Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 17;107(6):e2523-e2531.
doi: 10.1210/clinem/dgac074.

C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: The REGARDS Study

Kaitlyn M Peper  1 , Boyi Guo  2 , D Leann Long  2 , George Howard  2 , April P Carson  3 , Virginia J Howard  4 , Suzanne E Judd  2 , Neil A Zakai  5   6 , Andrea Cherrington  7 , Mary Cushman  5   6 , Timothy B Plante  5
Affiliations

C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: The REGARDS Study

Kaitlyn M Peper et al. J Clin Endocrinol Metab. .

Abstract

Context: Black adults experience more type 2 diabetes mellitus and higher inflammatory markers, including C-reactive protein (CRP), than White adults. Inflammatory markers are associated with risk of incident diabetes but the impact of inflammation on racial differences in incident diabetes is unknown.

Objective: We assessed whether CRP mediated the Black-White incident diabetes disparity.

Methods: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30 239 US Black and White adults aged ≥45 years in 2003-2007 with a second visit approximately 10 years later. Among participants without baseline diabetes, adjusted sex- and race-stratified risk ratios for incident diabetes at the second visit by CRP level were calculated using modified Poisson regression. Inverse odds weighting estimated the percent mediation of the racial disparity by CRP.

Results: Of 11 073 participants without baseline diabetes (33% Black, 67% White), 1389 (12.5%) developed diabetes. Black participants had higher CRP at baseline and greater incident diabetes than White participants. Relative to CRP < 3 mg/L, CRP ≥ 3 mg/L was associated with greater risk of diabetes in all race-sex strata. Black participants had higher risk of diabetes at CRP < 3 mg/L, but not at CRP ≥ 3 mg/L. In women, CRP mediated 10.0% of the racial difference in incident diabetes. This mediation was not seen in men.

Conclusion: Higher CRP is a risk factor for incident diabetes, but the excess burden of diabetes in Black adults was only seen in those with lower CRP, suggesting that inflammation is unlikely to be the main driver of this racial disparity.

Keywords: C-reactive protein; inflammation; racial disparities; risk factors; type 2 diabetes.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Estimated Black–White risk ratio for diabetes by continuous CRP in men and women. Comparing the excess risk in incident diabetes among Black relative to White participants, adjusting for age, age squared, and prediabetes.
See this image and copyright information in PMC

Comment in

References

    1. Howard G, Safford MM, Moy CS, et al. Racial differences in the incidence of cardiovascular risk factors in older black and white adults. J Am Geriatr Soc. 2017;65(1):83-90. - PMC - PubMed
    1. Kulick ER, Moon YP, Cheung K, Willey JZ, Sacco RL, Elkind MSV. Racial–ethnic disparities in the association between risk factors and diabetes: the Northern Manhattan Study. Prev Med. 2016;83:31-36. - PMC - PubMed
    1. Howard G, Peace F, Howard VJ. The contributions of selected diseases to disparities in death rates and years of life lost for racial/ethnic minorities in the United States, 1999–2010. Prev Chronic Dis. 2014:11:140138. - PMC - PubMed
    1. Carson AP, Long DL, Cherrington AL, et al. Sex differences in factors contributing to the racial disparity in diabetes risk. Am J Prev Med. Published online December 2, 2020. Doi: 10.1016/j.amepre.2020.09.016 - DOI - PMC - PubMed
    1. Barzilay JI, Linn A, Heckbert SR, Cushman M, et al. The relation of markers of inflammation to the development of glucose disorders in the elderly: the Cardiovascular Health Study. Diabetes N Y. 2001;50(10):2384-2389. - PubMed

Publication types