Clinical and metabolic factors associated with chronic low-grade inflammation in type 2 diabetic patients

Aim. To identify the clinical and metabolic factors associated with serum concentration of high sensitivity C-reactive protein (hsCRP) and alpha 1-acid glycoprotein (alpha 1-AGP) in patients with type 2 diabetes. Material and methods. The study involved 210 patients with type 2 diabetes. Levels of hsCRP and alpha 1-AGP were measured using ELISA and compared with those of the control (30 healthy normal individuals). Levels of acute-phase proteins, fat mass and glucose variability (GO were compared among demographic, anthropometric, biochemical and haematological parameters. The fat mass was determined with Dual-energy X-ray absotptiometty (DEXA). GV parameters including mean amplitude of glycaemic excursions, continuous overlapping net glycaemic action (CONGA), T-index, M-value and mean absolute glucose change (NAG) were derived from continuous glucose monitoring. Results. Levels of hsCRP and alpha 1-AGP significantly increased (p < 0.0001) in patients with diabetes compared with controls. hsCRP level positively correlated with total, truncal and android fat (r = 0.34, r = 0.28 and r = 0.31; respectively, p < 0.00004). al-AGP level showed no relationship with fat mass but positively correlated with mean glucose, CONGA, M-value and MAG (r = 0.38, r = 0.36, r = 0.43 and r = 0.4; respectively, p < 0.0001). Patients with the highest hsCRP levels (>75 percentile) had a greater body mass index (p = 0.00009) as well as truncal and android fat mass (p = 0.04 and p = 0.03, respectively) than those with the lowest levels (<25 percentile). High level of al-AGP (>75 percentile) was associated with urinary albumin/ creatinine ratio (p = 0.01) and GV indices (M-value: p = 0.02, 1VIAG: p = 0.04). Conclusions. Levels of acute phase proteins (hsCRP and al-AGP) increased in patients with type 2 diabetes. Levels of hsCRP were associated with fat mass; meanwhile, al-AGP levels were associated with short-time GV in these patients. The results lend support to the notion that both obesity and enhanced GV are involved in the development of chronic low-grade inflammation associated with type 2 diabetes.