High-Sensitivity C-Reactive Protein Is Associated With Incident Type 2 Diabetes Among African Americans: The Jackson
Valery S Effoe1, Adolfo Correa2, Haiying Chen3
1Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC veffoe@wakehealth.edu.
Insights
High-sensitivity C-reactive protein (hs-CRP) may predict type 2 diabetes in African Americans, particularly those with lower insulin resistance. This inflammation marker
Area of Science:
- Cardiovascular Health
- Metabolic Disease Research
- Epidemiology
Background:
- Previous studies on high-sensitivity C-reactive protein (hs-CRP) and incident type 2 diabetes in African Americans yielded inconclusive results.
- The Jackson Heart Study cohort provides a unique opportunity to investigate this association in a large, specific population.
Purpose of the Study:
- To examine the association between hs-CRP levels and the incidence of type 2 diabetes in a large African American cohort.
- To explore the influence of obesity and insulin resistance on this relationship.
Main Methods:
- hs-CRP levels were measured in 3,340 participants.
- Incident diabetes was defined using established criteria (fasting glucose, physician diagnosis, medication use, or A1C).
- Cox regression models were employed, adjusting for numerous covariates including BMI, waist circumference, and HOMA-insulin resistance (HOMAIR).
Main Results:
- Over a median follow-up of 7.5 years, 17.4% of participants developed diabetes.
- Elevated hs-CRP (third vs. first tertile) was associated with increased diabetes risk (HR 1.64).
- This association was attenuated by BMI and waist circumference, and became non-significant after adjusting for HOMAIR, suggesting a role for insulin resistance.
Conclusions:
- Low-grade inflammation, indicated by hs-CRP, may contribute to diabetes development in African Americans.
- The association appears more pronounced in individuals with lower levels of insulin resistance.
- Further research is warranted to elucidate the interplay between inflammation, insulin resistance, and diabetes risk in this population.
Objective:
Previous studies on the association between hs-CRP and incident type 2 diabetes among African Americans have been inconclusive. We examined the association between hs-CRP and incident diabetes in a large African American cohort (Jackson Heart Study).
Research Design And Methods:
hs-CRP was measured in 3,340 participants. Incident diabetes was defined by fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or A1C ≥6.5% (48 mmol/mol) at follow-up. Cox regression was used to estimate hazard ratios (HRs) for incident diabetes, adjusting for age, sex, education, diabetes family history, alcohol, HDL, triglycerides, hypertension status, hypertension medications, physical activity, BMI, HOMA-insulin resistance (HOMAIR), and waist circumference.
Results:
Participants (63% women) were aged 53.3 ± 12.5 years. During a median follow-up of 7.5 years, 17.4% developed diabetes (23.1/1,000 person-years, 95% CI 21.3-25.1). After adjustment, the HR (hs-CRP third vs. first tertile) was 1.64 (95% CI 1.26-2.13). In separate models, further adjustment for BMI and waist circumference attenuated this association (HR 1.28 [95% CI 0.97-1.69] and 1.35 [95% CI 1.03-1.78, P < 0.05 for trend], respectively). Upon adding HOMAIR in the models, the association was no longer significant. In adjusted HOMAIR-stratified analysis, the hs-CRP-diabetes association appeared stronger in participants with HOMAIR <3.0 compared with HOMAIR ≥3.0 (P < 0.0001 for interaction). The association was also stronger among nonobese participants, although not significant when adjusted for HOMAIR.
Conclusions:
Low-grade inflammation, as measured by hs-CRP level, may have an important role in the development of diabetes among African Americans with a lesser degree of insulin resistance.
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