Inflammatory Load Across Diabetes Duration: CRP and ESR Patterns and Their Metabolic Correlates

Area of Science:

• Endocrinology
• Immunology
• Nephrology

Background:

• Type 2 diabetes mellitus (T2DM) is associated with chronic low-grade inflammation, a key factor in cardiometabolic complications.
• The relationship between diabetes duration, reflecting cumulative metabolic exposure, and systemic inflammatory burden is not fully understood.

Purpose of the Study:

• To investigate inflammatory patterns across different durations of T2DM.
• To explore the associations of these inflammatory patterns with metabolic, renal, and cardiovascular factors.

Main Methods:

• A cross-sectional study of 250 adults with T2DM.
• Analysis of diabetes duration continuously and in strata (0-4, 5-9, 10-14, ≥15 years).
• Assessment of inflammatory markers C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR); nonlinear associations evaluated using quadratic regression.

Main Results:

• A U-shaped, nonlinear association was observed between diabetes duration and CRP levels, with peaks in early (0-4 years) and long-standing (≥15 years) T2DM.
• ESR levels were highest in long-standing T2DM and differed significantly across duration strata.
• CRP correlated with BMI and triglyceride-to-HDL ratio, while both CRP and ESR showed stronger associations with chronic kidney disease (CKD) than atherosclerotic cardiovascular disease (ASCVD).

Conclusions:

• Inflammatory burden in T2DM exhibits a nonlinear pattern across diabetes duration, elevated in both early and late stages.
• Systemic inflammation is more closely associated with renal dysfunction than established cardiovascular disease in T2DM.
• Findings suggest a cardio-renal-inflammatory axis where prolonged diabetes contributes to renal decline, amplifying inflammation.