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

AimsTo 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.MethodsThe 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.ResultsA 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.ConclusionsIntensive 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.