C-reactive protein and the risk of developing type 2 diabetes in Aboriginal Australians

Abstract

ObjectiveTo investigate the association between C-reactive protein (CRP) and the risk of developing diabetes in Aboriginal Australians. Research design and methodsHigh sensitivity CRP levels were measured in 620 Aboriginal participants aged 20-74 years free from diabetes at baseline in a remote community in the Northern Territory of Australia. Participants were followed for a median of 11 years to identify newly diagnosed cases of diabetes. Cox proportional hazards models were used to assess the relationship of CRP levels with the risk of developing diabetes over the follow-up period. ResultsA total of 109 participants were newly diagnosed with diabetes. Incident rates were 10.8, 16.6 and 28.8 per 1000 person-years for people in the lower, middle and upper tertile groups of baseline CRP levels, respectively. After adjusting for age, sex, BMI, baseline glucose regulation status, total cholesterol, urine albumin to creatinine ratio, systolic blood pressure, smoking and alcohol drinking, the association between diabetes and CRP remained significant, with a hazard ratio of 1.23 (95% confidence interval (CI) 1.05, 1.45) corresponding to a doubling in CRP values. Similarly, the adjusted hazard ratio for development of diabetes in people in the upper tertile versus the bottom two tertiles of CRP was 1.75 (95% CI 1.19, 2.56). ConclusionsCRP is independently associated with the development of diabetes in Aboriginal people. Our findings support a role of inflammation in the etiology of diabetes in the high risk population of Aboriginal Australians.

The independent associations of HbA1c, C-reactive protein and birth weight with cardiovascular disease, diabetes mellitus and chronic kidney disease in a remote Indigenous Australian community: a prospective cohort study

“…Consistent with this study, Claes et al (2014) also found that median CRP levels were higher in Indigenous Australian CKD patients than non-Indigenous Australian CKD patients [287]. Secondly, Wang and Hoy used a cohort study design which followed participants for up to 13 years and found a positive and significant association between CRP and risk for type 2 diabetes [44]. The third study by Wang and Hoy conducted in 2010, also found a positive and significant association between CRP and CVD incidence in a prospective cohort following participants for up to 13 years [288].…”

“…Sixty seven (6%) had an HbA1c greater than or equal to 6.5% (48 mmol/mol), but had no record of diagnosis or management of diabetes, while 158 (13%) participants had a prior diagnosis of diabetes. A further 195 participants were identified as high risk for developing type 2 diabetes using the IEC (International Expert Committee) 6.0% (42 mmol/mol) cut-off and up to 568 (48%) participants by the ADA criteria of 5.7-6.4% (39)(40)(41)(42)(43)(44)(45)(46) mmol/mol). Participants with known diabetes had HbA1c levels at time of screening between 4.9% (30 mmol/mol) and 15.6% (147 mmol/mol).…”

“…Due to difference in population samples for each measurement analysed, sensitivity analysis was conducted using only participants with complete information for BW, WC and BMI. Due to the drastic changes in mortality rates by birth weight cohorts and reducing incidence of LBW over the past [40][41][42][43][44][45][46][47][48][49][50] years in this community the model adjusted for the decade the individual was born [155].…”

“…These include renal disease and albuminuria [26,27,41], hypertension [26,27], abnormal lipid profiles [42], increased BMI [43] and C-Reactive protein (CRP) [44]. Insulin resistance has also been shown to be positively associated with BMI, WHR, 2 hr fasting glucose, triglycerides, SBP & DBP [45][46][47][48][49][50].…”

“…Studies in Indigenous Australians have found associations of elevated CRP with chronic diseases such as diabetes and cardiovascular disease (CVD) hospitalisations [44,288]. A study in a remote Northern Territory community found high CRP was associated with numerous renal disease and CVD risk factors [285].…”