Skip to main content
Top
Published in: BMC Endocrine Disorders 1/2014

Open Access 01-12-2014 | Research article

Lifestyle and clinical factors associated with elevated C-reactive protein among newly diagnosed Type 2 diabetes mellitus patients: a cross-sectional study from the nationwide DD2 cohort

Authors: Elisabeth Svensson, Anil Mor, Jørgen Rungby, Klara Berencsi, Jens Steen Nielsen, Jacob V Stidsen, Søren Friborg, Ivan Brandslund, Jens Sandahl Christiansen, Henning Beck-Nielsen, Henrik Toft Sørensen, Reimar W Thomsen

Published in: BMC Endocrine Disorders | Issue 1/2014

Login to get access

Abstract

Background

We aimed to examine the prevalence of and modifiable factors associated with elevated C-reactive Protein (CRP), a marker of inflammation, in men and women with newly diagnosed Type 2 Diabetes mellitus (DM) in a population-based setting.

Methods

CRP was measured in 1,037 patients (57% male) with newly diagnosed Type 2 DM included in the prospective nationwide Danish Centre for Strategic Research in Type 2 Diabetes (DD2) project. We assessed the prevalence of elevated CRP and calculated relative risks (RR) examining the association of CRP with lifestyle and clinical factors by Poisson regression, stratified by gender. We used linear regression to examine the association of CRP with other biomarkers.

Results

The median CRP value was 2.1 mg/L (interquartile range, 1.0 – 4.8 mg/L). In total, 405 out of the 1,037 Type 2 DM patients (40%) had elevated CRP levels (>3.0 mg/L). More women (46%) than men (34%) had elevated CRP. Among women, a lower risk of elevated CRP was observed in patients receiving statins (adjusted RR (aRR) 0.7 (95% confidence interval (CI) 0.6-0.9)), whereas a higher risk was seen in patients with central obesity (aRR 2.3 (95% CI 1.0-5.3)). For men, CRP was primarily elevated among patients with no regular physical activity (aRR 1.5 (95% CI 1.1-1.9)), previous cardiovascular disease (aRR1.5 (95% CI 1.2-1.9) and other comorbidity. For both genders, elevated CRP was 1.4-fold increased in those with weight gain >30 kg since age 20 years. Sensitivity analyses showed consistent results with the full analysis. The linear regression analysis conveyed an association between high CRP and increased fasting blood glucose.

Conclusions

Among newly diagnosed Type 2 DM patients, 40% had elevated CRP levels. Important modifiable risk factors for elevated CRP may vary by gender, and include low physical activity for men and central obesity and absence of statin use for women.
Literature
1.
go back to reference Schulze MB, Rimm EB, Li T, Rifai N, Stampfer MJ, Hu FB: C-reactive protein and incident cardiovascular events among men with diabetes. Diabetes Care. 2004, 27: 889-894. 10.2337/diacare.27.4.889.CrossRefPubMed Schulze MB, Rimm EB, Li T, Rifai N, Stampfer MJ, Hu FB: C-reactive protein and incident cardiovascular events among men with diabetes. Diabetes Care. 2004, 27: 889-894. 10.2337/diacare.27.4.889.CrossRefPubMed
2.
go back to reference Kengne AP, Batty GD, Hamer M, Stamatakis E, Czernichow S: Association of C-reactive protein with cardiovascular disease mortality according to diabetes status: pooled analyses of 25,979 participants from four U.K. prospective cohort studies. Diabetes Care. 2012, 35: 396-403. 10.2337/dc11-1588.CrossRefPubMedPubMedCentral Kengne AP, Batty GD, Hamer M, Stamatakis E, Czernichow S: Association of C-reactive protein with cardiovascular disease mortality according to diabetes status: pooled analyses of 25,979 participants from four U.K. prospective cohort studies. Diabetes Care. 2012, 35: 396-403. 10.2337/dc11-1588.CrossRefPubMedPubMedCentral
3.
go back to reference Ong KL, Allison MA, Cheung BM, Wu BJ, Barter PJ, Rye KA: Trends in C-reactive protein levels in US adults from 1999 to 2010. Am J Epidemiol. 2013, 177: 1430-1442. 10.1093/aje/kws443.CrossRefPubMed Ong KL, Allison MA, Cheung BM, Wu BJ, Barter PJ, Rye KA: Trends in C-reactive protein levels in US adults from 1999 to 2010. Am J Epidemiol. 2013, 177: 1430-1442. 10.1093/aje/kws443.CrossRefPubMed
4.
go back to reference Ford ES, Liu S, Mannino DM, Giles WH, Smith SJ: C-reactive protein concentration and concentrations of blood vitamins, carotenoids, and selenium among United States adults. Eur J Clin Nutr. 2003, 57: 1157-1163. 10.1038/sj.ejcn.1601667.CrossRefPubMed Ford ES, Liu S, Mannino DM, Giles WH, Smith SJ: C-reactive protein concentration and concentrations of blood vitamins, carotenoids, and selenium among United States adults. Eur J Clin Nutr. 2003, 57: 1157-1163. 10.1038/sj.ejcn.1601667.CrossRefPubMed
5.
go back to reference Rojo-Martinez G, Soriguer F, Colomo N, Calle A, Goday A, Bordiu E, Delgado E, Menendez E, Ortega E, Urrutia I, Girbes J, Castano L, Catala M, Gaztambide S, Valdes S: Factors determining high-sensitivity C-reactive protein values in the Spanish population. Di@bet.es study. Eur J Clin Invest. 2013, 43: 1-10.CrossRefPubMed Rojo-Martinez G, Soriguer F, Colomo N, Calle A, Goday A, Bordiu E, Delgado E, Menendez E, Ortega E, Urrutia I, Girbes J, Castano L, Catala M, Gaztambide S, Valdes S: Factors determining high-sensitivity C-reactive protein values in the Spanish population. Di@bet.es study. Eur J Clin Invest. 2013, 43: 1-10.CrossRefPubMed
6.
go back to reference Albert MA, Glynn RJ, Ridker PM: Alcohol consumption and plasma concentration of C-reactive protein. Circulation. 2003, 107: 443-447. 10.1161/01.CIR.0000045669.16499.EC.CrossRefPubMed Albert MA, Glynn RJ, Ridker PM: Alcohol consumption and plasma concentration of C-reactive protein. Circulation. 2003, 107: 443-447. 10.1161/01.CIR.0000045669.16499.EC.CrossRefPubMed
7.
go back to reference Hung J, Knuiman MW, Divitini ML, Davis T, Beilby JP: Prevalence and risk factor correlates of elevated C-reactive protein in an adult Australian population. Am J Cardiol. 2008, 101: 193-198. 10.1016/j.amjcard.2007.07.061.CrossRefPubMed Hung J, Knuiman MW, Divitini ML, Davis T, Beilby JP: Prevalence and risk factor correlates of elevated C-reactive protein in an adult Australian population. Am J Cardiol. 2008, 101: 193-198. 10.1016/j.amjcard.2007.07.061.CrossRefPubMed
8.
go back to reference Hirata A, Ohnaka K, Morita M, Toyomura K, Kono S, Yamamoto K, Adachi M, Kawate H, Takayanagi : Behavioral and clinical correlates of high-sensitivity C-reactive protein in Japanese men and women. Clin Chem Lab Med. 2012, 50: 1469-1476.CrossRefPubMed Hirata A, Ohnaka K, Morita M, Toyomura K, Kono S, Yamamoto K, Adachi M, Kawate H, Takayanagi : Behavioral and clinical correlates of high-sensitivity C-reactive protein in Japanese men and women. Clin Chem Lab Med. 2012, 50: 1469-1476.CrossRefPubMed
9.
go back to reference Thomsen RW, Friborg S, Nielsen JS, Schroll H, Johnsen SP: The Danish centre for strategic research in type 2 diabetes (DD2): organization of diabetes care in Denmark and supplementary data sources for data collection among DD2 study participants. Clin Epidemiol. 2012, 4: 15-19.CrossRefPubMedPubMedCentral Thomsen RW, Friborg S, Nielsen JS, Schroll H, Johnsen SP: The Danish centre for strategic research in type 2 diabetes (DD2): organization of diabetes care in Denmark and supplementary data sources for data collection among DD2 study participants. Clin Epidemiol. 2012, 4: 15-19.CrossRefPubMedPubMedCentral
10.
go back to reference Thomsen RW, Nielsen JS, Ulrichsen SP, Pedersen L, Hansen AM, Nilsson T: The Danish centre for strategic research in type 2 diabetes (DD2) study: collection of baseline data from the first 580 patients. Clin Epidemiol. 2012, 4: 43-48.CrossRefPubMedPubMedCentral Thomsen RW, Nielsen JS, Ulrichsen SP, Pedersen L, Hansen AM, Nilsson T: The Danish centre for strategic research in type 2 diabetes (DD2) study: collection of baseline data from the first 580 patients. Clin Epidemiol. 2012, 4: 43-48.CrossRefPubMedPubMedCentral
11.
go back to reference Nielsen JS, Thomsen RW, Steffensen C, Christiansen JS: The Danish centre for strategic research in type 2 diabetes (DD2) study: implementation of a nationwide patient enrollment system. Clin Epidemiol. 2012, 4: 27-36.CrossRefPubMedPubMedCentral Nielsen JS, Thomsen RW, Steffensen C, Christiansen JS: The Danish centre for strategic research in type 2 diabetes (DD2) study: implementation of a nationwide patient enrollment system. Clin Epidemiol. 2012, 4: 27-36.CrossRefPubMedPubMedCentral
12.
go back to reference Pedersen CB, Gotzsche H, Moller JO, Mortensen PB: The Danish civil registration system. A cohort of eight million persons. Dan Med Bull. 2006, 53: 441-449.PubMed Pedersen CB, Gotzsche H, Moller JO, Mortensen PB: The Danish civil registration system. A cohort of eight million persons. Dan Med Bull. 2006, 53: 441-449.PubMed
13.
go back to reference Lynge E, Sandegaard JL, Rebolj M: The Danish national patient register. Scand J Publ Health. 2011, 39: 30-33. 10.1177/1403494811401482.CrossRef Lynge E, Sandegaard JL, Rebolj M: The Danish national patient register. Scand J Publ Health. 2011, 39: 30-33. 10.1177/1403494811401482.CrossRef
14.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40: 373-383. 10.1016/0021-9681(87)90171-8.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40: 373-383. 10.1016/0021-9681(87)90171-8.CrossRefPubMed
15.
go back to reference Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sorensen HT: The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish national registry of patients. BMC Med Res Methodol. 2011, 11: 83-10.1186/1471-2288-11-83.CrossRefPubMedPubMedCentral Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sorensen HT: The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish national registry of patients. BMC Med Res Methodol. 2011, 11: 83-10.1186/1471-2288-11-83.CrossRefPubMedPubMedCentral
16.
go back to reference Johannesdottir SA, Horvath-Puho E, Ehrenstein V, Schmidt M, Pedersen L, Sorensen HT: Existing data sources for clinical epidemiology: the Danish national database of reimbursed prescriptions. Clin Epidemiol. 2012, 4: 303-313.CrossRefPubMedPubMedCentral Johannesdottir SA, Horvath-Puho E, Ehrenstein V, Schmidt M, Pedersen L, Sorensen HT: Existing data sources for clinical epidemiology: the Danish national database of reimbursed prescriptions. Clin Epidemiol. 2012, 4: 303-313.CrossRefPubMedPubMedCentral
17.
go back to reference Pearson TA, Mensah GA, Hong Y, Smith SC: CDC/AHA workshop on markers of inflammation and cardiovascular disease: application to clinical and public health practice: overview. Circulation. 2004, 110: e543-e544. 10.1161/01.CIR.0000148979.11121.6B.CrossRefPubMed Pearson TA, Mensah GA, Hong Y, Smith SC: CDC/AHA workshop on markers of inflammation and cardiovascular disease: application to clinical and public health practice: overview. Circulation. 2004, 110: e543-e544. 10.1161/01.CIR.0000148979.11121.6B.CrossRefPubMed
18.
go back to reference Ford ES: Body mass index, diabetes, and C-reactive protein among U.S. adults. Diabetes Care. 1999, 22: 1971-1977. 10.2337/diacare.22.12.1971.CrossRefPubMed Ford ES: Body mass index, diabetes, and C-reactive protein among U.S. adults. Diabetes Care. 1999, 22: 1971-1977. 10.2337/diacare.22.12.1971.CrossRefPubMed
19.
go back to reference Khera A, Vega GL, Das SR, Ayers C, McGuire DK, Grundy SM, de Lemos JA: Sex differences in the relationship between C-reactive protein and body fat. J Clin Endocrinol Metab. 2009, 94: 3251-3258. 10.1210/jc.2008-2406.CrossRefPubMedPubMedCentral Khera A, Vega GL, Das SR, Ayers C, McGuire DK, Grundy SM, de Lemos JA: Sex differences in the relationship between C-reactive protein and body fat. J Clin Endocrinol Metab. 2009, 94: 3251-3258. 10.1210/jc.2008-2406.CrossRefPubMedPubMedCentral
20.
go back to reference Taylor F, Ebrahim S: Statins work just as well in women as in men: comment on “Statin therapy in the prevention of recurrent cardiovascular events”. Arch Intern Med. 2012, 172: 919-920.CrossRefPubMed Taylor F, Ebrahim S: Statins work just as well in women as in men: comment on “Statin therapy in the prevention of recurrent cardiovascular events”. Arch Intern Med. 2012, 172: 919-920.CrossRefPubMed
21.
go back to reference Bertoni AG, Burke GL, Owusu JA, Carnethon MR, Vaidya D, Barr RG, Jenny NS, Ouyang P, Rotter JI: Inflammation and the incidence of type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2010, 33: 804-810. 10.2337/dc09-1679.CrossRefPubMedPubMedCentral Bertoni AG, Burke GL, Owusu JA, Carnethon MR, Vaidya D, Barr RG, Jenny NS, Ouyang P, Rotter JI: Inflammation and the incidence of type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2010, 33: 804-810. 10.2337/dc09-1679.CrossRefPubMedPubMedCentral
22.
go back to reference Ajani UA, Ford ES, Mokdad AH: Prevalence of high C-reactive protein in persons with serum lipid concentrations within recommended values. Clin Chem. 2004, 50: 1618-1622. 10.1373/clinchem.2004.036004.CrossRefPubMed Ajani UA, Ford ES, Mokdad AH: Prevalence of high C-reactive protein in persons with serum lipid concentrations within recommended values. Clin Chem. 2004, 50: 1618-1622. 10.1373/clinchem.2004.036004.CrossRefPubMed
23.
go back to reference Soinio M, Marniemi J, Laakso M, Lehto S, Ronnemaa T: High-sensitivity C-reactive protein and coronary heart disease mortality in patients with type 2 diabetes: a 7-year follow-up study. Diabetes Care. 2006, 29: 329-333. 10.2337/diacare.29.02.06.dc05-1700.CrossRefPubMed Soinio M, Marniemi J, Laakso M, Lehto S, Ronnemaa T: High-sensitivity C-reactive protein and coronary heart disease mortality in patients with type 2 diabetes: a 7-year follow-up study. Diabetes Care. 2006, 29: 329-333. 10.2337/diacare.29.02.06.dc05-1700.CrossRefPubMed
24.
go back to reference Bruno G, Fornengo P, Novelli G, Panero F, Perotto M, Segre O, Zucco C, Deambrogio P, Bargero G, Perin PC: C-reactive protein and 5-year survival in type 2 diabetes: the Casale Monferrato Study. Diabetes. 2009, 58: 926-933. 10.2337/db08-0900.CrossRefPubMed Bruno G, Fornengo P, Novelli G, Panero F, Perotto M, Segre O, Zucco C, Deambrogio P, Bargero G, Perin PC: C-reactive protein and 5-year survival in type 2 diabetes: the Casale Monferrato Study. Diabetes. 2009, 58: 926-933. 10.2337/db08-0900.CrossRefPubMed
25.
go back to reference Brunner EJ, Kivimaki M, Witte DR, Lawlor DA, Davey SG, Cooper JA, Miller M, Lowe GD, Rumley A, Casas JP, Shah T, Humphries SE, Hingorani AD, Marmot MG, Timpson NJ, Kumari M: Inflammation, insulin resistance, and diabetes–Mendelian randomization using CRP haplotypes points upstream. PLoS Med. 2008, 5: e155-10.1371/journal.pmed.0050155.CrossRefPubMedPubMedCentral Brunner EJ, Kivimaki M, Witte DR, Lawlor DA, Davey SG, Cooper JA, Miller M, Lowe GD, Rumley A, Casas JP, Shah T, Humphries SE, Hingorani AD, Marmot MG, Timpson NJ, Kumari M: Inflammation, insulin resistance, and diabetes–Mendelian randomization using CRP haplotypes points upstream. PLoS Med. 2008, 5: e155-10.1371/journal.pmed.0050155.CrossRefPubMedPubMedCentral
26.
go back to reference Vepsalainen T, Soinio M, Marniemi J, Lehto S, Juutilainen A, Laakso M, Ronnemaa T: Physical activity, high-sensitivity C-reactive protein, and total and cardiovascular disease mortality in type 2 diabetes. Diabetes Care. 2011, 34: 1492-1496. 10.2337/dc11-0469.CrossRefPubMedPubMedCentral Vepsalainen T, Soinio M, Marniemi J, Lehto S, Juutilainen A, Laakso M, Ronnemaa T: Physical activity, high-sensitivity C-reactive protein, and total and cardiovascular disease mortality in type 2 diabetes. Diabetes Care. 2011, 34: 1492-1496. 10.2337/dc11-0469.CrossRefPubMedPubMedCentral
27.
go back to reference Strom A, Kolb H, Martin S, Herder C, Simon MC, Koenig W, Strom A, Kolb H, Martin S, Herder C, Simon MC, Koenig W, Heise T, Heinemann L, Roden M, Schloot NC: Improved preservation of residual beta cell function by atorvastatin in patients with recent onset type 1 diabetes and high CRP levels (DIATOR trial). PLoS One. 2012, 7: e33108-10.1371/journal.pone.0033108.CrossRefPubMedPubMedCentral Strom A, Kolb H, Martin S, Herder C, Simon MC, Koenig W, Strom A, Kolb H, Martin S, Herder C, Simon MC, Koenig W, Heise T, Heinemann L, Roden M, Schloot NC: Improved preservation of residual beta cell function by atorvastatin in patients with recent onset type 1 diabetes and high CRP levels (DIATOR trial). PLoS One. 2012, 7: e33108-10.1371/journal.pone.0033108.CrossRefPubMedPubMedCentral
28.
go back to reference Hopps E, Canino B, Caimi G: Effects of exercise on inflammation markers in type 2 diabetic subjects. Acta Diabetol. 2011, 48: 183-189. 10.1007/s00592-011-0278-9.CrossRefPubMed Hopps E, Canino B, Caimi G: Effects of exercise on inflammation markers in type 2 diabetic subjects. Acta Diabetol. 2011, 48: 183-189. 10.1007/s00592-011-0278-9.CrossRefPubMed
Metadata
Title
Lifestyle and clinical factors associated with elevated C-reactive protein among newly diagnosed Type 2 diabetes mellitus patients: a cross-sectional study from the nationwide DD2 cohort
Authors
Elisabeth Svensson
Anil Mor
Jørgen Rungby
Klara Berencsi
Jens Steen Nielsen
Jacob V Stidsen
Søren Friborg
Ivan Brandslund
Jens Sandahl Christiansen
Henning Beck-Nielsen
Henrik Toft Sørensen
Reimar W Thomsen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2014
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/1472-6823-14-74

Other articles of this Issue 1/2014

BMC Endocrine Disorders 1/2014 Go to the issue