Association Between Hepcidin, Insulin Resistance And CRP in Type 2 Diabetes Patients at The Korle-Bu Teaching Hospital

ABSTRACT

Background: Diabetes Mellitus (DM) is a significant cause of morbidity and mortality and remains a global health challenge. Type 2 diabetes (T2DM) is a leading root of cardiovascular diseases worldwide. Growing evidence indicates a strong association between T2DM and high level of hepcidin; a major regulator of iron homeostasis. Iron overload is an important risk factor that plays a major role in pathogenesis of diabetes and its complications. Insulin resistance and elevated c-reactive proteins have been shown to predict the occurrence of target organ damage in diabetes and in the general population, possibly across all age ranges. The study of the relationship between the major regulator of iron metabolism; hepcidin, C- reactive protein (CRP) and insulin resistance (IR) in type 2 diabetes patients may shed more light on the mechanisms of diabetes complications which may ultimately improve prevention and management strategies of this debilitating disease. General Aim: this study sought to investigate the association between hepcidin, insulin resistance and C-reactive protein levels with T2DM and their connected variables in samples of diabetes patients at Korle-Bu teaching Hospital. Method: In the case-control study design, 111 T2DM patients were recruited from the National Diabetes Management and Research Centre (NDMRC), Korle-Bu, and 29 non-diabetic adults (controls) were recruited from surrounding communities. Body mass index, triglycerides, glucose, insulin, hepcidin and C- reactive protein levels were determined for each participant. HOMA2-IR was calculated. T2DM was defined as a fasting plasma glucose (FPG) level ≥ 7.0 mmol/L, and the use of anti-diabetic drugs. Statistical analyses were performed using SPSS version 20. iv Anthropometric measurements such as body fat, weight (kg), height (m), waist circumference (m) and hip circumference (m) were also measured. Results: in unadjusted analysis, a significant difference in mean values of FPG, Total cholesterol, HDL cholesterol, Low density Lipoprotein cholesterol, Triglyceride, insulin, and HOMA-IR was observed between subjects with and without T2DM. CRP level was significantly higher in both T2DM and non T2DM subjects (p = 0.02). In both cases and controls, there was a significant association and positive correlation between CRP and hepcidin (p< 0.01), log insulin (p= 0.02), and HOMA-IR (p= 0.05). Subjects with higher CRP levels (> 3.0 mg/L) are at increased risk of T2DM compared to those with low CRP levels. Hepcidin correlated negatively with IR (p= 0.05) and Insulin (p= 0.02) and correlated negatively with β cell function (p= 0.04) and insulin sensitivity (p= 0.04). Conclusions: These results suggest that elevated CRP, increased IR and reduced hepcidin levels are associated with T2DM. Recommendations: Further work with larger sample size as well as other confounding protein analysis should be carried out in the future. Further longitudinal studies should be carried out to identify the causative link which might be unique to the Ghanaian.