Changes in fasting blood glucose status and incidence of cardiovascular disease: The China-PAR project

BACKGROUND

The effect of long-standing prediabetes or its transition on incident cardiovascular disease (CVD) is unclear. This study aimed to evaluate the association of changes in fasting blood glucose (FBG) status with the risk of developing CVD.

METHODS

This research included 12 145 Chinese adults aged 35-74 years and free from diabetes mellitus (DM) at baseline. Study participants were cross-classified into six categories according to glucose at the first (1998-2001) and the second visit after 8 years: normal fasting glucose (NFG; 50-99 mg/dl), impaired FBG (IFG; 100-125 mg/dl), and DM. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for CVD associated with transition of glucose status.

RESULTS

During a median follow-up of 5.5 years, 373 incident CVD cases occurred. Compared with participants remaining persistent NFG, a higher risk of developing CVD was identified among those remaining persistent IFG, progressing to DM from NFG or from IFG, with the multivariate-adjusted HR (95% CI) of 1.792 (1.141, 2.816), 1.723 (1.122, 2.645) and 1.946 (1.120, 3.381), respectively. Furthermore, when stratified by glucose status at baseline, persistent IFG and progression from IFG to DM still increased CVD risk in comparison with reversion from IFG to NFG, with the multivariate-adjusted HR (95% CI) of 1.594 (1.003, 2.532) and 1.913 (1.080, 3.389).

CONCLUSIONS

Participants with long-standing IFG and progressing to DM had a higher risk of developing CVD. Further well-designed studies are warranted to assess the association of other phenotypes or prediabetes duration with CVD.

Dose-response associations between serum creatinine and type 2 diabetes mellitus risk: A Chinese cohort study and meta-analysis of cohort studies

BACKGROUND

This study aims to investigate the association between serum creatinine and risk of type 2 diabetes mellitus (T2DM) based on a cohort analysis and meta-analysis of cohort studies.

METHODS

We enrolled 41 439 participants aged ≥18 years without T2DM at baseline, who had ≥2 health examinations based on an ongoing prospective cohort in Beijing. Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and 95% CIs. For the meta-analysis, cohort studies reporting risk estimates for the serum creatinine-T2DM association were included. A random-effects model was used to calculate summary relative risks (RRs) and restricted cubic splines to model the dose-response association.

RESULTS

During a mean follow-up of 3.54 years, 1867 developed T2DM. Low serum creatinine was associated with increased risk of T2DM; adjusted HRs (95% CIs) across sex-specific quartiles were 1.45 (1.24, 1.71), 1.19 (1.02, 1.39), 1.07 (0.92, 1.24), and 1.00 (reference). The association was significant for both sexes and individuals with overweight or obesity. In the meta-analysis of six cohort studies (including the current study) involving 115 767 participants and 5370 T2DM events, the pooled RR was 1.61 (95% CI 1.35, 1.92), comparing the lowest with the highest category of serum creatinine. We found a linear association between serum creatinine and T2DM risk (P_nonlinearity = .082) and an increased risk of T2DM with each 0.1-mg/dL decrease in serum creatinine (RR = 1.07; 95% CI 1.04, 1.09).

CONCLUSIONS

The cohort study and meta-analysis provide further evidence supporting the negative association between serum creatinine and T2DM risk in a linear dose-response pattern.

Dose-response association between the triglycerides: High-density lipoprotein cholesterol ratio and type 2 diabetes mellitus risk: The rural Chinese cohort study and meta-analysis

BACKGROUND

High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) levels are traditional risk factors for type 2 diabetes mellitus (T2DM). This study evaluated the dose-response relationship between the TG/HDL-C ratio and T2DM risk.

METHODS

The study included 11 946 adults without baseline diabetes from the Rural Chinese Cohort Study. Cox proportional hazards regression was used to investigate the association between the TG/HDL-C ratio and T2DM. The dose-response relationship was evaluated by restricted cubic spline analysis. In addition, pooled odds ratios (OR) were calculated with a random-effects model in a meta-analysis including the present study and another three eligible articles.

RESULTS

During 2007-14, 618 patients with T2DM were identified (9.68/1000 person-years). People in the highest TG/HDL-C ratio quartile had a higher T2DM risk than those in the lowest quartile (adjusted hazard ratio [aHR] 2.11, 95% confidence interval [CI] 1.55-2.86); however, the association between the TG/HDL-C ratio and T2DM was stronger in females than males (aHR 1.27 [95% CI 1.16-1.39; and 1.19 [95% CI 1.04-1.37], respectively). In body mass index-specific analysis, the association was stronger in normal weight than overweight/obese people. The dose-response meta-analysis showed that a 1-unit increment in the TG/HDL-C ratio increased the T2DM risk by 28% (95% CI 20%-36%), with a positive linear relationship (P_linear  = 0.326).

CONCLUSIONS

The TG/HDL-C ratio was an independent risk factor of T2DM, especially in females, and linearly increased the risk of T2DM; thus, it may be a useful indicator to identify future T2DM.