Association of changes in inflammation with variation in glycaemia, insulin resistance and secretion based on the KORA study

Research output: Contribution to journalArticle


Aims: Subclinical systemic inflammation may contribute to the development of type 2 diabetes, but its association with early progression of glycaemic deterioration in persons without diabetes has not been fully investigated. Our primary aim was to assess longitudinal associations of changes in pro-inflammatory (leukocytes, high-sensitivity C-reactive protein (hsCRP)) and anti-inflammatory (adiponectin) markers with changes in markers that assessed glycaemia, insulin resistance, and secretion (HbA1c, HOMA-IR, and HOMA-ß). Furthermore, we aimed to directly compare longitudinal with cross-sectional associations. Materials and methods: This study includes 819 initially nondiabetic individuals with repeated measurements from the Cooperative Health Research in the Region of Augsburg (KORA) S4/F4 cohort study (median follow-up: 7.1 years). Longitudinal and cross-sectional associations were simultaneously examined using linear mixed growth models. Changes in markers of inflammation were used as independent and changes in markers of glycaemia/insulin resistance/insulin secretion as dependent variables. Models were adjusted for age, sex, major lifestyle and metabolic risk factors for diabetes using time-varying variables in the final model. Results: Changes of leukocyte count were positively associated with changes in HbA1c and HOMA-ß while changes in adiponectin were inversely associated with changes in HbA1c. All examined cross-sectional associations were statistically significant; they were generally stronger and mostly directionally consistent to the longitudinal association estimates. Conclusions: Adverse changes in low-grade systemic inflammation go along with glycaemic deterioration and increased insulin secretion independently of changes in other risk factors, suggesting that low-grade inflammation may contribute to the development of hyperglycaemia and a compensatory increase in insulin secretion.


  • Tonia de las Heras Gala
  • Christian Herder
  • Femke Rutters
  • Maren Carstensen-Kirberg
  • Cornelia Huth
  • Coen D.A. Stehouwer
  • Giel Nijpels
  • Casper Schalkwijk
  • Allan Flyvbjerg
  • Paul W. Franks
  • Jacqueline Dekker
  • Christa Meisinger
  • Wolfgang Koenig
  • Michael Roden
  • Wolfgang Rathmann
  • Annette Peters
  • Barbara Thorand
  • IMI DIRECT Consortium
External organisations
  • Helmholtz Zentrum München
  • Heinrich Heine University Düsseldorf
  • Amsterdam UMC - Vrije Universiteit Amsterdam
  • Maastricht University Medical Centre
  • Steno Diabetes Center Copenhagen
  • Technical University of Munich
  • University of Ulm
  • German Centre for Cardiovascular Research
  • German Center for Diabetes Research
  • Ludwig-Maximilian University of Munich
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Endocrinology and Diabetes


  • glycaemic deterioration, HbA, inflammation, insulin resistance, ß-cell function
Original languageEnglish
Article numbere3063
JournalDiabetes/Metabolism Research and Reviews
Issue number8
Publication statusPublished - 2018
Publication categoryResearch