The Role Of The Chronic Inflammation In The Incidence And Development Of Type 2 Diabetes

BackgroundType 2 diabetes mellitus, a metabolic disease characterized by chronic hyperglyceamia caused by insulin resistant. Although insulin resistance and impaired insulin secretion are the main physiological abnormalities in type 2 diabetes, the specific underlying determinants of these metabolic defects remain uncertain. Type 2 diabetes mellitus is dramatically increased in incidence recently years, for which Chinese people have an impressive witness. China is now one of the top three countries with the most type 2 diabetes patients in the world. Because of the resultant macro- and micro- vascular injury, this disease has caused great economic and functional medical burdens in China. In recent years, more and more research evidences have indicated that chronic inflammation may be associated with insulin resistance and type 2 diabetes. C-reactive protein (CRP), as one of the most sensitive indicator of acute inflammatory proteins, is a sensitive marker of inflammation. Therefore, studying the association between CRP and type 2 diabetes and pre-diabetes could explain the role of chronic inflammation in the development of type 2 diabetes.ObjectTo describe the basic epidemiological characteristic of pre-diabetic patients and the newly diagnosed type 2 diabetes patients. To supply the epidemiological evidence about the role of dietary nutrition in the incidence of type 2 diabetes, we evaluate the relationship between T2DM and lifestyle risk factors, such as dietary, nutrition, smoking, drinking, exercise and inheritance in Hubei province. On the basis of such evidence, we then study the effect of chronic inflammation on the development of type 2 diabetes. The predict role of C-reactive protein on the type 2 diabetes and pre-diabetic status is examined.MethodA questionnaire was used to obtain information of the subjects who were recruited and contacted from the outpatients who visited Department of Endocrinology, Tongji Medical College Hospital, Wuhan, People's Republic of China from January 2004 to August 2007. According to the results of OGTT, all subjects were divided into NGT, CGT and T2DM group. The differences of subjects'characters, behavior and dietary customs were analyzed among three groups. The geometric means of CRP levels were assigned to increasing categories of diabetes status to estimate the increasing trend of hyperglycemia according to CRP levels in stratified analyses by BMI and sex. We used multiple logistic regression to estimate the association between CRP and risk of IGT/IFG and T2DM, adjusting for multiple risk factors.Result(1) The BMI was different between the NGT, CGT and T2DM groups. The BMI were significantly higher in the T2DM group as compared with the NGT group (P<0.01). The prevalence of hypertension were higher in the T2DM group as compared with the NGT group (P<0.01). Dyslipidemia were not significantly different between the NGT, CGT and T2DM groups. There is not difference of daily dietary frequency among the NGT, CGI and T2DM groups. (2) Compared with subjects with NGT, body mass index (BMI), fasting blood glucose, homoeostatis model assessment insulin resistance (HOMA-IR), blood pressure, dyslipidemia, and serum CRP levels were gradually increased in subjects with IGT/IFG and T2DM. In stratified analyses, increasing CRP levels were strongly associated with prevalence of T2DM in different BMI strata. After adjustment for sex, age, BMI, education, alcohol consumption, smoking, hypertension status, recreational physical activity, and occupational physical activity, the ORs across quartiles of CRP were 1.00, 1.13, 1.25, and 1.59 for IGT/IFG (P for trend: 0.036) and 1.00, 1.39, 1.78, and 2.39 for T2DM (P for trend: 0.007).ConclusionType 2 diabetes mostly affects the middle age and old age peoples. But more and more younglings are suffering from the disease. Smoking, drinking, and other unhealthy lifestyles may increase the risk of diabetes. The results of this study suggest that serum CRP is the risk of insulin resistance and type 2 diabetes, and could be related to the occurrence of insulin resistance and type 2 diabetes. Elevated CRP levels are a strong independent predictor of type 2 diabetes and pre-diabetes, independent of obesity and other risk factors. It is suggested that type 2 diabetes may be a chronic inflammatory response and anti-inflammatory treatment may improve insulin sensitivity.