The effect of intensive risk factor management in type 2 diabetes on inflammatory biomarkers.

AIMS: To determine whether intensive risk factor management reduced markers of inflammation in middle-aged and older people with type 2 diabetes who either had, or were at risk for cardiovascular disease (CVD), and whether these effects were mediated by adiposity.

METHODS

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was a multicenter double 2 by 2 factorial randomized controlled trial of 10,251 middle-aged and older people who had type 2 diabetes, a GHbA1c of 7.5% or greater, and evidence of CVD or CVD risk factors. Biomarkers were assessed in a subset of 562 participants. Intervention effects on high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) were tested using linear regression models.

RESULTS

A significantly lower average hs-CRP was noted in the intensive versus the standard glycemic group (p=0.029). Adjusting for change in BMI or waist circumference resulted in larger differences in adjusted hs-CRP (p<0.001 and p<0.002, respectively) between the glycemic intervention groups.

CONCLUSIONS

Intensive glycemic control was associated with a reduction in hs-CRP in this study population. Intervention associated increases in adiposity suppressed the beneficial effect of intensive glycemic control on lowering hs-CRP.