Meal testing and postprandial state of type 2 diabetic patients with metabolic syndrome.

BACKGROUND AND AIMS: C reactive protein (CRP), a non-specific acute phase reactant, has been associated with multiple patogenic mechanisms involved in chronic illnesses, but up to now the significance of CRP in the postprandial state in diabetes mellitus has not been addressed. MATERIAL AND METHODS: We evaluated 58 type 2 diabetic patients (33F/25 M) with associated metabolic syndrome. The main characteristics of the patients were: age 58.1+/-9.15 years, duration of diabetes 3.9+/-3.07 years, BMI 26.2+/-3.26 kg/m2, waist circumference 97.7+/-9.88 cm and HbA1c 7.2+/-1.2%. Men and women were matched for age, duration of diabetes, BMI and HbA1c. The patients had a 330 kcal standard meal, blood samples were taken in fasting condition and 2 and 4 hours postprandial and the following parameters were obtained: glycemia, total cholesterol, HDL-cholesterol, triglycerides, apolipoprotein A1 and B and also CRP levels. The patients were also evaluated through duplex scan 2D ultrasound for intima-media thickness (IMT) of common carotid artery bilaterally. Data were analysed with Epi Info, SPSS and Statistica Software. RESULTS: Fasting CRP correlated to BMI and waist circumference (p=0.0068 and p=0.038 respectively). At two hours postprandial, we found a significant nonparametric correlation between CRP level and total cholesterol (p=0.01), which remained significant even after adjusting for age, BMI, HbA1c and blood pressure values (adjusted p=0.018). Patients in the lowest quartile for CRP level compared to those in the highest quartile had lower fasting apolipoprotein B levels (146 vs 197 mg/dl, p=0.042), lower postprandial blood glucose levels (188 vs 241 mg/dl, p=0.035) and lower nonHDL-cholesterol levels (148 vs 192 mg/dl, p=0.005). Common carotid artery IMT correlated with the duration of diabetes (p=0.026) and systolic blood pressure values both in clino and orthostatism (p=0.007 and p=0.006 respectively). CONCLUSION: The results confirm that C reactive protein and apolipoprotein B have close relationships with other components of the metabolic syndrome in type 2 diabetic patients. High CRP and apolipoprotein B levels could be a marker for an excessive postprandial response, leading to an increased risk for chronic vascular complications and atherogenesis.