The relationship between C-Reactive protein and mortality in adults with diabetes: Influences of demographic characteristics, lifestyle behaviors, and medications

Background and aims: This study assesses the influence of demographic, lifestyle, and medication in the association between CRP and mortality in a national sample of adults with diabetes. Methods and results: Cross-sectional study of data from 1999 to 2010 National Health and Nutrition Examination Survey (unweighted n = 3952; Weighted n = 19,064,710). Individuals were categorized as having diabetes if told by a provider they had diabetes, were taking insulin or other diabetes medications, or had a glycosylated hemoglobin A1c (HbA1c) ≥ 6.5%. CRP was classified into four categories: normal (≤0.1 mg/dL); moderate risk (0.11–0.3 mg/dL); high-risk (0.31–1.0 mg/dL); very high-risk (>1.0 mg/dL). Higher risk for mortality was associated with a very high-risk of CRP (HR = 1.88 (95% CI: 1.27–2.78), being a current (HR = 1.49 (95% CI: 1.10–2.01) or former (HR = 1.34 (95% CI: 1.03–1.73) smoker, and taking insulin (HR = 1.60 (95% CI: 1.25–2.05), taking anti-hypertensives (HR = 1.50 (95% CI: 1.22–1.85), and having co-morbidities such as cancer (HR = 1.32 (95% CI: 1.05–1.66) and hepatitis infection (HR = 1.76 (95% CI: 1.07–2.91), while taking Metformin (HR = 0.62 (95% CI: 0.50–0.76) had a lower risk of mortality. Conclusion: In this sample of adults with diabetes, demographic, lifestyle, and medication factors influenced the association between CRP and mortality. Interventions should focus on these factors to reduce mortality in adults with diabetes.