Department of Ultrasound, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, P.R. China.
Department of Internal Medicine, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, 330006, P.R. China.
Cardiovasc Diabetol. 2024 Jan 6;23(1):17. doi: 10.1186/s12933-023-02108-8.
Atherosclerosis is closely linked with glucose metabolism. We aimed to investigate the role of the atherogenic index of plasma (AIP) in the reversal of prediabetes to normal blood glucose levels or its progression to diabetes.
This multi-center retrospective cohort study included 15,421 prediabetic participants from 32 regions across 11 cities in China, under the aegis of the Rich Healthcare Group's affiliated medical examination institutions. Throughout the follow-up period, we monitored changes in the glycemic status of these participants, including reversal to normal fasting glucose (NFG), persistence in the prediabetic state, or progression to diabetes. Segmented regression, stratified analysis, and restricted cubic spline (RCS) were performed based on the multivariable Cox regression model to evaluate the association between AIP and the reversal of prediabetes to NFG or progression to diabetes.
During a median follow-up period of 2.9 years, we recorded 6,481 individuals (42.03%) reverting from prediabetes to NFG, and 2,424 individuals (15.72%) progressing to diabetes. After adjusting for confounders, AIP showed a positive correlation with the progression from prediabetes to diabetes [(Hazard ratio (HR) 1.42, 95% confidence interval (CI):1.24-1.64)] and a negative correlation with the reversion from prediabetes to NFG (HR 0.89, 95%CI:0.81-0.98); further RCS demonstrated a nonlinear relationship between AIP and the reversion from prediabetes to NFG/progression to diabetes, identifying a turning point of 0.04 for reversion to NFG and 0.17 for progression to diabetes. In addition, we observed significant differences in the association between AIP and reversion from prediabetes to NFG/progression to diabetes across age subgroups, specifically indicating that the risk associated with AIP for progression from prediabetes to diabetes was relatively higher in younger populations; likewise, a younger age within the adult group favored the reversion from prediabetes to NFG in relation to AIP.
Our study, for the first time, reveals a negative correlation between AIP and the reversion from prediabetes to normoglycemia and validates the crucial role of AIP in the risk assessment of prediabetes progression. Based on threshold analysis, therapeutically, keeping the AIP below 0.04 was of paramount importance for individuals with prediabetes aiming for reversion to NFG; preventatively, maintaining AIP below 0.17 was vital to reduce the risk of diabetes onset for those with prediabetes.
动脉粥样硬化与葡萄糖代谢密切相关。我们旨在研究血浆致动脉粥样硬化指数（AIP）在糖尿病前期逆转为正常血糖水平或进展为糖尿病中的作用。
这项多中心回顾性队列研究纳入了来自中国 11 个城市 32 个地区的 15421 名糖尿病前期参与者，由瑞慈医疗集团下属医疗机构开展。在整个随访期间，我们监测了这些参与者的血糖状态变化，包括逆转为正常空腹血糖（NFG）、维持糖尿病前期状态或进展为糖尿病。基于多变量 Cox 回归模型，使用分段回归、分层分析和限制性立方样条（RCS）评估 AIP 与糖尿病前期向 NFG 逆转或进展为糖尿病之间的关联。
在中位随访 2.9 年期间，我们记录了 6481 名（42.03%）个体从糖尿病前期逆转为 NFG，2424 名（15.72%）个体进展为糖尿病。在调整混杂因素后，AIP 与糖尿病前期向糖尿病进展呈正相关[（危险比（HR）1.42，95%置信区间（CI）：1.24-1.64）]，与糖尿病前期向 NFG 逆转呈负相关[（HR 0.89，95%CI：0.81-0.98）]；进一步的 RCS 显示 AIP 与糖尿病前期向 NFG 逆转/进展为糖尿病之间存在非线性关系，确定 NFG 逆转的转折点为 0.04，糖尿病进展的转折点为 0.17。此外，我们观察到 AIP 与糖尿病前期向 NFG 逆转/进展为糖尿病之间的关联在年龄亚组之间存在显著差异，具体表明 AIP 与糖尿病前期向糖尿病进展相关的风险在年轻人群中相对较高；同样，在成年人群中，年龄越小，AIP 与糖尿病前期向 NFG 逆转相关。
我们的研究首次揭示了 AIP 与糖尿病前期向正常血糖水平逆转之间的负相关关系，并验证了 AIP 在糖尿病前期进展风险评估中的关键作用。基于阈值分析，对于糖尿病前期患者，治疗上应将 AIP 控制在 0.04 以下，以促进向 NFG 逆转；对于糖尿病前期患者，预防上应将 AIP 控制在 0.17 以下，以降低糖尿病发病风险。
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