, impaired glucose tolerant, and newly diagnosed type 2 diabetic subjects. Diabetes Metab 2003; 29: 65–71.PubMedCrossRefGoogle Scholar
  28. 28.
    Schalkwijk CG, Ligtvoet N, Twaalfhoven H, Jager A, Blaauwgeers HGT, Schlingemann RO, Tarnow L, Parving HH, Stehouwer CDA, van Hinsbergh VWM. Amadori-albumin in type 1 diabetic patients: correlation with markers of endothelial function, association with diabetic nephropathy and localization in retinal capillaries. Diabetes 1999; 48: 2446–53.PubMedCrossRefGoogle Scholar
  29. 29.
    Bierhaus A, Hofmann MA, Ziegler R, Nawroth PP. AGEs and their interaction with AGE-receptors in vascular disease and diabetes mellitus. I. The AGE concept. Cardiovasc Res 1998; 37: 586–600.PubMedCrossRefGoogle Scholar
  30. 30.
    The Euclid Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet 1997; 349: 1787–92.CrossRefGoogle Scholar
  31. 31.
    Perkins B, Ficociello L, Silva K, Finkelstein D, Warram J, Krolewski A. Regression of microalbuminuria in type 1 diabetes. N Engl J Med 2003; 348: 2285–93.PubMedCrossRefGoogle Scholar

Copyright information

© Association of Clinical BIochemists of India 2007

Authors and Affiliations

  • Kaushik Bhowmick
    • 1
  • A. V. M. Kutty
    • 1
  • H. V. Shetty
    • 1
  1. 1.Department of BiochemistrySri Devaraj Urs Medical College and R.L. Jalappa HospitalKarnataka

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