Department of General Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong, China.
Department of Nephrology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong, China.
Sci Rep. 2024 Aug 5;14(1):18098. doi: 10.1038/s41598-024-69169-x.
Despite the clear association between remnant cholesterol (RC)and diabetes risk, no study to date has examined the relationship between RC and reversal of prediabetes to normoglycemia. This retrospective cohort study included a total of 15,023 patients with prediabetes who underwent a physical examination between 2010 and 2016. The link between initial RC levels and the reversion from prediabetes to normoglycemia was analyzed using the Cox proportional-hazards regression model. Additionally, the study explored the possible relationship between RC and the probability of returning normoglycemia by applying Cox proportional hazards regression models with cubic spline functions. To address competing risks, a multivariate Cox regression analysis was undertaken, treating the onset of diabetes as a competing risk event for reversing prediabetes to normoglycemia. Additionally, the study incorporated extensive subgroup analyses alongside multiple sensitivity analyses, enhancing the reliability and robustness of the results. After adjusting for covariates, the findings indicated that RC was inversely associated with the likelihood of reverting to normoglycemia (per 5 mg/dL increase, HR = 0.918, 95% CI 0.909-0.927). The analysis also revealed a nonlinear relationship between RC and normoglycemia reversion, with an inflection point at 51.08 mg/dL. For RC values below this inflection point (RC < 50.08 mg/dL), the HR for the probability of returning to normoglycemia was 0.907 (95% CI 0.897-0.917 per 5 mg/dL). Additionally, the competing risks model demonstrated a negative relationship between RC and the reversal of prediabetes to normoglycemia (SHR = 0.92, 95% CI 0.91-0.93). Sensitivity analyses confirmed the robustness and stability of these results. This study demonstrated a negative and non-linear association between RC and the probability of reversion to normoglycemia in Chinese adults with prediabetes. By actively intervening to reduce RC levels, at least to below 51.08 mg/dL, further reduction of RC may significantly increase the probability of returning to normoglycemia from prediabetes.
尽管残胆固醇（RC）与糖尿病风险之间存在明确的关联，但迄今为止尚无研究探讨 RC 与将前驱糖尿病逆转为正常血糖之间的关系。这项回顾性队列研究共纳入了 15023 名患有前驱糖尿病的患者，他们在 2010 年至 2016 年间接受了体检。使用 Cox 比例风险回归模型分析了初始 RC 水平与前驱糖尿病逆转为正常血糖之间的关系。此外，该研究还通过应用 Cox 比例风险回归模型和三次样条函数来探讨 RC 与恢复正常血糖的概率之间的可能关系。为了解决竞争风险问题，进行了多变量 Cox 回归分析，将糖尿病的发病视为将前驱糖尿病逆转为正常血糖的竞争风险事件。此外，该研究还进行了广泛的亚组分析和多次敏感性分析，提高了结果的可靠性和稳健性。在调整了协变量后，研究结果表明，RC 与恢复正常血糖的可能性呈负相关（每增加 5mg/dL，HR=0.918，95%CI 0.909-0.927）。分析还显示 RC 与正常血糖恢复之间存在非线性关系，拐点为 51.08mg/dL。对于低于该拐点的 RC 值（RC<50.08mg/dL），恢复正常血糖的概率的 HR 为 0.907（每增加 5mg/dL，95%CI 为 0.897-0.917）。此外，竞争风险模型显示 RC 与前驱糖尿病向正常血糖的逆转之间呈负相关（SHR=0.92，95%CI 0.91-0.93）。敏感性分析证实了这些结果的稳健性和稳定性。这项研究表明，在中国患有前驱糖尿病的成年人中，RC 与恢复正常血糖的概率之间存在负相关和非线性关系。通过积极干预降低 RC 水平，至少降低至 51.08mg/dL 以下，进一步降低 RC 可能会显著增加从前驱糖尿病恢复正常血糖的概率。
