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Life sciences · Journal article
Frontiers in Endocrinology · October 16, 2026
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Aims To investigate the association between high-grade inflammation and incident type 2 diabetes (T2D) and assess how this risk varied according to metabolic abnormalities and risk factor control. Methods Within the Kailuan cohort, 9,347 individuals with high-grade inflammation (hsCRP ≥10 mg/L) between 2006/2007 and 2016/2017 were dynamically matched by age and sex at a prespecified 1:4 ratio to 31,584 non-inflamed participants. Multivariable Cox regression models adjusted for demographic, lifestyle, renal, lipid, blood pressure, and adiposity-related factors were used to estimate hazard ratios (HRs) for incident T2D overall, across metabolic and risk factor strata. Results Participants with high-grade inflammation had greater adiposity and more adverse metabolic profiles than matched non-inflamed participants. During a median 10.1 years of follow-up, T2D developed in 17.7% of participants with high-grade inflammation and 13.1% of matched non-inflamed participants. High-grade inflammation was associated with a 24% higher adjusted risk of T2D (HR 1.24, 95% CI 1.16–1.33). Diabetes risks were further elevated when high-grade inflammation coexisted with metabolic abnormalities, ranging from 2.25 for overweight/obesity to 4.24 for impaired fasting glucose. Management of BMI, waist-to-height ratio, or blood pressure largely attenuated the excess risk, whereas favorable smoking or renal function control alone was insufficient. Conclusions High-grade inflammation was associated with a higher risk of T2D, particularly in the presence of metabolic abnormalities. Maintaining a healthy weight and optimal blood pressure may help attenuate this risk, highlighting the potential importance of integrating high-grade inflammation and metabolic status in diabetes risk assessment and prevention.