Association Between C-Reactive Protein and Type 2 Diabetes in a Tunisian Population
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Association Between C-Reactive Protein and Type 2 Diabetes in a Tunisian Population Hanen Belfki,1,4 Samir Ben Ali,1 Souha Bougatef,1 Decy Ben Ahmed,3 Najet Haddad,3 Awatef Jmal,2 Monia Abdennebi,2 and Habiba Ben Romdhane1
Abstract—The aim of this study was to investigate the association of CRP levels with type 2 diabetes (T2D) and its related variables in a sample of the Tunisian population. Our sample included 129 patients with T2D and 187 control subjects. Body mass index (BMI), plasma lipids, glucose, insulin, and CRP concentrations were measured for each participant. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. T2D was defined as a fasting plasma glucose (FPG) level≥7.0 mmol/L, the use of anti-diabetic drugs, or both. Statistical analyses were performed using SPSS 11.5. A significant difference in mean values of BMI, plasma lipids, FPG, insulin, and HOMA-IR was observed between subjects with and without T2D. CRP level was significantly higher in subjects with T2D than those without (p=0.023), and this result persisted even after adjustment for age, gender, BMI, smoking, and alcohol consumption. In both diabetes statuses, log CRP was significantly associated with FPG, insulin, and HOMA-IR. Subjects with elevated CRP levels (>5 mg/L) had an increased risk of T2D (OR=2.02, 95% CI 1.18–3.46, p=0.010) than those whose CRP levels were less or equal to 5 mg/L. Even after adjustment for potentially confounding factors, the risk of T2D was still increased in subjects with elevated CRP levels (OR=1.91, 95% CI 1.08–3.36, p=0.025). These results suggest that elevated CRP levels are independently associated with T2D. KEY WORDS: C-reactive protein; inflammation; type 2 diabetes; insulin resistance.
worldwide and a dramatic socioeconomic burden due to vascular complications, the etiology of T2D is not yet completely understood [5]. It has been hypothesized that T2D is a manifestation of an ongoing acute-phase response that is primarily characterized by alterations of the so-called acute-phase proteins, such as C-reactive protein (CRP) [6, 7]. Experimental studies have shown that hyperglycemia stimulates the release of the inflammatory cytokine interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) from various cell types and results in the induction and secretion of acute-phase reactants by adipocytes [8, 9]. CRP is an acute-phase reactant produced primarily in the liver under the stimulation of adipocyte-derived proinflammatory cytokines, including IL-6 and TNF-α [10]. CRP is the most commonly measured circulating marker for subclinical inflammation, with widely available, stable, and standardized assays for its measurement [11]. CRP has emerged as a powerful risk marker for cardiovascular disease [12–14]. Several studies showed that patients with an elevated CRP have up to 8.5-fold increase in morbidity and mortality [15, 16]. Cross-sectional studies have also
INTRODUCTION Type 2 diabetes (T2D) is an important public health problem worldwide because of its high prevalence and complications [1]. T
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