Wake Forest School of Medicine, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
Diabetes Res Clin Pract. 2012 Mar;95(3):389-98. doi: 10.1016/j.diabres.2011.09.027. Epub 2011 Oct 22.
To 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.
The 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.
A 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.
Intensive 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.
确定强化危险因素管理是否能降低 2 型糖尿病中老年患者（伴或不伴心血管疾病（CVD）风险）的炎症标志物，以及这些效果是否与肥胖有关。
心血管风险降低行动（ACCORD）试验是一项多中心、2x2 双因素随机对照试验，共纳入 10251 名年龄在中年及以上、患有 2 型糖尿病、糖化血红蛋白（GHbA1c）≥7.5%且有 CVD 或 CVD 危险因素证据的患者。其中 562 名患者进行了生物标志物评估。采用线性回归模型检验强化与标准血糖控制组间高敏 C 反应蛋白（hs-CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的干预效果。
与标准血糖组相比，强化血糖组的平均 hs-CRP 显著降低（p=0.029）。调整 BMI 或腰围的变化后，血糖干预组间调整后 hs-CRP 的差异更大（p<0.001 和 p<0.002）。
在本研究人群中，强化血糖控制与 hs-CRP 降低有关。与强化血糖控制相关的肥胖增加抑制了 hs-CRP 降低的有益作用。
