Relationship between insulin resistance and C-reactive protein in a patient population treated with second generation antipsychotic medications

Abstract

C-reactive protein (CRP) is an inflammatory marker associated with obesity, insulin resistance, and cardiovascular disease. A recent study found CRP levels to be higher in individuals treated with certain antipsychotic medications such as olanzapine; however, it is not clear whether this is associated directly with drug intake or indirectly with drug-associated weight gain and insulin resistance. The objective of this study was to explore the potential predictors of CRP including insulin resistance, components of the metabolic syndrome, psychiatric diagnosis, and antipsychotic medication in patients treated with antipsychotics. Sixty-four outpatients without diabetes being treated with a single second generation antipsychotic medication had direct measurements of insulin resistance at the end of a 180-min infusion of glucose, insulin, and octreotide (insulin suppression test) as well as components of the metabolic syndrome. Insulin resistance was the strongest predictor of CRP (r=0.52, P<0.001). When adjusted for insulin resistance, there was no significant relationship between CRP and any of the components of the metabolic syndrome criteria, specific drug treatment or psychiatric diagnoses. In conclusion, insulin resistance is strongly associated with CRP levels and likely contributes to earlier associations between CRP and certain antipsychotic treatments.

Fig. 1

There is a moderate positive relationship between number of metabolic syndrome criteria and a specific measure of insulin resistance (SSPG concentration, r=0.55, p<0.001); however, there is great overlap in SSPG values in patients meeting from between 1 to 5 of the metabolic syndrome criteria. The horizontal line across the box represents the median and the boundaries of the box represent the lower and upper quartiles.