Carotid Intima Media Thickness and High Sensitivity C-Reactive Protein Levels in Prediabetes and its Correlation with Homeostatic Model Assessment for Insulin Resistance

Abstract

Introduction: Hyperglycaemia and insulin resistance are two important risk factors for the development of atherosclerosis and Atherosclerotic Cardiovascular Disease (ASCVD). Whilst the association of diabetes and atherosclerosis has well been studied and is well known, the data on prediabetes is limited. Carotid Artery Intima-media Thickness (CIMT) and high sensitivity C-reactive Protein (hsCRP) are recognised markers of subclinical atherosclerosis. Aim: To measure CIMT and hsCRP levels in prediabetics in cases and controls and correlate them with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Materials and Methods: Fifty prediabetic patients and 50 age, sex and Body Mass Index (BMI) matched controls were enrolled in this case control study. Serum fasting and postprandial blood sugars, glycated haemoglobin (HbA1c) and fasting insulin levels were measured in cases and controls. HOMA-IR index was calculated from fasting glucose and insulin values. All cases and controls were subjected to bilateral CIMT measurements and the mean was tabulated. Serum hsCRP values were assessed and compared between both the groups by unpaired t-test. Results: The mean serum fasting insulin level among cases was 12.22 mIU/mL and that of the control group was 5.37 mIU/mL (p-value <0.0001). HOMA-IR mean values were 3.31±1.56 and 1.16±0.44 in cases and controls respectively (p-value <0.0001). Mean CIMT was found to be statistically higher in prediabetics (0.59±0.11 mm) when compared to controls (0.45±0.07 mm) (p<0.0001). Serum hsCRP levels were also statistically higher in prediabetics (5.75±4.16 mg/L) than that of controls (1.86±1.67mg/L) (p<0.0001). There was a positive correlation between mean CIMT and HOMA-IR (p-value=0.0001) (r=0.515), hsCRP levels and HOMA-IR (p-value=0.0001) (r=0.512). Conclusion: Serum hsCRP levels and CIMT can be employed as predictors of atherosclerotic risk and ASCVD in prediabetics. This would help us to identify high risk individuals and thus targeting them for early lifestyle and pharmacological management.

Keywords

• atherosclerotic cardiovascular disease
• lifestyle
• predictor