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Differential White Blood Cell Count and Type 2 Diabetes: Systematic Review and Meta-Analysis of Cross-Sectional and Prospective Studies

Gkrania-Klotsas, E; Ye, Z; Cooper, AJ; Sharp, SJ; Luben, R; Biggs, ML; Chen, LK; ... Langenberg, C; + view all (2010) Differential White Blood Cell Count and Type 2 Diabetes: Systematic Review and Meta-Analysis of Cross-Sectional and Prospective Studies. PLOS ONE , 5 (10) , Article e13405. 10.1371/journal.pone.0013405. Green open access

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Abstract

Objective: Biological evidence suggests that inflammation might induce type 2 diabetes (T2D), and epidemiological studies have shown an association between higher white blood cell count (WBC) and T2D. However, the association has not been systematically investigated.Research Design and Methods: Studies were identified through computer-based and manual searches. Previously unreported studies were sought through correspondence. 20 studies were identified (8,647 T2D cases and 85,040 non-cases). Estimates of the association of WBC with T2D were combined using random effects meta-analysis; sources of heterogeneity as well as presence of publication bias were explored.Results: The combined relative risk (RR) comparing the top to bottom tertile of the WBC count was 1.61 (95% CI: 1.45; 1.79, p = 1.5*10(-18)). Substantial heterogeneity was present (I-2 = 83%). For granulocytes the RR was 1.38 (95% CI: 1.17; 1.64, p = 1.5*10(-4)), for lymphocytes 1.26 (95% CI: 1.02; 1.56, p = 0.029), and for monocytes 0.93 (95% CI: 0.68; 1.28, p = 0.67) comparing top to bottom tertile. In cross-sectional studies, RR was 1.74 (95% CI: 1.49; 2.02, p = 7.7*10(-13)), while in cohort studies it was 1.48 (95% CI: 1.22; 1.79, p = 7.7*10(-5)). We assessed the impact of confounding in EPIC-Norfolk study and found that the age and sex adjusted HR of 2.19 (95% CI: 1.74; 2.75) was attenuated to 1.82 (95% CI: 1.45; 2.29) after further accounting for smoking, T2D family history, physical activity, education, BMI and waist circumference.Conclusions: A raised WBC is associated with higher risk of T2D. The presence of publication bias and failure to control for all potential confounders in all studies means the observed association is likely an overestimate.

Type: Article
Title: Differential White Blood Cell Count and Type 2 Diabetes: Systematic Review and Meta-Analysis of Cross-Sectional and Prospective Studies
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0013405
Publisher version: http://dx.doi.org/10.1371/journal.pone.0013405
Language: English
Additional information: © 2010 Gkrania-Klotsas et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. EGK is supported by the Medical Research Council through a Clinical Research Training Fellowship and the Cambridge BRC-NIHR. EPIC-Norfolk is supported by grant funding from the Medical Research Council and Cancer Research United Kingdom with additional support from the Stroke Association, British Heart Foundation, Research Into Ageing, and the Academy of Medical Science. The sponsors had no role in the design and conduct of the study, collection, management, analysis and interpretation of the data, and preparation, review, or approval of the manuscript. VL is supported by the Rachadapiseksompoj Faculty of Medicine Research Fund Chulalongkorn University, Thailand, and by the National Institutes of Health (grants T37-TW00049 and T37-MD-100449). PIVUS work was supported by the Swedish Research Council, the Swedish Foundation for Strategic Research, the Royal Swedish Academy of Science, Uppsala University Hospital and AstraZeneca R&D, Moelndal. The sponsors had no role in the PIVUS study design, analyses, writing or decision to publish the manuscript. The Cardiovascular Health Study research was supported by contract numbers N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, and grant numbers U01 HL080295, R01 HL-075366 and R01 HL-094555 from the National Heart, Lung, and Blood Institute; R01 AG-023629, R01 AG-15928, R01 AG-20098, and AG-027058 from the National Institute on Aging; the University of Pittsburgh Claude. D. Pepper Older Americans Independence Center P30-AG-024827, with additional contribution from the National Institute of Neurological Disorders and Stroke. A full list of principal CHS investigators and institutions can be found at http://www.chs-nhlbi.org/pi.htm. JO and GN's work was supported by grants from Vastmanland's research foundation against cardiovascular disease and SparbanksstiftelsenNya. GN had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Keywords: C-REACTIVE PROTEIN, ERYTHROCYTE SEDIMENTATION-RATE, METABOLIC SYNDROME, INSULIN-RESISTANCE, LEUKOCYTE COUNT, CARDIOVASCULAR-DISEASE, EPIC-NORFOLK, ENDOTHELIAL DYSFUNCTION, ATHEROSCLEROSIS RISK, INFLAMMATORY MARKERS
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/1318688
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