The difference in correlation between insulin resistance index and chronic inflammation in type 2 diabetes with and without metabolic syndrome


1 Department of Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Insulin resistance (IR) is associated with low-grade systemic inflammation. It plays an important role in the pathogenesis of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in patients with metabolic syndrome (MetS). It is unclear whether diabetic patients with MetS confer elevated CVD risk and outcomes beyond the impact of individual's components of MetS. The aim of this study is to highlight the central role of IR, inflammation, triglyceride/high-density lipoprotein- cholesterol (TG/HDL-C) ratio, and atherogenic index of plasma (AIP) in T2DM with MetS.
Materials and Methods: This cross-sectional study comprised 130 men distributed into three groups, namely Controls: 40 nondiabetic healthy volunteers; Group I: 40 T2DM patients without MetS, and Group II: 50 T2DM patients with MetS. Fasting blood samples were collected for the measurement of blood lipid profile, glucose, insulin, hemoglobin A1c, and high-sensitivity C-reactive protein (hs-CRP). TG/HDL-C ratio, AIP, and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.
Results: Significant positive association was observed between HOMA-IR and hs-CRP only in Group II and between HOMA-IR and TG/HDL-C ratio in all subjects. Significant differences were seen in waist and hip circumferences, waist/hip ratio, body mass index, systolic blood pressure, fasting blood glucose, TGs, HDL-C, insulin, hs-CRP, HOMA-IR, TG/HDL ratio, and AIP between Controls and Group I with Group II.
Conclusions: In T2DM with MetS, coexistence of elevated atherogenic indices, systemic inflammation, and association between HOMA-IR and TG/HDL-C ratio were seen. These factors are considered having important role in elevated CVD risk beyond MetS components in these patients.


Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.  Back to cited text no. 1
Haffner SM. The metabolic syndrome: Inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol 2006;97:3A-11A.  Back to cited text no. 2
Kahn SE, Zinman B, Haffner SM, O'Neill MC, Kravitz BG, Yu D, et al. Obesity is a major determinant of the association of C-reactive protein levels and the metabolic syndrome in type 2 diabetes. Diabetes 2006;55:2357-64.  Back to cited text no. 3
Freeman DJ, Norrie J, Caslake MJ, Gaw A, Ford I, Lowe GD, et al. C-reactive protein is an independent predictor of risk for the development of diabetes in the West of Scotland Coronary Prevention Study. Diabetes 2002;51:1596-600.  Back to cited text no. 4
Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract 2014;105:141-50.  Back to cited text no. 5
Meshkani R, Adeli K. Hepatic insulin resistance, metabolic syndrome and cardiovascular disease. Clin Biochem 2009;42:1331-46.  Back to cited text no. 6
Akbarzadeh M, Eftekhari MH, Dabbaghmanesh MH, Hasanzadeh J, Bakhshayeshkaram M. Serum IL-18 and hsCRP correlate with insulin resistance without effect of calcitriol treatment on type 2 diabetes. Iran J Immunol 2013;10:167-76.  Back to cited text no. 7
van Greevenbroek MM, Schalkwijk CG, Stehouwer CD. Obesity-associated low-grade inflammation in type 2 diabetes mellitus: Causes and consequences. Neth J Med 2013;71:174-87.  Back to cited text no. 8
Sung JW, Lee SH, Byrne CD, Chung PW, Won YS, Sung KC. High-sensitivity C-reactive protein is associated with the presence of coronary artery calcium in subjects with normal blood pressure but not in subjects with hypertension. Arch Med Res 2014;45:170-6.  Back to cited text no. 9
Rudolf J, Lewandrowski KB. Cholesterol, lipoproteins, high-sensitivity C-reactive protein, and other risk factors for atherosclerosis. Clin Lab Med 2014;34:113-27, vii.  Back to cited text no. 10
Alexander CM, Landsman PB, Teutsch SM, Haffner SM; Third National Health and Nutrition Examination Survey (NHANES III); National Cholesterol Education Program (NCEP). NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes 2003;52:1210-4.  Back to cited text no. 11
Katakami N, Kaneto H, Funahashi T, Shimomura I. Type 2 diabetes and atherosclerosis: Focusing on metabolic syndrome. Diabetol Int 2013;4:143-8.  Back to cited text no. 12
Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, Del Cañizo-Gómez FJ. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength? World J Diabetes 2014;5:444-70.  Back to cited text no. 13
Krintus M, Koziński M, Kuligowska-Prusińska M, Laskowska E, Janiszewska E, Kubica J, et al. The performance of TG to high-density lipoprotein cholesterol ratio in acute coronary syndromes using a diagnostic decision tree. Folia Med Copernicana 2015;3:13-9.  Back to cited text no. 14
da Luz PL, Favarato D, Faria-Neto JR Jr., Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo) 2008;63:427-32.  Back to cited text no. 15
Vega GL, Barlow CE, Grundy SM, Leonard D, DeFina LF. Triglyceride-to-high-density-lipoprotein-cholesterol ratio is an index of heart disease mortality and of incidence of type 2 diabetes mellitus in men. J Investig Med 2014;62:345-9.  Back to cited text no. 16
Tan MH, Johns D, Glazer NB. Pioglitazone reduces atherogenic index of plasma in patients with type 2 diabetes. Clin Chem 2004;50:1184-8.  Back to cited text no. 17
Marques-Vidal P, Bastardot F, Känel R, Paccaud F, Preisig M, Waeber G, et al. Association between circulating cytokine levels, diabetes and insulin resistance in a population-based sample (CoLaus study). Clin Endocrinol 2013;78:232-41.  Back to cited text no. 18
Preethi B, Kumar KP, Jaisri G, Suresh K. High-sensitivity C-reactive protein a surrogate marker of insulin resistance. J Physiol Pathophysiol 2013;4:29-36.  Back to cited text no. 19
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37 Suppl 1:S81-90.  Back to cited text no. 20
Rezaianzadeh A, Namayandeh SM, Sadr SM. National cholesterol education program adult treatment panel III versus international diabetic federation definition of metabolic syndrome, which one is associated with diabetes mellitus and coronary artery disease? Int J Prev Med 2012;3:552.  Back to cited text no. 21
[PUBMED]  Medknow Journal  
Simental-Mendía LE, Castañeda-Chacón A, Rodriguez-Morán M, Aradillas-García C, Guerrero-Romero F. Relationship between elevated triglyceride levels with the increase of HOMA-IR and HOMA-ß in healthy children and adolescents with normal weight. Eur J Pediatr 2015;174:597-605.  Back to cited text no. 22
Flowers E, Molina C, Mathur A, Reaven GM. Use of plasma triglyceride/high-density lipoprotein cholesterol ratio to identify increased cardio-metabolic risk in young, healthy South Asians. Indian J Med Res 2015;141:68.  Back to cited text no. 23
[PUBMED]  Medknow Journal  
Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, Abrishami M, Juya M, Khodaee G, et al. Atherogenic index of plasma (AIP): A marker of cardiovascular disease. Med J Islam Repub Iran 2015;29:627-35.  Back to cited text no. 24
Piranfar MA. The correlation between high-sensitivity C-reactive protein (HSCRP) serum levels and severity of coronary atherosclerosis. Int Cardiovasc Res J 2014;8:6.  Back to cited text no. 25
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.  Back to cited text no. 26
Tsuriya D, Morita H, Morioka T, Takahashi N, Ito T, Oki Y, et al. Significant correlation between visceral adiposity and high-sensitivity C-reactive protein (hs-CRP) in Japanese subjects. Intern Med 2011;50:2767-73.  Back to cited text no. 27
Mahajan A, Tabassum R, Chavali S, Dwivedi OP, Bharadwaj M, Tandon N, et al. High-sensitivity C-reactive protein levels and type 2 diabetes in urban North Indians. J Clin Endocrinol Metab 2009;94:2123-7.  Back to cited text no. 28
Suh S, Lee MK. Metabolic syndrome and cardiovascular diseases in Korea. J Atheroscler Thromb 2014;21 Suppl 1:S31-5.  Back to cited text no. 29
Farooqui AA, Farooqui T, Panza F, Frisardi V. Metabolic syndrome as a risk factor for neurological disorders. Cell Mol Life Sci 2012;69:741-62.  Back to cited text no. 30
Jeppesen J, Hansen TW, Rasmussen S, Ibsen H, Torp-Pedersen C, Madsbad S. Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease: A population-based study. J Am Coll Cardiol 2007;49:2112-9.  Back to cited text no. 31
Sun M, Zhang L, Chen S, Liu X, Shao X, Zou H. Association of C-reactive protein and metabolic disorder in a Chinese population. Int J Environ Res Public Health 2015;12:8228-42.  Back to cited text no. 32