Raised C-reactive protein in recent onset type 1 diabetes

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in type 1 diabetes (T1DM). Traditional risk factors alone fail to explain the high prevalence and incidence of CVD in T1DM. Inflammation is likely to contribute to CVD and C-reactive protein (CRP) may be involved. Like CRP alpha (1)-acid glycoprotein (AGP) is an acute phase protein which may be relevant, however no data is available on CRP and AGP at diagnosis of T1DM and shortly thereafter. This study investigated serum CRP and AGP measured in adolescents with recent onset T1DM both at diagnosis and after 1 year of intensive insulin therapy. None of the patients had signs of diabetes-associated complications. CRP and AGP were measured in 43 Caucasian T1DM patients (25M and 18F, mean age 14.9+ 9.1 yrs), and 43 age/sex matched controls (26M and 17F, mean age 17.3+ 5.0 yrs) using an immunonephelometric assay. All patients underwent intensive insulin therapy since diagnosis. Patients were all controlled 1 year after diagnosis (HbA1c<7%). There were no significant differences in CRP and AGP between patients and controls at diagnosis. Interestingly hs-CRP levels significantly increased 1 year after diagnosis median at 1 year 0.69, (range 0.14-15.5 mg/l) vs. median at diagnosis 0.43 (range 0.14-7.04 mg/l), p= 0.04; for males: median at 1 year 0.77 (range 0.14-15.5 mg/l) vs. median at diagnosis 0.35 (range 0.14-7.47 mg/l, p=0.04); interestingly in females the increase of hs-CRP at 1 year was not significant. AGP levels were not significantly different in either males or females at 1 year compared to diagnosis. This is the first report that shows that, despite good metabolic control, after the onset of T1DM 1 year is sufficient to increase hs-CRP levels, particularly in males. A low degree of inflammatory activation may occur in T1DM patients soon after disease diagnosis, thus explaining the increased risk of vascular complications associated with this disease. Prospective studies are needed to verify hs-CRP as a prognostic marker for cardiovascular disease in T1DM.