Type 2 Diabetes Drives Inflammation Irrespective of BMI

Inflammation in patients with type 2 diabetes is independent of obesity, an observation that may partly explain the increased risk of cardiovascular disease among patients with diabetes.

Irrespective of body mass index patients with type 2 diabetes had significantly higher mean white blood cell counts than age, gender, and BMI controls (P<0.001), reported Kathryn L. Pedula, M.S., and colleagues, of the Center for Health Research at Kaiser Permanente Northwest in Portland, Oregon.

Inflammation, the authors reported at the meeting of the European Association for the Study of Diabetes here, has been linked to increased risk of cardiovascular disease, although it is not an independent risk factor for cardiac events.
"More research is necessary to determine the relative contributions of hyperglycemia and other diabetes characteristics to increased inflammation in order to identify mechanisms for reducing the burden of cardiovascular disease in patients with type 2 diabetes," she said.

The finding emerged from an analysis of outpatient medical records. The authors identified 8,444 patients with type 2 diabetes and an equal number of age, gender, and BMI-matched controls. They included patients who had complete blood and platelet counts taken during outpatient visits in 2005. Patients whose blood tests were done during hospitalizations and patients with HIV or cancer were excluded.

The researchers determined co-morbidities using linked electronic medical records on conditions such as cardiovascular disease, hypertension, and dyslipidemias. They also constructed multivariate models comparing white blood cell and platelet counts between diabetes patients and controls across the levels of BMI, controlling for co-morbidities.

The average BMI across the entire sample was 33 (32.6 ±7.3 kg/m2), and 13% of matched pairs were extremely obese, with a BMI greater than 40 kg/m2.

In an analysis controlling for potential confounders, the authors found that white blood cell counts among patients with diabetes were on average 0.7 x 109 higher than among controls (P<0.0001).
Average platelet levels, in contrast, were not associated with diabetes status, the authors determined.

When they looked at markers by therapy type, they found that there were significant associations between sulfonylurea monotherapy and elevated platelet counts (P<0.05), and between insulin monotherapy and both WBC and platelet counts (P<0.05). No other therapies, combinations, or diet and exercise were significantly associated with differences in inflammatory markers, however.

They concluded that "inflammatory markers are consistently higher in persons with type 2 diabetes mellitus relative to controls, irrespective of obesity status."

Practice Pearl:Explain to interested patients that this study suggests that patients with type 2 diabetes may have increased inflammation even in those with lean body mass. This inflammation may contribute to increased risk of cardiovascular disease.

 European Association for the Study of Diabetes Annual Meeting: Pedula KL et al. "Diabetes is Associated with Inflammation Independent of Obesity: A Community-Based Sample of Routine Care Patients." Abstract 267, presented Sept. 18.
BMC Med 2007; doi:10.1186/1741-7015-5-29.

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