Zhang YW, Xu MR, Li MH, Li LX. Product of C-reactive protein and fasting C-peptide indicates cardiovascular risk in type 2 diabetes: A real-world study. World J Diabetes 2026; 17(4): 117063 [DOI: 10.4239/wjd.v17.i4.117063]
Corresponding Author of This Article
Lian-Xi Li, MD, PhD, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Shanghai 200233, China. lilx@sjtu.edu.cn
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Endocrinology & Metabolism
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Observational Study
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Apr 15, 2026 (publication date) through Apr 14, 2026
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Publication Name
World Journal of Diabetes
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1948-9358
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Zhang YW, Xu MR, Li MH, Li LX. Product of C-reactive protein and fasting C-peptide indicates cardiovascular risk in type 2 diabetes: A real-world study. World J Diabetes 2026; 17(4): 117063 [DOI: 10.4239/wjd.v17.i4.117063]
World J Diabetes. Apr 15, 2026; 17(4): 117063 Published online Apr 15, 2026. doi: 10.4239/wjd.v17.i4.117063
Product of C-reactive protein and fasting C-peptide indicates cardiovascular risk in type 2 diabetes: A real-world study
Ya-Wen Zhang, Man-Rong Xu, Meng-Han Li, Lian-Xi Li
Ya-Wen Zhang, Man-Rong Xu, Meng-Han Li, Lian-Xi Li, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
Author contributions: Li LX supervised the study, conceptualized the research, and acquired funding; Zhang YW was responsible for writing the original draft and visualization; Xu MR conducted the investigation and edited the manuscript; Li MH developed the methodology and performed validation; all authors contributed to the article and approved the submitted version.
Supported by National Natural Science Foundation of China, No. 81770813 and No. 82070866; and the National Key Research and Development Plan, No. 2018YFC1314905.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine [Approval No. 2018-KY-018(K)].
Informed consent statement: All patients had signed written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: All data generated and analyzed in this study are included in the present article. Detailed statistical procedures and the complete dataset are available from the corresponding author upon reasonable request.
Corresponding author: Lian-Xi Li, MD, PhD, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Shanghai 200233, China. lilx@sjtu.edu.cn
Received: November 28, 2025 Revised: January 8, 2026 Accepted: February 11, 2026 Published online: April 15, 2026 Processing time: 137 Days and 17.7 Hours
Abstract
BACKGROUND
The combined effects of C-reactive protein (CRP) and fasting C-peptide (FCP) on cardiovascular risk remain unclear.
AIM
To introduce a novel variable, the CRP-FCP product and to evaluate whether it better reflects the cardiovascular risk burden than either biomarker alone in patients with type 2 diabetes mellitus (T2DM).
METHODS
Overall, 8486 patients with T2DM were enrolled and stratified into quartiles based on CRP-FCP product to compare their clinical characteristics. The associations of CRP, FCP, and the CRP-FCP product with cardiovascular events (CVEs), cerebrovascular events (CBVEs), and cardio-CBVEs (CCBVEs, defined as the presence of CVEs and/or CBVEs) were analyzed by logistic regression. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the discriminative performance of the CRP-FCP product.
RESULTS
The adjusted prevalences of CVEs, CBVEs, and CCBVEs increased significantly across the CRP-FCP product quartiles (all P < 0.05 for trend). In fully adjusted models, the CRP levels were positively associated with CBVEs (P = 0.016) and CCBVEs (P = 0.005), but not with CVEs (P = 0.070). Conversely, higher FCP levels were associated with an increased risk of CVEs (P = 0.039) and CCBVEs (P = 0.007), but not with CBVEs (P = 0.290). Notably, the CRP-FCP product was independently associated with all three outcomes (all P < 0.05). ROC analyses showed that the area under the curve values of the CRP-FCP product were 0.550 for CVEs, 0.555 for CBVEs, and 0.558 for CCBVEs.
CONCLUSION
The CRP-FCP product was linked to an increased risk of CVEs, CBVEs and CCBVEs. The CRP-FCP product may provide a more comprehensive assessment of the cardiovascular risk burden than CRP or FCP alone in patients with T2DM.
Core Tip: This study introduces the product of C-reactive protein and fasting C-peptide as a novel composite indicator. It better reflects the combined effects of inflammation and insulin resistance and shows more stable associations with cardiovascular and cerebrovascular events than either component alone in patients with type 2 diabetes mellitus, supporting its potential value as a composite marker reflecting the overall cardiovascular risk burden.
