Cui Cancan, Song Jiayin, Zhang Lingyu, Han Ning, Xu Wanqi, Sheng Chen, Xin Guangda, Cui Xiaofeng, Yu Lili, Liu Lin
Department of Radiology, China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China.
Department of Endocrinology, Changchun University of Chinese Medicine, Jilin University, Changchun, China.
Cardiovasc Diabetol. 2025 Jan 6;24(1):5. doi: 10.1186/s12933-024-02567-7.
The stress hyperglycemia ratio (SHR) has recently gained attention as a marker for acute hyperglycemia, which has been linked to adverse clinical outcomes. However, its independent role in the development of type 2 diabetes (T2D) remains understudied. This cohort study aimed to assess the association between SHR and the incidence of T2D.
The study included 8978 participants aged 45 or older, free of diabetes at baseline, from the China Health and Retirement Longitudinal Study (CHARLS). Incident T2D up to December 31, 2020, was the primary outcome. Participants were divided into SHR quartiles, and Cox proportional hazards regression and fine-gray competing risk models were used to assess SHR's association with T2D onset, adjusting for fasting glucose and HbA1c.
The mean age of participants was 59.0 ± 9.5 years, and 51.5% were women. Over a mean follow-up of 7.8 years, 1084 participants developed T2D. Cox regression analysis revealed that individuals in the highest SHR quartile had a significantly higher risk of T2D onset compared to those in the lowest quartile (HR 1.48, 95% CI 1.26-1.75, P for trend < 0.001). Stratified analyses by sex, obesity, and smoking showed consistent results. Adding SHR to fasting glucose and HbA1c models improved the AUC for T2D prediction (DeLong Test, P = 0.013).
SHR is independently associated with incident T2D, suggesting its potential use in the risk stratification and prediction for T2D, beyond glucose and HbA1c.
应激性高血糖比率（SHR）作为急性高血糖的一个标志物最近受到关注，急性高血糖已与不良临床结局相关联。然而，其在2型糖尿病（T2D）发生发展中的独立作用仍研究不足。这项队列研究旨在评估SHR与T2D发病率之间的关联。
该研究纳入了来自中国健康与养老追踪调查（CHARLS）的8978名45岁及以上的参与者，这些参与者在基线时无糖尿病。截至2020年12月31日的新发T2D为主要结局。参与者被分为SHR四分位数组，并使用Cox比例风险回归和精细灰色竞争风险模型来评估SHR与T2D发病的关联，同时对空腹血糖和糖化血红蛋白（HbA1c）进行校正。
参与者的平均年龄为59.0±9.5岁，51.5%为女性。在平均7.8年的随访中，1084名参与者发生了T2D。Cox回归分析显示，与最低四分位数组相比，SHR最高四分位数组的个体发生T2D的风险显著更高（风险比[HR]为1.48，95%置信区间[CI]为1.26 - 1.75，趋势P值<0.001）。按性别、肥胖和吸烟进行的分层分析显示结果一致。将SHR加入空腹血糖和HbA1c模型可提高T2D预测的曲线下面积（德龙检验，P = 0.013）。
SHR与新发T2D独立相关，表明其在T2D风险分层和预测中除血糖和HbA1c之外的潜在用途。
