Abstract
The linkage of obesity, inflammation, and type 2 diabetes mellitus (T2DM) has been extensively investigated for over a decade. However, the association between inflammatory biomarkers, including C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α), and T2DM is still inconsistent and limited. Thus, this study is aimed at elucidating the association between inflammatory marker levels and the risk of developing T2DM in many aspects. Among 296 subjects enrolled in 2013, 248 non-T2DM subjects who were completely reinvestigated in 2014 and 2015 were included in a 2-year retrospective analysis. Multivariate logistic regression was performed to evaluate the association of baseline inflammatory marker levels and variation with incidence of T2DM. After the 2-year follow-up, 18.6% of total subjects had developed T2DM. The risk of developing T2DM was significantly increased in subjects with a high level of baseline CRP (OR = 4.02, 95% CI: 1.77-9.12, P = 0.001), and a stronger impact was found with the combination of high CRP and IL-6 levels (OR = 5.11, 95% CI: 1.27-20.49, P = 0.021). One-year inflammatory marker variation analysis also revealed the significant association of elevated TNF-α and risk of developing T2DM (OR = 4.88, 95% CI: 1.01-23.49, P = 0.048). In conclusion, besides consideration of CRP levels alone, our findings suggested that IL-6 outstandingly plays a contributing role in T2DM progression and elevated TNF-α levels over time could be a potential predictor of T2DM.
Highlights
Diabetes is an important cause of morbidity and mortality that leads the top ten public health burdens in Thailand [1]
This study includes nondiabetic subjects aged 35-66 years who were initially examined in 2013 and subsequently reexamined based on identical procedures in 2014 and 2015. After excluding those who identified as type 2 diabetes mellitus (T2DM) at baseline by fasting blood glucose (FBG), 2-hour blood glucose (2-h BG), and glycated hemoglobin (HbA1c) [30], 248 eligible subjects who completed on reexamination in 2014 and 2015 were entered for longitudinal analysis
They were divided into two groups according to incidence of T2DM as follows: the nonprogression group: subjects who were diabetes-free throughout the study period, and the progression group: subjects who were identified as T2DM at any reexamination year
Summary
Diabetes is an important cause of morbidity and mortality that leads the top ten public health burdens in Thailand [1]. According to the recent report in 2017, the prevalence of diabetes was 8.3% among a nationwide adult population, representing over 4 million diabetic cases in Thailand [2]. The northeastern region was estimated to have the highest morbidity rate, especially in those aged 35-60 years [3]. This may be due to the widespread transition from an agricultural to an industrial society in this region that changes lifestyle habits and subsequently contributes to metabolic disease. Previous studies have extensively reported the association of elevated CRP levels with insulin resistance and progression of T2DM [6, 10,11,12]
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