C-reactive protein and glycemic control in adults with diabetes.
OBJECTIVE
Recent evidence suggests that poor glycemic control is significantly associated with the development of macrovascular complications of diabetes. Studies have indicated that C-reactive protein (CRP) is an important risk factor for cardiovascular disease. The purpose of this study was to determine the relation between CRP and HbA(1c) in a large national sample of individuals with diabetes.


METHODS
A nationally representative sample of noninstitutionalized U.S. adults aged 17 years and over with nongestational diabetes was derived from the National Health and Nutrition Examination Survey III (1988-1994) (n = 1,018). Respondents with diabetes were stratified by HbA(1c) level. The main outcome measure was elevated (>0.30 mg/dl) CRP.


RESULTS
In unadjusted analyses, respondents with diabetes who had elevated HbA(1c) levels (> or =9.0%) had a significantly higher percent of elevated CRP than people with low (<7%) HbA(1c) levels (P < 0.001). In adjusted regression analysis, after controlling for age, race, sex, smoking, length of time with diabetes, insulin, and BMI, HbA(1c) was significantly associated with an increased likelihood of elevated CRP for HbA(1c) >9.0% (OR 2.15, 95% CI 1.07-4.32) and for HbA(1c) >11.0% (4.40, 1.87-10.38). Higher HbA(1c) also predicted elevated CRP in the regression model when HbA(1c) was analyzed as a continuous variable (1.20, 1.07-1.34).


CONCLUSIONS
In this study, the likelihood of elevated CRP concentrations increased with increasing HbA(1c) levels. These findings suggest an association between glycemic control and systemic inflammation in people with established diabetes.
King
Dana E
DE
Department of Family Medicine, Medical University of South Carolina, Charleston 29425, USA. kingde@musc.edu
Mainous
Arch G
AG
Buchanan
Thomas A
TA
Pearson
William S
WS
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D044469:Racial Groups; D012907:Smoking
D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin