Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 16462

AbstractMaterial and MethodsResultsDiscussionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 6 | Page : 1165 - 1168

Acute Phase Reactants in Type 2 Diabetes Mellitus and Their Correlation with the Duration of Diabetes Mellitus

Vishakha V Mahajan, Indrayani C Apte, Shilpa S Shende

M.B.B.S.,M.D., Assistant Professor, Dept of Biochemistry, IGGMC, Nagpur -440018. 2. MSc,PhD., Prof. and Head, Dept of Biochemistry, IGGMC,Nagpur-440018. 3. M.B.B.S.,M.D., Assistant Professor, Dept. of Biochemistry, IGGMC, Nagpur – 440018.

Correspondence Address :
Vishakha V. Mahajan
Assistant Professor, Dept. of Biochemistry,
IGGMC, Nagpur- 440018.
E-mail: dr.vishakha4u@gmail.com
Phone: 9822474848

Abstract

Introduction: Poorly controlled blood glucose levels can lead to complications in type 2 diabetes mellitus. The risk of the complications increases with an increase in the duration of hyperglycaemia. Numerous studies have shown the association between chronic subclinical inflammation and the risk of developing type 2 diabetes. Acute phase reactants are the markers of inflammation. In our study, we assessed the correlation of the levels of the acute phase reactants with an increase in the duration of diabetes mellitus. We also studied the correlation between these acute phase reactants with the traditional risk pre-dictors of diabetic complications.

Materials and Methods: This was a case control study which included 60 uncontrolled, type 2, diabetes mellitus cases and 30 non-diabetic, apparently normal controls. The cases were classified into two groups. Group I comprised of 30 cases which had a duration of diabetes of less than 10 years and group II comprised of 30 cases which had a duration of diabetes of more than 10 years. Three acute phase reactants; C reactive protein, ceruloplasmin and total sialic acid were assessed as the markers of inflammation. Cardiovascular risk was assessed by measuring the lipid profile. 24 hour urinary albumin was measured as a marker of incipient diabetic nephropathy.

Results: A significant increase was seen in all the three acute phase reactants in group I as compared to those in the controls (P< 0.01). The increase in these acute phase reactants was more significant (P< 0.001) in group II as compared to that in group I. There was a significant positive correlation between all the acute phase reactants , C reactive protein (r=0.9, P<0.001), ceruloplasmin (r=0.3, P<0.001) and total sialic acid (r=0.9, P<0.001) and the LDL:HDL cholesterol ratio in group II. A significant positive correlation was also seen between C reactive protein (r=0.5, P<0.001), ceruloplasmin (r=0.9, P<0.001) and total sialic acid (r=0.9, P<0.001) and the 24 hour urinary albumin in group II.

Conclusion: There was a significant increase in the level of the acute phase reactants with an increase in the duration of diabetes mellitus. There was a significant correlation between inflammation and the diabetic complications.

Keywords

Acute phase reactants, Type 2 diabetes mellitus, Inflammation, Diabetic complications

Introduction
Diabetes mellitus (DM) is a heterogenous, metabolic disease which is characterized by hyperglycaemia and long term complications. The late complications of diabetes are: (a) microangiopathy i.e. abnormalities of the small arteries which include diabetic nephropathy, retinopathy, neuropathy and (b) macroangiopathy i.e. abnormalities of the large arteries which include coronary heart disease and peripheral vascular disease. The risk of the chronic complications increases as a function of the duration of hyperglycaemia. The complications usually become apparent in the second decade of the hyperglycaemia (1).

Acute phase reactants (APRs) are the markers of inflammation. They are synthesized in response to tissue damage and inflammation. During inflammation, their concentrations increase thousand fold over the normal levels. They are mainly produced by hepatocytes, but they can also be synthesized by adipocytes, fibroblasts, endothelial cells, etc (2).

Recent studies have shown that low grade inflammation is associated with the risk of developing type 2 DM (3).There are only few reports regarding the role of inflammation in diabetic complications. Considering this fact, the present study was carried out to find out the changes in the levels of the acute phase reactantswith an increase in the duration of diabetes mellitus and their role in the diabetic complications.

Material and Methods

This study was carried out in the Department of Biochemistry, Indira Gandhi Government Medical College, Nagpur. This case control study was carried out on a total of 90 subjects. 30 healthy and apparently normal, non-diabetic subjects were selected as the controls. 60 cases of uncontrolled type 2 diabetes mellitus were selected, which were diagnosed on the basis of the glycosylated haemoglobin levels (HbA1c >6.5%) (4). The diabetic cases were recruited from the Diabetic OPD, Department of Medicine, Indira Gandhi Government Medical College, Nagpur. Out of these 60 cases of DM, 30 cases had DM for less than 10 years, which were categorized as group I. The rest of the 30 cases had DM for more than 10 years, which were categorized as group II. The subjects were of both sexes, who were in the age group of 30-60 years. Subjects with any inflammatory disease, those who were on statin therapy, smokers, women who were taking oestrogen which contained medications and pregnant women were excluded from the study.

A requisite clearance from the institutional ethical committee was obtained. Fasting blood samples were collected from all the partic(i2p)ants after taking their written i(n3fo) rmed consent. Haemolyzed and lipaemic samples were excluded. The blood samples were analyzed for glycosylated haemoglobin by the cation-exchange resin method. In this method, a haemolysed preparation of whole blood was mixed continuously for 5 minutes with a weakly binding cation exchange resin. During this mixing, the nonglycosylated haemoglobin binds to the ion exchange resin, leaving the gycosylated haemoglobin(GHb) free in the supernatant. The percent glycosylated haemoglobin was determined by measuring the absorbances of the GHb fraction and the total haemoglobin fraction. The ratio of the absorbances of the GHb fraction and the total haemoglobin fraction of the control and test was used to calculate the percent glycosylated haemoglobin of the sample. The serum C-reactive protein (CRP) was analyzed by the turbilatex method (kit- MERCK laboratory).In this method, the latex particles which were coated with specific human anti-CRP were agglutinated when they were mixed with samples which contained CRP. This agglutination caused an absorbance change which could be quantified by comparision from a calibrator of known CRP concentration. The determination of serum ceruloplasmin (kit- MERCK laboratory) is based on the reaction between ceruloplasmin as an antigen and the specific antiserum as the antibody. This reaction forms an insoluble complex which produces a turbidity which is measured spectrophotometrically. The serum total sialic acid was measured by a chemical method which was used by Plucinsky MC et al (5), serum total cholesterol and triglycerides were evaluated by an enzymatic method, serum HDL cholesterol was evaluated by phosphotungstate precipitation followed by an enzymatic method and serum LDL and VLDL cholesterol were evaluated by using Friedewald (6) formula. Also, 24 hour urinesamples were collected and analyzed for urinary albumin by the pyrogallol red method. All the parameters were analyzed by using a semiautomatic analyzer (Transasia Erba Chem–5 Plus).

Statistical analysis
Statistical analysis was done by using the Graph Pad Prism software. The data was expressed as mean + SD. The significance of the differences in the values of the parameters among the controls and group I and group II was evaluated by using ANOVA (Analysis of Variance). The comparisons between the two groups were done by applying the Student’s ‘t’ test. Pearson’s correlation coefficient was employed to find out the correlations between thethree acute phase reactants and the LDL:HDL ratio and the 24 hour urinary albumin in group II.

Results

We observed the significance of the differences (P<0.001) in the values of all the parameters in the controls and group I and group II by using ANOVA. All the three acute phase reactants; C reactive protein, ceruloplasmin and total sialic acid were significantly increased in group I as compared to the controls (P< 0.01). The increase in these acute phase reactants was more significant (P< 0.001) in group II as compared to group I . 24 hour urinary albumin was significantly increased (P<0.01) in group I as compared to the controls. The increase in urinary albumin was more significant (P<0.001) in group II as compared to that in group I. The serum total cholesterol, LDL cholesterol (LDL-C) and VLDL cholesterol levels showed a significant increase (p<0.01) in group I as compared to those in the controls and a highly significant increase (P<0.001) in group II as compared to those in group I. The serum HDL cholesterol (HDL-C) level was significantly lower in group I (P<0.01) as compared to that in the controls. The decease in the HDL-C level was more significant (P<0.001) in group II as compared to that in group I. Also in our study, the LDL-C : HDL-C ratio was significantly increased (P<0.01) in group I as compared to that in the controls and it was much more significantly (P<0.001) increased in group II as compared to group I. There was a significant positive correlation between all acute phase reactants ; C reactive protein (r=0.9, P<0.001), ceruloplasmin (r=0.3, P<0.001) and total sialic acid (r=0.9, P<0.001) and the LDL:HDL cholesterol ratio in group II. A significant positive correlation was also seen between C reactive protein (r=0.5, P<0.001) , ceruloplasmin (r=0.9, P<0.001) and total sialic acid (r=0.9, P<0.001) and the 24 hour urinary albumin in group II.

Discussion

In this study, all the three acute phase reactants showed a significant increase in the group I diabetes cases as compared to the controls (Table/Fig 1), which was in accordance with the reports of previous studies by Caparevic Z et al (7), Diamond M et al (8) and Gavella M et al (9). In the last few years, numerous studies have shown that low grade inflammation is associated with the risk of developing type 2 diabetes. Furthermore, nowadays, it has been accepted that chronic subclinical inflammation is a part of theinsulin resistance syndrome. The mechanisms by which chronic inflammation can evoke type 2 diabetes are not clear. However, it is known that adipose tissue can synthesize and release the main pro-inflammatory cytokines, tumour necrosis factor-alpha (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6), and that the inflammatory markers are associated with the body fat mass. The pro-inflammatory cytokines and acute phase reactants are involved in multiple metabolic pathways which are relevant to insulin resistance, including insulin regulation, reactive oxygen species, lipoprotein lipase action and adipocyte function.Therefore, the activated innate immunity and inflammation are relevant factors in the pathogenesis of diabetes, with convincing data that type 2 diabetes includes an inflammatory component (3).

We observed that there was a rise in the level of all the three acute phase reactants with an increase in the duration of diabetes mellitus (Table/Fig 1). As DM is a chronic inflammatory state, an aberrant continuation of some aspects of the acute phase response may lead to the underlying tissue damage that accompanies the disease and can contribute to further complications (2).

According to Tan KC et al (9),(10), chronic hyperglycaemia in uncontrolled type 2 diabetic patients causes the non enzymatic glycation of proteins, which leads to the formation of advanced glycation end products (AGEs). These AGEs can trigger the inflammatory response and are implicated in the pathogenesis of many complications of diabetes mellitus.

According to Wright E et al (11), oxidative stress through the production of reactive oxygen species (ROS) has been proposed as the root cause which underlies the development of insulin resistance, β cell dysfunction, impaired glucose tolerance and type 2 DM and its complications. The markers of inflammation, the well recognized manifestations of oxidative stress, have also been observed to be increased in response to the intermittent, elevated glucose levels. One of the many sequelae which lead to the generation of ROS is the cytokine induced stimulation of the acute phase reactant synthesis by the liver.

The risk of the chronic complications in diabetes mellitus increases as a function of the duration of hyperglycaemia; they usually become apparent in the second decade of the hyperglycaemia. Glomerular hyperfusion and renal hypertrophy occur in the first years after the onset of diabetes mellitus and cause an increase in the glomerular filtration rate. During the first five years of diabetes mellitus, thickening of the glomerular basement membrane, glomerular hypertrophy and mesangial volume expansion occur, as the glomerular filtration rate returns to normal. After 5 to 10 years, about 40% of the individuals begin to excrete small amounts of albumin in the urine. Microalbuminuria is defined as a urinary albumin excretion of 30-300 mg/day. The Group II cases in our study had microalbuminuria (urinary albumin 274 +78 mg/day). The appearance of microalbminuria is a very important predictor of incipient diabetic nephroathy (1).

The Group II cases in our study showed dyslipidaemia. According to Framingham’s study (12), the persons with an LDL-C : HDL-C ratio which was greater than 5 were at a high risk of developing coronary heart disease (CHD) and those with a ratio between 2 - 5 were at an intermediate risk of developing CHD. So, in comparison with Framingham’s study, the group II diabetics (LDL-C: HDL-C ratio= 4.76) were at an intermediate to high risk of developing CHD. This showed that the group II diabetics with a disease durationof more than 10 years were prone to renal and cardiovascular complications.

We observed a significant positive correlation between all the three acute phase reactants and the LDL-C:HDL-C ratio and also the 24 hour urinary albumin in group II diabetics. Thus, our study revealed that there was a significant correlation between inflammation and the diabetic complications. Nayak BS et al (13), Liao L et al (14), Panichi V et al (15), Pu L J et al (16) and Chen J et al (17) also demonstrated that the diabetic complications exhibited a sign of inflammation.

In conclusion, the pathogenetic vision of diabetes mellitus has changed in the last few years, with inflammatory pathways playing pivotal roles in the development and progression of the diabetic complications. These new pathogenic factors can lead to a consideration of new therapeutic approaches. The modulation of inflammatory processes in the setting of diabetes is nowadays a matter of great interest. It is possible that in the coming years, the hope of new therapeutic strategies which are based on antiinflammatory properties, with beneficial actions on the diabetic complications, can be translated into real clinical treatments.

References

1.
Braunwald E, Stephen LH, Anthony SF, Longo DL, Dennis LK, Jameson JL,et al. Harrison’s Principles of Internal Medicine. 15th ed. New York: McGraw Hill companies; 2001;2: 2109-22.
2.
The acute phase reactants. [online]. Tue Jun 27 14: 33:11 MET DST 1995. hulin@fmed.SK,Uniba. Available from:URL:http://nic.sav.sk/ logos/books/scientific/node 35.html
3.
Navarro JF, Mora C. The role of inflammation in diabetic complications. Nephrol Dial Transplant 2005 Dec ;20(12): 2601-04.
4.
Standards of medical care in diabetes -2010. American Diabetes Association. Diabetes Care. 2010 Jan;33 (1):S11-61.
5.
Pluckinsky MC, Riley WM, Prorok JJ, Alhadeff JA. Total and lipid associated serum sialic acid levels in cancer patients with different primary sites and different degrees of metastatic involvement. Cancer. 1986 Dec 15;58(12) : 2680-5.
6.
Friedwald WT, Levy RL, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without the use of the pre-parative ultracentrifuge. Clin chem. 1972 Jun;18(6): 499-502.
7.
Caparevic Z, Kostic N, Ilic S, Stojanovic D, Ivanovic AM. Oxidized LDL and C-reactive protein as markers for the detection of accelerated atherosclerosis in type 2 diabetics. Med Pregl. 2006 Mar–Apr; 59(3-4): 160-4.
8.
Daimon M, Susa S, Yamatani K, Manake H, Hama K, Kimura M et al. Hyperglycaemia is a factor for an increase in serum ceruloplasmin in type 2 diabetics. Diabetes Care. 1998 Sep; 21(9):1525-8.
9.
Gavella M, Lipovac V, Car A, Vucic ´ M, Sokolic ´ L, Rakos R,et al. Serum sialic acid in subjects with impaired glucose tolerance and in newly diagnosed type 2 diabetic patients. Acta Diabetol. 2003 Jun; 40(2): 95-100.
10.
Tan KC, Chow WS, Tam S, Bucala R, Betteridge J. The association between the acute phase reactants and the advanced glycation end products in type 2 diabetes. Diabetes Care. 2004 Jan; 27(1): 223-8.
11.
Wright E, Scism-Bacon JL. Oxidative stress in type 2 diabetes mellitus. Int J Clin Pract. 2006 Mar; 60(3):308-14.
12.
Gordon T, Kannel WB, Castelli WP, Dawber TR. Lipoproteins, cardiovascular disease and death: The Framingham study. Arch Intern Med. 1981 Aug;141(9):1128-31
13.
Nayak BS, Roberts L. The relationship between the inflammatory markers and the metabolic and anthropometric variables in the Caribbean type 2 diabetic patients with and without microvacular complications. J inflamm (Lond). 2006 Dec 22;3:17.
14.
Liao L, Lei MX, Chen HL, Wu J, Guo LJ. High sensitive C-reactive protein and type 2 diabetic nephropathy. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2004 Dec;29(6):627-30.
15.
Panichi V, Taccola D, Rizza M, Consani C, Migliori M, Filippi C, et al. Ceruloplasmin and acute phase protein levels are associated with cardiovascular disease in chronic dialysis patients. J Nephrol. 2004 Sep-Oct;17(5):715-20.
16.
Pu LJ, Lu L, Xu XW, Zhang RY, Zhang Q, Zhang JS, Hu J, Yang ZK, Ding FH, Chen QJ, Lou S,Shen J, Fang DH, Shen WF. The values of serum glycated albumin and high-sensitivity C-reactive protein levels in the prediction of the presence of coronary artery disease in patients with type 2 diabetes. Cardiovasc Diabetol. 2006 Dec 20;5:27.
17.
Chen J, Gall MA, Yokoyama H, Jensen JS, Deckert M, Parving HH,et al. Raised serum sialic acid concentrations in NIDDM patients with and without diabetic nephropathy. Diabetes Care. 1996 Feb;19(2): 130-4.

Tables and Figures
[Table / Fig - 1]
DOI and Others

JCDR/2011/1614

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com