High-sensitivity C-reactive protein concentrations among patients with and without diabetes in a multiethnic population of Singapore: CREDENCE Study

Abstract

Objectives

To determine whether high-sensitivity C-reactive protein (hs-CRP) concentrations differ between Chinese, Malays, and Indians with and without type 2 diabetes mellitus and to look for an association with demographic, metabolic and therapeutic variables.

Methods

Phase 1: We retrieved records of 50 Chinese, 51 Malay, and 67 Indian individuals who had routine health screening blood tests. Phase 2: We recruited 111 Chinese, 68 Malays, and 67 Indians with type 2 diabetes mellitus and measured their hs-CRP in addition to standard laboratory tests.

Results

Phase 1: The median hs-CRP was 0.6 mg/L (0.2–6.2) in Chinese, 1.2 mg/L (0.2–7.9) in Malays, and 1.9 mg/L (0.2–10.0) in Indians. The Indians had higher hs-CRP compared to Chinese (P < 0.05) when adjusted for age, sex, body mass index (BMI), lipids, blood pressure, and smoking, and a significant correlation was seen between female sex, smoking status, fasting glucose and triglyceride concentration, and hs-CRP in all three ethnicities. Phase 2: The median hs-CRP was 1.2 mg/L (0.2–9.9) in Chinese, 2.2 mg/L (0.2–9.0) in Malays, and 2.3 mg/L (0.2–9.8) in Indians. Indians had higher hs-CRP when compared to Chinese (P < 0.05) and a significant correlation was seen between BMI, female gender, diabetes, and the use of metformin and hs-CRP in all three ethnicities (P < 0.05) when adjusted for the above variables and use of aspirin, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACE-I/ARB), statin, metformin, rosiglitazone, sulfonylurea, glinides, acarbose, and insulin.

Conclusion

hs-CRP concentrations are significantly higher in Indians compared to the Chinese (in both the diabetic and nondiabetic individuals) after adjustment for the various demographic, metabolic, and therapeutic variables.

Keywords:

• C-reactive protein
• ethnicity
• diabetes mellitus
• cardiovascular disease

Supplementary tables

Supplementary Table 1 Robust regression in Phase 1 and Phase 2

Supplementary Table 2 Robust regression in Phase 1

Supplementary Table 3 Robust regression in Phase 2

Acknowledgments

We would like to thank the Endocrine and Metabolic Society of Singapore (EMSS) for the research grant that funded this study. We would like to thank Ms Hui Ling Tan, Ms Stephania Sim, Ms Linda Koh, Ms Christina Woo, Ms Rahayu Binte Osman and Ms Licia Tan for helping in the data collection and recruitment of patients.

Author contributions

RD was the principal investigator and conceptualized the study project, organized the study, collected and analyzed the data, and was involved in the writing of the manuscript. MJ conceptualized the study project, helped in the organization of the study, and in the writing of the final manuscript. BL and MLT helped in the patient recruitment and in data collection and analysis. SPC and RC were the principal medical statisticians for the statistical analysis. RH and ML helped in the overall conceptualization, organization of study, data processing, and in a critical review of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.