Gender factors affect the association between inflammatory response and glucose homeostasis in acute illness

Background: Systemic inflammation is associated with insulin resistance and increased plasma glucose concentrations. We hypothesized that the link between systemic inflammation and glucose control may be gender dependent. Research methods and procedures: We studied 33 male and 30 female consecutive patients admitted to a ward of internal medicine for acute illnesses associated with increased C-reactive protein (CRP) concentrations (>10 mg/L). Patients with a previous diagnosis of diabetes mellitus and those requiring glucocorticoids, insulin or artificial nutrition were excluded. Results: Fasting plasma glucose and CRP were determined on admission and after 1 week. On admission, CRP concentrations (106±10 mg/L, mean±SEM) correlated directly (r=0.46; p<0.001) with fasting plasma glucose (94±3 mg/dL) after logarithmic transformation in pooled patients. At the end of follow-up, patients with decreased CRP concentrations (29 men and 25 women) were selected for statistical analysis. These groups were matched for age, body mass index, initial CRP and glucose levels as well as for changes in CRP concentrations (men, 71%±3%; women, 73%±3%). In female patients the glucose concentrations were significantly decreased at the end of the follow-up period by 8.9±2.9 mg/dL (Wilcoxon signed-rank test). In contrast, despite improvement of the inflammatory marker, the plasma glucose concentration did not decrease at the end of the follow-up period in males (+6.3±3.6 mg/dL). Changes in glucose concentration were significantly different between gender groups (Mann-Whitney U test). Conclusion: During the recovery phase of illness, the link between a decline in inflammatory response and an improvement in glucose homeostasis is gender dependent.