Transition of cardiometabolic status and the risk of type 2 diabetes mellitus among middle-aged and older Chinese: A national cohort study

Aims/Introduction The cardiometabolic index (CMI) has been proposed as a novel indicator of cardiometabolic status. This study aimed to investigate the effects of CMI and its longitudinal transitions on the development of type 2 diabetes mellitus in middle-aged and older Chinese. Materials and Methods We used data from the China Health and Retirement Longitudinal Study (2011-2018). CMI was calculated as the product of the waist circumference to height ratio and the triglyceride to high-density lipoprotein cholesterol ratio. At baseline in 2011, the subjects were classified into low- and high-CMI groups, and then divided into four transition patterns during follow-up, i.e. maintained-low, low-to-high, high-to-low, and maintained-high CMI. The hazard ratios (HRs) of different transition patterns for type 2 diabetes mellitus were calculated using multivariable Cox frailty models. Results During 2011-2018, 7,347 participants were included. Participants with a high-CMI at baseline had a significantly higher risk of new-onset type 2 diabetes mellitus than those with a low-CMI (HR = 1.78, 95% CI:1.55-2.05). For subjects with a low-CMI at baseline, the risk of developing type 2 diabetes mellitus increased by 75% if their CMI status changed to high during follow-up (HRlow-to-high = 1.75, 95% CI:1.35-2.28). Meanwhile, for subjects with a maintained-high CMI, no significant risk reduction for type 2 diabetes mellitus was found when their CMI changed to low status (HRhigh-to-low = 0.77, 95% CI: 0.58-1.01). Conclusions Baseline CMI levels and longitudinal CMI transition patterns were associated with a higher risk of type 2 diabetes mellitus. Early anti-lipid measures should be taken to prevent type 2 diabetes mellitus in middle-aged and older Chinese.