From the Guidelines
Yes, both ESR and CRP can be elevated in uncontrolled diabetes, as evidenced by a study published in 2024 1, which found that serum CRP and ESR can be significantly elevated in patients with active Charcot neuro-osteoarthropathy, a complication of diabetes. These inflammatory markers often rise in patients with poorly controlled blood glucose levels due to the chronic inflammatory state that diabetes creates in the body. In uncontrolled diabetes, persistent hyperglycemia leads to oxidative stress, advanced glycation end products formation, and activation of inflammatory pathways, all of which can trigger an inflammatory response. Some key points to consider include:
- ESR values may increase moderately, while CRP levels can be significantly elevated, particularly in patients with complications such as diabetic foot ulcers, infections, or cardiovascular disease.
- The elevation of these markers correlates with the severity and duration of hyperglycemia, with studies showing that improved glycemic control through medication adjustment, insulin therapy, diet, and exercise can lead to a reduction in these inflammatory markers.
- Elevated ESR and CRP are non-specific indicators of inflammation and can be caused by numerous other conditions, so these findings should be interpreted within the clinical context and not used alone to diagnose or monitor diabetes. Additionally, a study published in 2014 1 found that adolescents with type 2 diabetes mellitus had higher levels of C-reactive protein and interleukin-6 compared with obese adolescents without diabetes mellitus and normal-weight controls, further supporting the link between uncontrolled diabetes and elevated inflammatory markers.
From the Research
ESR and CRP Elevations in Uncontrolled Diabetes
- ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are markers of inflammation that can be elevated in various conditions, including uncontrolled diabetes 2, 3.
- A study published in 1999 found that noncontrolled type II diabetic subjects had increased levels of CRP, and multiple regression analysis showed a significant association between CRP levels and hyperglycemia 2.
- Another study published in 2019 found that patients with type 2 diabetes mellitus had elevated levels of ESR, CRP, and other inflammatory markers, and there was a significant positive correlation between HbA1c and CRP levels 3.
- The elevation of ESR and CRP in uncontrolled diabetes can be attributed to the chronic inflammation and oxidative stress associated with hyperglycemia 3, 4.
Relationship between Glycemic Control and Inflammatory Markers
- Studies have shown that there is a strong correlation between inflammation and glycemic control in patients with type 2 diabetes mellitus 3, 4.
- The American Heart Association and the Centers for Disease Control and Prevention have defined three cardiovascular risk categories relative to CRP levels, highlighting the importance of CRP testing in assessing cardiovascular risk in patients with diabetes 4.
- Effective glycemic control can help reduce inflammation and oxidative stress, thereby decreasing the risk of cardiovascular complications in patients with diabetes 5, 6.