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. 2024 Oct 8;24(1):2736.
doi: 10.1186/s12889-024-20048-0.

Associations of cardiometabolic index with diabetic statuses and insulin resistance: the mediating role of inflammation-related indicators

Bin Xu #  1   2 , Qian Wu #  3   4 , Guoqing Yin #  1 , Lingchen Lu  5 , Rui La  6 , Yaxin Zhang  7 , Jiasuer Alifu  1 , Wen Zhang  1 , Fushan Guo  2 , Beina Ji  2 , Fuad A Abdu  8 , Wenliang Che  9
Affiliations

Associations of cardiometabolic index with diabetic statuses and insulin resistance: the mediating role of inflammation-related indicators

Bin Xu et al. BMC Public Health. .

Abstract

Background: This study aimed to analyze the associations of cardiometabolic index (CMI) with diabetic statuses and insulin resistance (IR) using data from the National Health and Nutrition Examination Survey (NHANES) and examined the potential mediating role of inflammation in these correlations.

Methods: This study enrolled 9477 participants across four NHANES cycles from 2011 to 2018. The primary outcomes of the study included the risk of having prediabetes, diabetes and the level of the homeostasis model assessment of IR (HOMA-IR). Other outcomes including the levels of fasting blood glucose (FBG), hemoglobin A1c (HbA1c), oral glucose tolerance test (OGTT) results, fasting insulin, the risk of oral hypoglycemic medicine use, insulin use, and retinopathy were also collected and analyzed. Logistic regression model, subgroup analysis, restricted cubic spine (RCS), and Pearson correlation coefficients were conducted to assess the associations of CMI with diabetic statuses and IR. The mediating role of inflammation was evaluated to investigate the potential mechanism of the associations between CMI and diabetic statuses.

Results: Among included participants, the CMI levels in normal participants, prediabetes and diabetes in this study were 0.48, 0.73 and 1.07. After multivariable adjustment, CMI was positively associated with the risk of prediabetes (OR = 1.49, 95% CI = 1.24-1.79), diabetes (OR = 2.14, 95% CI = 1.82-2.50) and the level of HOMA-IR (β = 2.57, 95% CI = 2.14-3.01). Besides, an increased CMI was correlated with higher levels of FBG, HBA1c, OGTT results and fasting insulin as well as the greater risk of oral hypoglycemic medicine use and insulin use. The RCS showed an inverted L-shaped association of CMI with prediabetes and diabetes (P for non-linearity < 0.001). According to Pearson correlation coefficients, higher CMI was linked to higher rises in HOMA-IR (r = 0.224, P < 0.001). Inflammation-related indicators including leukocyte and neutrophil demonstrated significant mediating effects in the associations of CMI with prediabetes (15.5%, 9.8%), diabetes (5.1%, 6.0%) and HOMA-IR (3.3%, 2.6%).

Conclusion: CMI was positively associated with the risk of worse diabetic statuses and higher level of IR while the associations may be partially mediated by inflammation-related indicators, suggesting that CMI could be a promising indicator for the prediction of severe diabetes and IR.

Keywords: Cardiometabolic index; Diabetes; Inflammatory; Insulin resistance; National Health and Nutrition Examination Survey.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participants selection from NHANES 2011–2018
Fig. 2
Fig. 2
The associations of CMI with prediabetes (A) and diabetes (B) visualized by restricted cubic spline
Fig. 3
Fig. 3
The pearson correlation coefficient of CMI with HOMA-IR
Fig. 4
Fig. 4
Subgroups analysis for the association between CMI and prediabetes
Fig. 5
Fig. 5
Subgroups analysis for the association between CMI and diabetes
Fig. 6
Fig. 6
Analysis of the mediation by leukocytes and neutrophils of the associations of CMI with prediabetes (A, B), diabetes (C, D), and HOMA-IR (E, F)
See this image and copyright information in PMC

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