The Relationships Of Inflammation And Immune-related Factors To Pre-diabetes And Diabetes

Objectives:1. To estimate the prevalence of pre-diabetic states and hidden diabetes mellitus aged 55-75 years at urban community and explore the associations of the traditional cardiovascular risk factors (age, sex, BMI, central obesity, waist circumference, hip circumference, abdominal circumference, waist-hip ratio and blood pressure) with pre-diabetes and diabetes.2. To explore the associations of inflammation and immune-related factors (C-reactive protein, IgE, tryptase and chymase) with pre-diabetes and diabetes and the associations of the interactions of inflammation and immune-related factors with each other and other factors with pre-diabetes and diabetes.Subjects and methods:In September -December, 2008, a total of 1197 permanent residents aged 55-75 years old from communities (covering three neighborhoods) were investigated, demographic and lifestyle risk data were collected, the blood pressure, Height, weight, waist circumference, abdominal circumference, and hip circumference were measured and fasting blood glucose and two-hour postprandial blood glucose were tested for all subjects. The prevalences and risk factors of pre-diabetes and diabetes were described and analyzed.From the 1197 subjects, 71 subjects with normal blood glucose, 189 subjects with pre-diabetes and 80 subjects patients with diabetes were selected (via informed consent), and further tested for high sensitivity C-reactive protein (hs-CRP), immunoglobulin E (IgE), tryptase and chymase and other biochemical indicators for exploring the associations of inflammation and immune-related factors and the interactions of inflammation and immune-related factors with each other and other factors with pre-diabetes and diabetes . Stratified weight method was used to estimate the prevalence rates of pre-diabetes and diabetes; single factor and multifactor Logistic regression analysis were used to analyze the associations of inflammation and immune-related factors and the interactions of inflammation and immune-related factors with each other and other factors with pre-diabetes and diabetes .Results:1. The prevalence estimation of pre-diabetes and diabetesTotal 1197 subjects without or unknown previous diabetes history were analyzed, male 377(31.50%)and female 820(68.50%);there were 267(22.30%) subjects with pre-diabetic and 123 (10.28%) subjects with hidden Diabetes, of the 267 pre-diabetic subjects, I-IFG subjects were 117 (9.77%), I-IGT subjects 77(6.43%), combined IFG /IGT subjects 73 (6.10%).Adjusted prevalence rates(95% confidence interval, 95%CI) of I-IFG, I-IGT, Combined IFG/IGT, Pre-diabetes states and hidden Diabetes mellitus were 9.84%(8.06-11.62%), 5.48%(4.23-6.73%), 5.94%(4.55-7.33%),21.26%(18.93-23.59%) and 10.12%(8.34-11.90%), respectively.In addition to I-IGT, there were no significant differences in adjusted prevalence estimation of I-IFG, combined IGT / IFG, pre-diabetes and diabetes based on gender.2. The associations of the traditional cardiovascular risk factors with pre-diabetes and diabetesThe proportions of overweight and obesity (based on BMI) were 36.1%, 51.3% and 53.7%, respectively, in the NG group, PDS group and the DM group; the proportions of central obesity were 47.2%, 64.0% and 75.6%, respectively, in three groups; and the proportions of HBP were 36.2%, 49.4% and 53.7%, respectively, in three groups.Multivariate logistic regression analysis results showed that age, BMI, central obesity, abdominal circumference, hip circumference, waist-hip ratio and blood pressure were related to both pre-diabetes and diabetes; with the increasing in the levels of risk factors, the relationships were also increased(P<0.05 for trend tests); compared with the PDS group, there were statistically significant in the central obesity, abdominal circumference and waist to hip in DM group(P<0.05). 3. The associations of inflammation and immune-related factors with pre-diabetes and diabetesCompared with the NG group, there were significances in HOMA-βindex and the HOMA-IR index in both PDS and DM groups, HOMA-βindex of PDS and DM groups were significantly lower than the NG group, and HOMA-IR index of PDS and DM groups were significantly higher than the NG group.Compared with the NG group, higher Hs-CRP levels (DM vs.PDS vs.NG: 5.0mg/dLvs. 5.0mg/dL vs.2.0mg/dL) and IgE levels (25IU/L vs .16 IU/L vs.9IU/L) were in both DM and PDS groups; higher chymase levels (23.05ug/ml vs.18.17ug/ml) were in DM group. There were not significances in tryptase levels in NG,PDS and DM groups.Compared with the NG group, multivariate logistic regression analysis(adjusted for age, gender, BMI and blood pressure) results showed that central obesity, fasting insulin level, HOMA-βindex, HOMA-IR index, hs-CRP and IgE were related to PDS, and there were linear trends between the associations of HOMA-βindex, HOMA-IR index, hs-CRP, and IgE with PDS.Compared with the NG group, multivariate logistic regression analysis(adjusted for age, gender, BMI and blood pressure) results showed that Age, gender, BMI, HOMA-βindex, HOMA-IR index, hs-CRP and IgE were linked with DM, and there were linear trends between the associations of HOMA-βindex, HOMA-IR index, hs-CRP, and IgE with DM.Compared with the PDS group, multivariate Logistic regression analysis showed that only HOMA-βindex was linked with the DM.The associations of interactions of inflammation and immune-related factors with each other and other factors with pre-diabetes and diabetes showed stronger associations with PDS and DM than individual effect of each factor.Conclusion:1. There were higher proportion rates in Pre-diabetes and hidden diabetes in middle and older population of urban community, enough attention should be paid on high-risk groups for blood glucose test for early intervention, reducing complications, thereby improving the quality of life of the elderly population. 2. In the stage of PDS, multiple cardiovascular risk factors already exist, including traditional cardiovascular risk factors and non-traditional cardiovascular risk factors.3. Both hs-CRP and IgE were related to DM and PDS; the associations of interactions of hs-CRP, IgE, tryptase and chymase with other factors with pre-diabetes and diabetes showed stronger associations with PDS and DM than individual effect of each factor.