Serum CRP levels are equally elevated in newly diagnosed type 2 diabetes and impaired glucose tolerance and related to adiponectin levels and insulin sensitivity

https://doi.org/10.1016/j.diabres.2005.10.025Get rights and content

Abstract

Aims

To measure the serum highly sensitive C-reactive protein (hs-CRP) and adiponectin levels, assess insulin sensitivity index (SI) and acute insulin response (AIR) in normal control (NC) subjects, patients with impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes mellitus (DM), and further explore the possible correlation between hs-CRP and SI, AIR and adiponectin in IGT and newly diagnosed type 2 DM groups.

Methods

Age and sex matched 28 normal subjects, 31 patients with IGT, and 31 patients with newly diagnosed type 2 DM were included in the study. SI and AIR were assessed by the reduced sample number of Bergman's minimal model method with intravenous glucose tolerance test in subjects of each group.

Results

Compared with NC group, serum hs-CRP was significantly increased in IGT and type 2 DM groups (p < 0.001), although there was no significant difference between the latter groups. Hs-CRP was negatively correlated with high density lipoprotein cholesterol (HDL-C), SI and adiponectin levels (p < 0.05 to p < 0.001), and positively correlated with systolic blood pressure (SBP), fasting plasma glucose (FPG), BMI, waist-to-hip ratio (WHR), postprandial 2h plasma glucose (2hPG), fasting serum insulin (FINS) and postprandial serum insulin (PSI) in IGT and newly diagnosed type 2 DM groups (p < 0.05 to p < 0.001). In general multivariate regression, only adiponectin was the significantly independent determinant for serum hs-CRP (regression coefficient −1.380; 95% CI −2.062 to 0.698, p < 0.001); meanwhile, TG, SI, hs-CRP, FINS, 2hPG and WHR were significantly independent determinants for serum adiponectin concentration (p < 0.05 to p < 0.001).

Conclusions

Elevated serum hs-CRP may play a role in the development of insulin resistance syndrome and type 2 diabetes. This elevation is accompanied by the opposite changes of adiponectin.

Introduction

C-reactive protein (CRP) is a most sensitive marker of inflammation. An association of CRP to the development of atherosclerotic disease has been observed in experimental and epidemiological studies [1], [2], [3], [4], [5]. Recent studies have shown that elevation of CRP concentrations is an independent predictive parameter of type 2 diabetes mellitus (DM) [6], [7], [8], [9], [10], which is also strongly associated with various components of the metabolic syndrome [11], [12], [13], [14].

Adiponectin is a 244 amino acid adipose-specific protein that has been shown to possess antiatherogenic and anti-inflammatory properties [15], [16], [17], [18] in addition to improving glucose tolerance and insulin resistance in mouse diabetic models [19]. Similarly, adiponectin is related to insulin resistance and adiposity in humans [20], [21], [22], [23], [24]. Recent study suggests that adiponectin is a protective factor against later development of diabetes [25]. A number of previous studies have reported that hs-CRP is inversely related to adiponectin and insulin sensitivity index (SI) in some subjects [26], [27], [28], [29], but few studies have examined these relationships in IGT and newly diagnosed type 2 DM subjects. In this study, we aimed to determine the levels of serum highly sensitive C-reactive protein (hs-CRP) and adiponectin, assess SI and acute insulin response (AIR) in normal control (NC) subjects, patients with impaired glucose tolerance (IGT) and newly diagnosed type 2 DM, and further explore the possible correlation between hs-CRP and SI, AIR and adiponectin in IGT and newly diagnosed type 2 DM groups.

Section snippets

Subjects

Approval for the study was obtained from the Clinical Research Ethics Committee, Shanghai Second Medical University. Informed consent was obtained from each of the participants. All participants were recruited at the Diabetes Center of Ruijin Hospital, Shanghai Second Medical University, Shanghai, China. Subjects were classified into glucose tolerance stages according to World Health Organization (WHO) 1999 criteria [30]. Twenty-eight NC subjects, 31 patients with IGT, and 31 patients with

Results

The main characteristics of study population were listed in Table 1. Age and gender distribution did not differ among the groups by selection. Compared with NC group, the waist circumference (WC), BMI, WHR, SBP, TG, 2hPG, FINS and PSI in IGT and type 2 DM groups were significantly increased. WC and PSI in IGT were significantly higher than those in type 2 DM group, but no significant differences in BMI, WHR, SBP, FINS, TG and HDL-C were detected between these two groups. The FPG in type 2 DM

Discussion

Recent studies have shown that CRP is strongly associated with various components of the metabolic syndrome, such as obesity, insulin resistance, and dyslipidaemia (elevated TG and reduced HDL-C) [11], [12], [13], [14]. The present results further confirmed that in subjects with IGT and type 2 DM, hs-CRP is strongly associated with various components of the metabolic syndrome. It is important to note, however, that the positive correlations between the FINS, PSI and hs-CRP levels probably

Acknowledgments

This work was funded by grants from the National Natural Science Foundation of China (30270626). There is no conflict of interest that would prejudice the impartiality of the research or a potential conflict of interest that is not fully declared within the text of the article.

We thank the participants who took part in this study.

References (42)

  • P. Libby et al.

    Inflammation and atherosclerosis

    Circulation

    (2002)
  • A.D. Pradhan et al.

    C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus

    J Am Med Assoc

    (2001)
  • J.I. Barzilay et al.

    The relation of markers of inflammation to the development of glucose disorders in the elderly: the Cardiovascular Health Study

    Diabetes

    (2001)
  • D.J. Freeman 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)
  • A. Festa et al.

    Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the Insulin Resistance Atherosclerosis Study

    Diabetes

    (2002)
  • B. Thorand et al.

    C-reactive protein as a predictor for incident diabetes mellitus among middle-aged men: results from the MONICA Augsburg cohort study

    Arch Intern Med

    (2003)
  • M. Frohlich et al.

    Association between C-reactive protein and features of the metabolic syndrome: a population-based study

    Diabetes Care

    (2000)
  • I. Lemieux et al.

    Elevated C-reactive protein: another component of the atherothrombotic profile of abdominal obesity

    Arterioscler Thromb Vasc Biol

    (2001)
  • D. Aronson et al.

    Association between fasting glucose and C-reactive protein in middle-aged subjects

    Diabetic Med

    (2003)
  • Y. Okamoto et al.

    An adipocyte-derived plasma protein, adiponectin, adheres to injured vascular walls

    Horm Metab Res

    (2000)
  • N. Ouchi et al.

    Novel modulator for endothelial adhesion molecules: adipocyte-derived plasma protein adiponectin

    Circulation

    (1999)
  • Cited by (64)

    • The effect of bariatric surgery on inflammatory markers in women with polycystic ovarian syndrome

      2018, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
      Citation Excerpt :

      Obese patients were found to have lower levels of adiponectin [12]. There is an inverse relationship between adiponectin and CRP [13], thus a higher level of adiponectin is beneficial in terms of insulin sensitivity and anti-inflammatory properties. It has been acknowledged, that obese PCOS patients, have high CRP levels [14,15] and low adiponectin levels [16–18].

    View all citing articles on Scopus
    1

    These authors contributed equally to this work.

    View full text