High-sensitivity C-reactive protein and risk of type 2 diabetes: A nationwide cohort study and updated meta-analysis.

ABSTRACT

OBJECTIVE: To prospectively examine the association of high sensitivity C-reactive protein (hs-CRP) with incident type 2 diabetes mellitus (T2DM) among middle-aged and elderly Chinese, and validate the association in an updated meta-analysis of prospective studies. METHODS: We used data from the China Health and Retirement Longitudinal Study, started in 2011-2012 with follow ups in 2013-2014 and 2015-2016. Multivariable Cox proportional hazard regressions were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between hs-CRP level and incident T2DM. An updated meta-analysis was conducted to combine our estimates with those in previous prospective studies. RESULTS: Included in the analyses were 7985 participants (mean age 59.38 years; men 46.73%). Higher hs-CRP was associated with increased risk of T2DM (multivariable-adjusted HR, 1.30; 95% CI 1.03, 1.64 for comparing extreme quartiles). The association was stronger in participants with body mass index (BMI) of 24.0 kg/m2 or higher than those with a BMI lower than 24.0 kg/m2 (p for interaction = 0.038). In a meta-analysis of 28 cohorts, 2 case-cohort, and 6 nested case-control studies among 125,356 participants with 10,759 cases, the pooled relative risk for T2DM was 1.77 (95% CI 1.60, 1.96) for the highest versus lowest level of hs-CRP. CONCLUSIONS: Hs-CRP was associated with higher risk of T2DM in middle-aged and elderly Chinese, and this association was confirmed by an updated meta-analysis of prospective studies. Our findings highlight the role of elevated hs-CRP in the development of T2DM.