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

ABSTRACT 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. Our study demonstrated that high CMI was a detrimental factor of new‐onset type 2 diabetes mellitus. Additionally, there were significant associations between transitions of CMI status and type 2 diabetes mellitus. For better prevention of type 2 diabetes mellitus, health workers should devote more attention to the general healthy population, and take measures to prevent their CMI progressing from low to high levels. The value of CMI as a reliable and efficient indicator of the early prevention of type 2 diabetes mellitus should be further investigated.