Serum C-Reactive Protein to Albumin Ratio as a Reliable Marker of Diabetic Neuropathy in Type 2 Diabetes Mellitus

Abstract

Type 2 diabetes mellitus may be complicated with chronic complications including diabetic neuropathy (DN). Timely diagnosis is crucial in treatment and maybe reversal of this complication. C reactive protein to albumin ratio (CAR) is considered as a marker of inflammation in various diseases that characterized with acute or chronic inflammation. Since diabetic neuropathy and type 2 diabetes mellitus are also associated with chronic, low grade inflammation, we aimed to study CAR levels of type 2 diabetic subjects with diabetic neuropathy and to compare to those in patients without diabetic neuropathy. Type 2 diabetic patients presented to our institutional outpatient clinics were divided into two according to the presence of DN. Subjects with DN were listed as DN group and others were as non-DN group. Characteristics and laboratory data, including CAR, in DN and non-DN groups were compared. Median CAR of the DN and non-DN groups were 2,19 (0,2-49)% and 0,56 (0,02-5,8)%, respectively (p<0.001). CAR was significantly and positively correlated with age (r=0.15, p<0.001), weight (r=0.19, p=0.01), BMI (r=0.11, p=0.03), waist circumference (r=0.10, p=0.046), fasting plasma glucose (r=0.14, p=0.004), serum creatinine (r=0.25, p<0.001), triglyceride (r=0.17, p<0.001), and LDL-cholesterol (r=0.13, p=0.001) levels. Moreover, CAR was inversely correlated with eGFR levels (r=-0.16, p<0.001). The sensitivity and specificity of CAR (when higher than 1,02%) in predicting diabetic neuropathy were 78% and 73%, respectively (AUC: 0.84, p<0.001, 95% CI: 0,82-0,87). Moreover, high CAR level was an independent risk factor of diabetic neuropathy (p<0.001, OR: 1.34, 95% CI: 0.48-1.62). In conclusion, elevated CAR levels could be considered as a marker of diabetic neuropathy.

Association between the Prognostic Nutritional Index and Chronic Microvascular Complications in Patients with Type 2 Diabetes Mellitus

“…Moreover, increased C-reactive protein levels were noted in subjects with diabetic neuropathy when compared to those without diabetic neuropathy [ 26 ]. Subsequently, a recent study confirmed the previous works by reporting increased C-reactive protein levels in diabetic neuropathy subjects compared to those of the diabetic patients without neuropathy [ 27 ]. Another inflammatory marker, high sensitivity C-reactive protein levels, were higher in the diabetic patients with diabetic foot ulcers, a complication closely associated with diabetic neuropathy, than those in diabetic patients without foot ulcers [ 28 ].…”

Investigation of the reasons for delayed presentation in proliferative diabetic retinopathy patients

“…Early detection and intervention can prevent blindness caused by DR [4,5], however delayed treatment may result in severe and irreversible consequences. Emerging evidence suggests that chronic inflammation may play a role in DR progression and possibly make the untreated PDR worse in patients failed to be identified in time [10][11][12][13][14]. While established methods for detecting DM [1] and DR [2,3] exist, this research sheds light on the complex and diverse factors contributing to delayed presentation of DR in Chinese patients, an area previously unexplored.…”

“…Emerging research [10,11], highlights a complex relationship between inflammation and various diabetic complications, including diabetic neuropathy [12], DR [13], and diabetic nephropathy [14]. This growing body of evidence suggests that the inflammatory characteristics of Type 2 DM may contribute to the progression of DR [10][11][12][13][14].…”

“…Emerging research [10,11], highlights a complex relationship between inflammation and various diabetic complications, including diabetic neuropathy [12], DR [13], and diabetic nephropathy [14]. This growing body of evidence suggests that the inflammatory characteristics of Type 2 DM may contribute to the progression of DR [10][11][12][13][14]. Specifically, studies have shown that individuals with poorly controlled diabetes, characterized by heightened inflammation [10,11], exhibit a higher risk of both faster DR progression [13] and delayed presentation due to the poor compliance [15].…”

Influence of Fibrinogen/Albumin Ratio and Fibrinogen/Pre-Albumin Ratio on Cardiac Autonomic Neuropathy in Type 2 Diabetes

“…6 Similarly, low-grade inflammation is important in the development of chronic diabetic complications, such as diabetic nephropathy, 7 retinopathy, 8 and neuropathy. 9 Several studies have confirmed that the onset and development of many cardiovascular diseases are closely related to inflammation. 10 For example, patients with coronary heart disease are in a state of increased inflammatory load.…”