High Sensitivity C-reactive Protein Concentrations, Lipid Status And Duration Of Type-1 Diabetes CURRENT

Background: Low-grade inflammation, duration of diabetes, hyperglycemia, and dyslipidemia in the presence of other traditional risk factors have been implicated in the development of vascular, neurologic, musculoskeletal and dermatologic complications observed in type 1 diabetes irrespective of other confounding factors. The study was aimed at assessing the relationship between hs-CRP concentrations, lipid status and duration of type-1 diabetes. Methods: Thirty-four patients aged 15-26 years comprising 14 females and 20 males diagnosed with type 1 diabetes ≤10 years duration, who at first clinical assessment and thorough medical examination presented with any or a combination of the symptoms of ketoacidosis, polyuria, polydipsia, malnutrition, blurred vision, paresthesia, body swelling and frothy urine at the Accident and Emergency Unit of Rasheed Shekoni Specialist Hospital, Jigawa Nigeria were enrolled for the study in a cross-sectional pattern after granting informed consent or obtaining assent from parents or guardians. Blood samples for lipid profile, fasting plasma glucose (FPG) and High sensitivity C - reactive protein (hs-CRP) measurement were collected from all patients through venipuncture after 10 hours overnight fast for biochemical testing. Lipid profile and FPG were assayed using enzymatic methods, hs- CRP via Enzyme Linked immunosorbent Assay (ELISA) technique and Urinalysis with point of care urine test strips. Data obtained was analyzed and presented as Frequency, Percentages, Mean ± SD and Pearson’s correlation with statistical significance at p≤0.05. Results: Patients biochemical characteristics were Fasting Plasma Glucose (9.86 ± 4.44), Total Cholesterol (4.77 ± 2.07), High Density Lipoprotein- Cholesterol (1.35±0.54), Triglycerides (2.17 ± 1.06), Low Density Lipoprotein- Cholesterol (2.29 ±1.49), hs-CRP (6.99 ± 5.44). Correlation matrix showed significant relationship between Triglycerides

and frothy urine at the Accident and Emergency Unit of Rasheed Shekoni Specialist Hospital, Jigawa Nigeria were enrolled for the study in a cross-sectional pattern after granting informed consent or obtaining assent from parents or guardians. Blood samples for lipid profile, fasting plasma glucose (FPG) and High sensitivity C -reactive protein (hs-CRP) measurement were collected from all patients through venipuncture after 10 hours overnight fast for biochemical testing. Lipid profile and FPG were assayed using enzymatic and hs-CRP (r; 0.378**, p; 0.005), Low Density Lipoprotein-Cholesterol and hs-CRP (r; 0.457*, p; 0.007). hs-CRP concentrations in relation to duration of type-1 diabetes were 1-3 years (3.57±4.10), 3-6 years (6.66±4.39) and 6-10 years (10.06±8.69).
Conclusions: Evaluation of hs-CRP concentrations irrespective of lipid status may serve as an inexpensive method of predicting the risk of development of diabetic complications in resource poor settings among patients with established type 1 diabetes as the duration progresses.
Background Type 1 diabetes results from an autoimmune process that destroys insulin producing ß cells within the endocrine pancreatic islet [1] and represents approximately 10% of diabetes cases globally [2] with < 10% of affected patients presenting with idiopathic pathogenesis and no evidence of autoimmunity hence classified as type 1B [3]. C-reactive protein is a type I acute phase response protein synthesized in the liver or adipose tissue when tissue injury or microbial invasion occurs and is regulated by pro-inflammatory cytokines [4]. Elevated plasma level of CRP is a marker for endothelial cell dysfunction in uncomplicated, well-controlled type 1 diabetes and atherosclerosis through inflammatory pathways [5].
Effective insulin treatment improves lipid status and glycaemia in patients with type 1 diabetes [6,7] However, in some patients elusive lipid abnormalities coexistent with hyperglycemia may accelerate vascular lesions [8] and metabolic crisis resulting from ketoacidosis [9].
The study was aimed at assessing the relationship between hs-CRP concentrations and duration of type 1 diabetes.

Discussion
Chronic inflammation characterized by elevated hs-CRP concentration has been reported to be associated with incident diabetes mellitus, hypertension and obesity [7]. Elevated hs-CRP concentration is independently linked with the development of type 1 diabetes [9,16] and type 2 diabetes [7,8]. We observed an above normal limit FPG among the patients despite the intensive blood glucose monitoring and a negative correlation between hs-CRP levels and FPG in our study which is in concordance with the studies of [5,6,11,12,13]. Studies have also reported an elevation of HBA1c among patients with type 1 diabetes [6,11,16] and type 2 diabetes [9,12,20]. Our inability to assay HbA1c might not give a true representation of glycemia which is a major limitation to our study.
Lipid profile among patients was within normal limits in our study. We observed a positive correlation between hs-CRP concentrations, triglycerides, TC and LDL-C as reported in studies [10][11][12][13][14]. This may be linked to the established association between systemic inflammation and lipid status in patients with diabetes and the fact that none of the patients recruited for our study was taking oral antihypertensive medication which is known to be associated with lower risk of obtaining elevated hs-CRP levels as reported by Svensson et al., 2014. Body mass index correlated positively with age, systolic blood pressure, diastolic blood pressure and waist circumference. Our study showed increased BMI among patients which is similar to [2,10,11,13,14,20] but contrary to the findings of [6]. Our study also observed that BMI and WC were elevated in females compared to males which are contrary to the reports of [12,15].
Our study also found a positive correlation between BMI, SBP and DBP which is in Our study observed a negative correlation between hs-CRP concentrations and the age of the patients which is contrary to the findings of [4,10,14] who reported that young age was associated with substantially higher prevalence of CRP than old age. Although, none of the studies enrolled patients strictly diagnosed with type 1 diabetes.
Hs-CRP concentration correlated negatively with the waist circumference of the patients in our study which is dissimilar to the finding of Klisic et al., 2014. The absence of measurement of the hip circumference in our study did not provide the basis for calculating the WHR which several studies [2,5,6,12] conducted employed. As a result, there was no room for comparison between our study and other studies.

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The strength of our study lies in its ability to employ both retrospective and prospective data and the capacity to recruit patients with type 1 diabetes only.
The limitation of the study includes its inability to enroll control subjects for comparison of findings between the diabetic patients and apparently healthy individuals and the small sample size because type 1 diabetic patients represent a minority group of patients that present with diabetes mellitus at the endocrinology clinic.

COMPETING INTEREST
The authors declare that they have no competing interests.
14 FUNDING No Source of funding was obtained for the study AUTHORS CONTRIBUTION BH, MSB, AMB and GYM were the principal investigators, conceptualized and organized the study. MSB, MA and IDG assisted with patient recruitment, data collection and analysis.
BH and MSB were the principal medical statisticians for data processing, statistical analysis and critical review of the manuscript. All authors read and approved the final manuscript.