Journal
DIABETOLOGIA
Volume 57, Issue 1, Pages 83-92Publisher
SPRINGER
DOI: 10.1007/s00125-013-3080-0
Keywords
Clinical science; Epidemiology; Human; Insulin sensitivity and resistance; Pathogenic mechanisms; Prediction and prevention of type 2 diabetes
Categories
Funding
- National Heart, Lung, and Blood Institute [HL-47887, HL-47889, HL-47890, HL-47892, HL-47902]
- General Clinical Research Centers Program (NCRR GCRC) [M01 RR431, M01 RR01346]
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [KL2TR001118, UL1TR001120] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR RESEARCH RESOURCES [M01RR001346] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [U01HL047892, U01HL047887, U01HL047890, U01HL047889] Funding Source: NIH RePORTER
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Aims/hypothesis White cell count has been shown to predict incident type 2 diabetes, but differential white cell count has received scant attention. We examined the risk of developing diabetes associated with differential white cell count and neutrophil: lymphocyte ratio and the effect of insulin sensitivity and subclinical inflammation on white cell associations. Methods Incident diabetes was ascertained in 866 participants aged 40-69 years in the Insulin Resistance Atherosclerosis Study after a 5 year follow-up period. The insulin sensitivity index (SI) was measured by the frequently sampled IVGTT. Results C-reactive protein was directly and independently associated with neutrophil (p < 0.001) and monocyte counts (p < 0.01) and neutrophil: lymphocyte ratio (p < 0.001), whereas SI was inversely and independently related to lymphocyte count (p < 0.05). There were 138 (15.9%) incident cases of diabetes. Demographically adjusted ORs for incident diabetes, comparing the top and bottom tertiles of white cell (1.80 [95% CI 1.10, 2.92]), neutrophil (1.67 [1.04, 2.71]) and lymphocyte counts (2.30 [1.41, 3.76]), were statistically significant. No association was demonstrated for monocyte count (1.18 [0.73, 1.90]) or neutrophil: lymphocyte ratio (0.89 [0.55, 1.45]). White cell and neutrophil associations were no longer significant after further adjusting for family history of diabetes, fasting glucose and smoking, but the OR comparing the top and bottom tertiles of lymphocyte count remained significant (1.96 [1.13, 3.37]). This last relationship was better explained by SI rather than C-reactive protein. Conclusions/interpretation A lymphocyte association with incident diabetes, which was the strongest association among the major white cell types, was partially explained by insulin sensitivity rather than subclinical inflammation.
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