High-sensitivity C-reactive protein, but not white blood cell count, independently predicted incident diabetes in a Japanese health screening population

Association between White Blood Cells Count and Diabetes Mellitus in Tabari Cohort Study: A Case-Control Study

BACKGROUND

White Blood Cells (WBC) can be a useful marker to predict diabetes. In this study, we aimed to investigate the association between WBC count with type 2 diabetes in a large-scaled population-based cohort study.

METHODS

In the present study we used a subset of data collected in enrolment phase of Tabari cohort study. Participants with fasting blood glucose ≥126 or those who report as having diabetes or taking glucose-lowering medications were selected as case group (1765 participants) and control group included participants who did not report as having diabetes (1765 participants) and they randomly selected from the baseline population. Hematology indices were measured for all participants using Celltac Alpha MEK-6510 K. Chi-squared and independent t-test were used to compare categorical and continuous variables, respectively.

RESULTS

The mean of WBC in diabetic patients and control group was 6.89 ± 1.67 and 6.37 ± 1.49 respectively (P ≤ 0.001). The odds of diabetes based on WBC count in crud model was 1.23 [CI 95% 1.181.28] and after adjustment for all possible confounding factor was 1.17 [CI 95% 1.111.23].

CONCLUSIONS

Results of the present study showed a significant association between WBC count and diabetes. This association remained significant after adjustment for all possible confounders.

Leukocyte count, C-reactive protein level and incidence risk of type 2 diabetes among non-smoking adults: A longitudinal finding over 12 years from the Korean Genome and Epidemiology Study

AIMS

Chronic low-grade inflammation is closely linked to the development and progression of type 2 diabetes mellitus (T2DM). Since inflammatory markers tend to be chronically elevated in current smokers, we examined the association of inflammatory markers, including leukocyte counts and C-reactive protein (CRP) levels, with incidence risk of T2DM in non-smoking adults.

METHODS

5568 non-smoking participants aged 40-69 years without diabetes at baseline were selected from the Korean Genome and Epidemiology Study (KoGES), a large prospective cohort study. The hazard ratios (HRs) with 95% confidence intervals (CIs) for incident T2DM according to leukocyte and CRP quartiles, respectively, were calculated using multivariate Cox proportional hazards regression models.

RESULTS

During the 12-year follow-up period, T2DM developed in 1030 subjects (18.5%, 1030/5568), with an incidence rate of 3.1-4.9 per 2 years. The cumulative incidence of T2DM increased proportionally with increasing leukocyte and CRP quartiles. Compared with the reference first quartile, the HRs of incident T2DM in the second, third, and fourth quartiles of leukocyte counts and third and fourth quartiles of CRP levels increased in a dose-dependent manner after adjusting for potentially confounding variables.

CONCLUSIONS

Leukocyte counts and CRP levels are predictors of incident T2DM independent of tobacco smoking.

Clinical significance of single and persistent elevation of serum high-sensitivity C-reactive protein levels for prediction of kidney outcomes in patients with impaired fasting glucose or diabetes mellitus

BACKGROUND

The association between high-sensitivity C-reactive protein (hs-CRP) and chronic kidney disease remains controversial and long-term longitudinal studies are limited. We aim to investigate the impact of single and persistent elevation of hs-CRP on kidney outcomes.

METHODS

Our study was based on a subgroup of patients with hyperglycemia from the Kailuan cohort. Patients were divided into three groups according to two consecutive hs-CRP levels: (1) no elevation (twice hs-CRP < 3 mg/L); (2) single elevation (once hs-CRP ≥ 3 mg/L); (3) persistent elevation (twice hs-CRP ≥ 3 mg/L). Kidney outcomes include kidney function decline (glomerular filtration rate [GFR] decline ≥ 30% within two years or doubling of serum c reatinine or development of end stage kidney disease [ESKD]), development and progression of proteinuria.

RESULTS

Regarding the outcomes of kidney function decline, development and progression of proteinuria, we included 18,665, 11,754 and 1710 patients into analyses, respectively. After 5 years of follow-up, the number of incident cases of kidney function decline, development and progression of proteinuria were 1891, 1337 and 171, respectively. Compared to patients with no elevation of hs-CRP levels, those with persistent but not single elevation of hs-CRP were at higher risk of kidney function decline (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.23-1.64) and development of proteinuria (1.49, 1.26-1.76), but not progression of proteinuria. The results were consistent with propensity score analysis.

CONCLUSION

Persistent but not single elevation of hs-CRP was independently associated with increased risk of kidney function decline, and development of proteinuria but not progression in patients with impaired fasting glucose or diabetes.

Perinatal urinary benzophenone-3 concentrations and glucose levels among women from a fertility clinic

BACKGROUND

Subfertile women have higher risk of glucose intolerance during pregnancy. Studies suggest associations between several endocrine disrupting chemicals (EDCs) and pregnancy glucose levels. However, the association between benzophenone-3 (BP-3), an EDC widely found in sunscreen, and pregnancy glucose levels remains unclear. We aimed to assess the association between perinatal exposures to BP-3 and pregnancy glucose levels in subfertile women.

METHODS

We evaluated 217 women from a prospective cohort based at a fertility clinic who had urinary BP-3 concentrations measured during 3-month preconception, first and/or second trimesters, and blood glucose measured at glucose load tests (GLTs) during late pregnancy. Multivariable linear and logistic regression models were used to assess associations between time-specific BP-3 in quartiles (Q1 - Q4) and mean glucose levels, as well as odds of abnormal GLT (glucose level ≥ 140 mg/dL), adjusting for potential confounders. Effect modification was assessed by age, season, BMI, infertility diagnosis, sex of fetus (es) and physical activity.

RESULTS

Women with higher first trimester BP-3 concentrations had lower mean glucose levels [mean glucose (95% CI) for Q4 vs Q1 = 103.4 (95.0, 112.5) vs. 114.6 (105.8, 124.2) mg/dL]. Women with higher second trimester BP-3 concentrations had lower odds of abnormal GLT [OR (95% CI) for Q3 vs. Q1 = 0.12 (0.01, 0.94)]. The associations between BP-3 and glucose levels were modified by several factors: women with female-factor infertility, urine collected during summer, older age, lower BMI, or carried female fetus (es) had the strongest inverse associations between BP-3 and glucose levels, while no associations were observed in the remaining subgroups.

CONCLUSIONS

Time-specific inverse associations between BP-3 and pregnancy glucose levels existed in subfertile women, and especially among certain subgroups of this high-risk-population.

White Blood Cell Count and C-Reactive Protein Independently Predicted Incident Diabetes: Yuport Medical Checkup Center Study

Aim: White blood cell (WBC) count or C-reactive protein (CRP) level alone may not fully indicate the chronic inflammation causing type 2 diabetes. We examined both WBC count and CRP level, independently and in combination, as predictive markers for type 2 diabetes and also considered the influence of obesity and other individual characteristics on the relationship. Materials and Methods: In total, 9,706 participants were enrolled with WBC < 10*10⁹/L and CRP < 10 mg/L using data from the Yuport Medical Checkup Center Study. The cumulative incidence of type 2 diabetes [defined either as known diabetes, fasting plasma glucose ≥ 7.0 mmol/L, or HbA1c ≥ 6.5% (47.5 mmol/mol)] was measured. Hazard ratios (HRs) were estimated using a Cox proportional hazards model. Results: During study period, 272 men (5.5%) and 113 women (2.4%) progressed to diabetes. The progression to diabetes was predicted by both increased baseline levels of WBC count [adjusted HR = 1.29 (95% CI: 1.04-1.60)] and CRP level [1.39 (1.10-1.74)], even after adjusting for possible confounders. The combined presence was more predictive of diabetes than either alone in a four-groups analysis [1.75 (1.28-2.40)]. In addition, the elevated HRs of either or both higher WBC and CRP levels were observed across four subgroups of body mass index (BMI), including low BMI, and people who had at least one occurrence of dyslipidemia. Conclusion: Increased WBC counts and CRP levels were predictive for type 2 diabetes and the combination augmented the risk of diabetes, regardless of whether the BMI was high or low.

Acute-phase proteins and incidence of diabetes: a population-based cohort study

AIMS

To examine the relationship between plasma levels of the acute-phase proteins ceruloplasmin, alpha-1-antitrypsin, orosomucoid, haptoglobin and C-reactive protein (CRP), and incidence of diabetes in the population-based Malmö Diet and Cancer Study-Cardiovascular Cohort (MDCS-CC).

METHODS

The study population consists of 4246 participants (aged 46-67 years, 60.8 % women) with no previous history of diabetes. Participants were followed, and incidence of diabetes was assessed by linkage with national registers and a clinical re-examination of the cohort. Cox proportional hazard regression analysis was used to compare incidence of diabetes in relation to sex-specific quartiles of the acute-phase proteins.

RESULTS

During a mean follow-up period of 15.6 ± 3.4 years, a total of 390 participants were diagnosed with diabetes. Orosomucoid, haptoglobin, and CRP showed a significant increased risk of diabetes after adjustment for potential confounders. However, further adjustments for fasting glucose at baseline resulted in significant association only for CRP. The multivariable-adjusted hazard ratios (HR: 4th vs. 1st quartile) were 1.18 (95 % CI: 0.83-1.67; p = 0.51), 1.19 (CI: 0.85-1.62; p = 0.10), and 1.40 (CI: 1.01-1.95; p = 0.046) for orosomucoid, haptoglobin, and CRP respectively.

CONCLUSION

The study demonstrated that there are associations between orosomucoid, haptoglobin and CRP and the risk of incidence of diabetes. However, after additional adjustment for fasting glucose levels at baseline, the association stayed significant only for CRP.