The trajectory of high sensitivity C-reactive protein is associated with incident diabetes in Chinese adults

Background: We performed a cohort study to evaluate the association between the CRP trajectory and incident diabetes in Chinese adults. Methods: Included were 6439 adults (4111 men and 2249 women; aged 46.6 ± 11.9 years). The concentration of high sensitivity CRP (hs-CRP) was measured in 2013 (baseline), 2014, and 2015. The hs-CRP trajectory was identified based the above three measurements by latent mixture modeling. Incident diabetes cases were diagnosed by fasting blood glucose (≥126 mg/dl) or Hb A1c (≥6.5%) during subsequent 3 years (2016-2018). Results: Hs-CRP concentration during 2013-2015 was classified into 3 levels: low (< 1.0 mg/L), moderate (1.0-3.0 mg/L), and high (≥3.0 mg/L) based on a statement by American Heart Association. We named four hs-CRP trajectories as following: "low-stable"(low in 2013 and maintained at low concentration in 2014 and 2015), "moderate-fluctuated"(moderate in 2013, then increased to high concentration in 2014, and decreased to low concentration in 2015), "high-decreased"(high in 2013 but decreased to moderate concentration in 2014 and 2015), and "moderate-increased (moderate in 2013 and increased to high concentration in 2014 and 2015)". We identified 235 incident diabetes during subsequent 3 years. The adjusted HR for incident diabetes was 1.71 (95% CI: 1.02, 2.87) comparing the moderate-increased and the low-stable group, after adjusting for potential confounders. In the secondary analyses, two single-measured hs-CRP concentration (in 2013 or in 2015) and the average of hs-CRP were associated with high risk of diabetes (P-trend< 0.01 for all). Conclusions: The hs-CRP trajectory pattern was associated with altered incident diabetes in Chinese adults.