Association Of Ultrasensitive C-reactive Protein With Insulin Resistance And Macrovascular Complications In Patients With Type 2 Diabetes Mellitus

Objective and BackgroundDue to the change of lifestyle and the improvement of life level, the number of adults with diagnosed type 2 diabetes (T2DM) worldwide will grow rapidly. The patients with T2DM are liable to complicate with macrovascular complications, including coronary heart disease(CHD) ,cerebral vascular disease(CVD) and peripheral vascular disease(PVD). This is the main reason of death and cripple in diabetic patients. Diabetic macrovascular complication has many risk factors, such as hypertension ,obesity,high cholesterol,smoking , duration of diabetes and insulin resistance. Recently presented studies have shown that some nontranditional risk factors,such as C-reactive protein(CRP) is association with diabetic macrovascular complications. CRP, is an sensitive marker of inflammation .A hypothesis is shown that atherosclerosis and T2DM may share common antecedents , that is mean the 'common soil' hypothesis. Both T2DM and atherosclerosis are multifactorial which appear to share a common inflammatory basis. We speculate that CRP may be a risk factor of developing T2DM and diabetic macrovascular complications. Because atherosclerosis is now considered in part to be a consequence of chronic low-grade inflammation, and among biomarkers of low level inflammation, CRP has emerged as perhaps the most clinically useful. So CRP was measured with a ultrasensitive(usCRP) immnoturbidimetric assay. We will observe its serum level of T2DM with and without macrovascular complication compared to mached controls and usecorrelation to assess the extent of association between usCRP and diabetic macrovascular complications risk factors,such as IR, and to investigate the usCRP concentration in the pathogenesis of type 2 diabetes mellitus and its macrovascular complications. MethodsNinety type 2 diabetic(T2DM) patients who visited Department of Endocrinology in The First Affiliated Hospital of Medical College, Zhe Jiang University and thirty normol control(groupl,Gl) were enrolled for the present study. Type 2 diabetes mellitus was diagnosed based on World Health Organization criteria in 1999. All T2DM patients were divided into two groups according to macrovascular complication. Group 2(G2,n=40): patients without macrovascular complication, group 3(G3,n=50): patients complicated with macrovascular disease, including 16 patients with coronary heart disease, 31 with carotid or lower limbs atheroma plaque, 3 with cerebral vascular stroke. We selected the subjects without insulin treatment to be able to assess their insulin sensitivity. All subjects had no evidence of current acute illness, including clinically significant disease and didn't use anti-infectious drugs or lipid-lowering drugs. None of the subjects had significant renal or liver dysfunction, they are blood and urine routine were normal, definite microvascular complication, such as the 24 hour urine albumin excrete 30mg were excluded. T2DM with macrovascular complication defined as follows: coronary artery disease; there were carotie or lower limbs atheroma plaque in the patients with T2DM by sensitive ultrasound B-mode; cerebrovascular disease (TIA,stroke or MR1 evidence), peripheral artery disease(intermittent cripple,pain). Patients with a history of acute myocardial infarction or angioplasty with the preceding 6 monthswere excluded.All subjects's Blood samples were obtained in the morning after an overnight fast. They all made the related examination. The low concentrations of usCRP was measured by ultrasensitive immnoturbidimetric assay. Samples for CRP were prepared by frozen, and stored at -20 掳C until the assay. The homeostasis model was used to assess insulin resistance (HOMA-IR), the formula for HOMA-IR is as follows: fasting insulin(mIU/L) xfasting glucose(mmol/L)/22.5. Date were presented as means卤standard deviation. T-test or one-way analysis of variance of biological data were performed, person correlation and stepwise linear regression were also performed. All statistical analysis were accomplished with the version 10.