Association of C-reactive protein with type 2 diabetes: prospective analysis and meta-analysis

Abstract

Aims/hypothesis We examined the association between serum C-reactive protein (CRP) and incident diabetes in a prospective study, and added these data to a literature-based meta-analysis to explore potential sources of heterogeneity between studies. Methods We analysed a case-control study nested within the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort, including 293 incident diabetes cases and 708 controls. We combined 16 published studies on CRP and incident diabetes in a random-effect meta-analysis. Results In the EPIC-Norfolk cohort, serum CRP was associated with a higher risk of diabetes after adjusting for age, sex, BMI, family history of diabetes, smoking and physical activity (OR 1.49, comparing the extreme thirds of CRP distribution [95% CI 1.03-2.15], p=0.03). However, the association was completely attenuated after further adjustment for WHR, serum γ-glutamyltransferase and serum adiponectin (OR 1.00; 95% CI 0.66-1.51, p=1.0). In a meta-analysis of 16 published studies with 3,920 incident diabetes cases and 24,914 controls, the RR was 1.72 (95% CI 1.54-1.92), comparing the extreme thirds of CRP distribution, with substantial heterogeneity between studies (I 2 =52.8%, p=0.007). Conclusions/interpretation Initial evidence of association between CRP and incident diabetes was confounded by central adiposity, markers of liver dysfunction and adiponectin in the primary analysis. Despite an overall positive association in the meta-analysis, considerable heterogeneity existed between studies. The degree of adjustment for central adiposity and baseline glycaemia explained some of this heterogeneity and suggests that CRP may not be an independent risk factor for type 2 diabetes.

Plasma procalcitonin and risk of type 2 diabetes in the general population

“…The link between obesity and diabetes is mediated through both low-grade inflammation and noninflammatory processes [1,7]. In our data, adjustment for adiposity attenuated the association of procalcitonin with type 2 diabetes risk.…”

Estimation of the contribution of biomarkers of different metabolic pathways to risk of type 2 diabetes

“…An inverse relationship between HDL-C and HbA1c levels has been described in type 2 diabetic patients [21,22], and poor glycemic control is shown to be an independent risk factor for low HDL-C in type 2 diabetes [23]. Finally, low-grade chronic inflammation has also been suggested to be involved in the pathway to diabetes [24][25][26][27][28][29][30][31][32][33][34].…”

A large multi-centre European study validates high-sensitivity C-reactive protein (hsCRP) as a clinical biomarker for the diagnosis of diabetes subtypes

“…Calculations In line with previous studies, hsCRP values >10 mg/l were considered likely to represent an acute inflammatory response and were excluded from further analyses [7,12,13]. Data from all centres were combined in a fixed effects meta-regression (Hedges-Olkin approach) using the statistical package Comprehensive Meta-Analysis (www.…”