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. 2025 Jan 6;24(1):5.
doi: 10.1186/s12933-024-02567-7.

The additive effect of the stress hyperglycemia ratio on type 2 diabetes: a population-based cohort study

Cancan Cui  1 , Jiayin Song  1 , Lingyu Zhang  2 , Ning Han  1 , Wanqi Xu  3 , Chen Sheng  4 , Guangda Xin  5 , Xiaofeng Cui  6 , Lili Yu  7 , Lin Liu  1
Affiliations

The additive effect of the stress hyperglycemia ratio on type 2 diabetes: a population-based cohort study

Cancan Cui et al. Cardiovasc Diabetol. .

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: SHR is independently associated with incident T2D, suggesting its potential use in the risk stratification and prediction for T2D, beyond glucose and HbA1c.

Keywords: Diabetes; Glucose; HbA1c; Stress hyperglycemia ratio (SHR).

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative hazard risk of diabetes by baseline SHR groups
Fig. 2
Fig. 2
Dose–response relationship of risk of diabetes and SHR level. Cox proportional hazards regression models with restricted cubic spline (RCS) analyses were performed with four knots. The reference point is set as the median value of SHR
Fig. 3
Fig. 3
Time-dependent predictive capacity of SHR beyond fasting glucose and HbA1c for predicting the onset of diabetes
See this image and copyright information in PMC

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References

    1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183: 109119. - PMC - PubMed
    1. Yin B, Ding L, Chen Z, Chen Y, Zhu B, Zhu Y. Combining HbA1c and insulin resistance to assess the risk of gestational diabetes mellitus: a prospective cohort study. Diabetes Res Clin Pract. 2023;199: 110673. - PubMed
    1. Vedantam D, Poman DS, Motwani L, Asif N, Patel A, Anne KK. Stress-induced hyperglycemia: consequences and management. Cureus. 2022;14(7): e26714. - PMC - PubMed
    1. Ding L, Zhang H, Dai C, Zhang A, Yu F, Mi L, Qi Y, Tang M. The prognostic value of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in patients with diabetes or prediabetes: insights from NHANES 2005–2018. Cardiovasc Diabetol. 2024;23(1):84. - PMC - PubMed
    1. Luo J, Xu S, Li H, Li Z, Gong M, Qin X, Zhang X, Hao C, Liu X, Zhang W, et al. Prognostic impact of stress hyperglycemia ratio in acute myocardial infarction patients with and without diabetes mellitus. Nutr Metab Cardiovasc Dis. 2022;32(10):2356–66. - PubMed

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