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Leif Groop

Leif Groop

Principal investigator

Leif Groop

A large multi-centre European study validates high-sensitivity C-reactive protein (hsCRP) as a clinical biomarker for the diagnosis of diabetes subtypes


  • G. Thanabalasingham
  • N. Shah
  • M. Vaxillaire
  • T. Hansen
  • T. Tuomi
  • D. Gasperikova
  • M. Szopa
  • E. Tjora
  • T. J. James
  • P. Kokko
  • F. Loiseleur
  • E. Andersson
  • S. Gaget
  • B. Isomaa
  • N. Nowak
  • H. Raeder
  • J. Stanik
  • P. R. Njolstad
  • M. T. Malecki
  • I. Klimes
  • Leif Groop
  • O. Pedersen
  • P. Froguel
  • M. I. McCarthy
  • A. L. Gloyn
  • K. R. Owen

Summary, in English

An accurate molecular diagnosis of diabetes subtype confers clinical benefits; however, many individuals with monogenic diabetes remain undiagnosed. Biomarkers could help to prioritise patients for genetic investigation. We recently demonstrated that high-sensitivity C-reactive protein (hsCRP) levels are lower in UK patients with hepatocyte nuclear factor 1 alpha (HNF1A)-MODY than in other diabetes subtypes. In this large multi-centre study we aimed to assess the clinical validity of hsCRP as a diagnostic biomarker, examine the genotype-phenotype relationship and compare different hsCRP assays. High-sensitivity CRP levels were analysed in individuals with HNF1A-MODY (n = 457), glucokinase (GCK)-MODY (n = 404), hepatocyte nuclear factor 4 alpha (HNF4A)-MODY (n = 54) and type 2 diabetes (n = 582) from seven European centres. Three common assays for hsCRP analysis were evaluated. We excluded 121 participants (8.1%) with hsCRP values > 10 mg/l. The discriminative power of hsCRP with respect to diabetes aetiology was assessed by receiver operating characteristic curve-derived C-statistic. In all centres and irrespective of the assay method, meta-analysis confirmed significantly lower hsCRP levels in those with HNF1A-MODY than in those with other aetiologies (z score -21.8, p < 5 x 10(-105)). HNF1A-MODY cases with missense mutations had lower hsCRP levels than those with truncating mutations (0.03 vs 0.08 mg/l, p < 5 x 10(-5)). High-sensitivity CRP values between assays were strongly correlated (r (2) a parts per thousand yenaEuro parts per thousand 0.91, p a parts per thousand currency signaEuro parts per thousand 1 x 10(-5)). Across the seven centres, the C-statistic for distinguishing HNF1A-MODY from young adult-onset type 2 diabetes ranged from 0.79 to 0.97, indicating high discriminative accuracy. In the largest study to date, we have established that hsCRP is a clinically valid biomarker for HNF1A-MODY in European populations. Given the modest costs and wide availability, hsCRP could translate rapidly into clinical practice, considerably improving diagnosis rates in monogenic diabetes.


  • Genomics, Diabetes and Endocrinology
  • EXODIAB: Excellence of Diabetes Research in Sweden

Publishing year












Document type

Journal article




  • Endocrinology and Diabetes


  • Biomarker
  • High-sensitivity C-reactive protein
  • hsCRP
  • Maturity-onset
  • diabetes of the young
  • MODY



Research group

  • Genomics, Diabetes and Endocrinology


  • ISSN: 1432-0428