Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
Prediabetes Progression and Regression on Objectively- Measured Physical Function: A Prospective Cohort Study: Shanhu Qiu, Yiming Zhu, Bo Xie, Wenji Chen, Duolao Wang, Xue Cai, Zilin Sun, Tongzhi Wu; Diabetes Metab J. 2023;47(6):859-868. Published online August 23, 2023; DOI: https://doi.org/10.4093/dmj.2022.0377

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Background
Prediabetes leads to declines in physical function in older adults, but the impact of prediabetes progression or regression on physical function is unknown. This study assessed this longitudinal association, with physical function objectivelymeasured by grip strength, walking speed, and standing balance, based on the Health and Retirement Study enrolling United States adults aged >50 years.
Methods
Participants with prediabetes were followed-up for 4-year to ascertain prediabetes status alteration (maintained, regressed, or progressed), and another 4-year to assess their impacts on physical function. Weak grip strength was defined as <26 kg for men and <16 kg for women, slow walking speed was as <0.8 m/sec, and poor standing balance was as an uncompleted fulltandem standing testing. Logistic and linear regression analyses were performed.
Results
Of the included 1,511 participants with prediabetes, 700 maintained as prediabetes, 306 progressed to diabetes, and 505 regressed to normoglycemia over 4 years. Grip strength and walking speed were declined from baseline during the 4-year followup, regardless of prediabetes status alteration. Compared with prediabetes maintenance, prediabetes progression increased the odds of developing weak grip strength by 89% (95% confidence interval [CI], 0.04 to 2.44) and exhibited larger declines in grip strength by 0.85 kg (95% CI, –1.65 to –0.04). However, prediabetes progression was not related to impairments in walking speed or standing balance. Prediabetes regression also did not affect any measures of physical function.
Conclusion
Prediabetes progression accelerates grip strength decline in aging population, while prediabetes regression may not prevent physical function decline due to aging.

Citations

Citations to this article as recorded by

Changes in impaired physical function in older adults and the influences of physical activity: a population-based cohort study
Shanhu Qiu, Bo Xie, Zilin Sun, Xue Cai, Tongzhi Wu
BMC Geriatrics.2026;[Epub] CrossRef
Development of a scoring system for vitality capacity assessment in older adults: a population-based study
Xue Cai, Cuirong Xu, Zhiju Gu, Tongzhi Wu, Shanhu Qiu
European Geriatric Medicine.2025;[Epub] CrossRef
Cluster-based subgroups of prediabetes and its association with prediabetes progression and regression: a prospective cohort study
Yan Liu, Yu Liu, Min Zhang, Xinchen Wang, Xiaoying Zhou, Haijian Guo, Bei Wang, Duolao Wang, Zilin Sun, Shanhu Qiu
Acta Diabetologica.2024; 62(7): 1139. CrossRef

Metabolic Risk/Epidemiology
Normalized Creatinine-to-Cystatin C Ratio and Risk of Diabetes in Middle-Aged and Older Adults: The China Health and Retirement Longitudinal Study: Shanhu Qiu, Xue Cai, Bo Xie, Yang Yuan, Zilin Sun, Tongzhi Wu; Diabetes Metab J. 2022;46(3):476-485. Published online March 7, 2022; DOI: https://doi.org/10.4093/dmj.2021.0074

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255 Download
18 Web of Science
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Abstract PDF Supplementary Material PubReader ePub

Background
Creatinine-to-cystatin C ratio is recently suggested to be a surrogate marker for sarcopenia. However, little is known about its association with diabetes. This study aimed to fill in this gap based on a large-scale prospective cohort.
Methods
A population-based representative sample of 5,055 participants aged ≥45 years from the China Health and Retirement Longitudinal Study was enrolled between 2011 and 2012 and followed at least once during the subsequent surveys at 2013, 2015, or 2018. Creatinine-to-cystatin C ratio was calculated and normalized by body weight. Incident diabetes was ascertained by plasma glucose, glycosylated hemoglobin, self-reported history, or use of anti-diabetic drugs. Logistic regression analysis and mediation analysis were employed.
Results
During follow-up, 634 participants developed diabetes. The risk of diabetes was gradually and significantly decreased with increased normalized creatinine–cystatin C ratio. The multivariable-adjusted odds ratio for diabetes was 0.91 (95% confidence interval, 0.83 to 0.99) per 1 standard deviation higher of normalized creatinine-to-cystatin C ratio, and this relationship remained significant after controlling for muscle strength. The risk reduction in diabetes was significantly larger in participants with normal-weight and high normalized creatinine-to-cystatin C ratio compared with those with overweight/obesity and high normalized creatinine-to-cystatin C ratio (P_interaction=0.01). Insulin resistance and inflammation appeared to be key mediators accounting for the observed relationship between normalized creatinine-to-cystatin C ratio and risk of diabetes, with their mediating effect being 93.1% and 22.0%, respectively.
Conclusion
High normalized creatinine-to-cystatin C ratio is associated with reduced risk of diabetes in middle-aged and older adults.

Citations

Citations to this article as recorded by

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Angiology.2026; 77(2): 212. CrossRef
Association between the sarcopenia index and osteoarthritis: a cross-sectional and longitudinal study
Xin Cai, Tianzuo Lan, Zong Jiang, Fang Tang, Haixia Fan
European Journal of Medical Research.2026;[Epub] CrossRef
Normalized creatinine-to-cystatin C ratio and cardiovascular disease risk in populations with cardiovascular–kidney–metabolic syndrome stages 0–3: findings from a national and prospective cohort study
Defei Chen, Yuhui Li, Tailin Ran, Fu Song, Zheng Yang, Weilin Tan, Qiuyi Lu, Lanxin Tang, Lining Yang, Dingqun Bai
European Journal of Medical Research.2026;[Epub] CrossRef
Normalized creatinine-to-cystatin C ratio and atherosclerotic cardiovascular disease risk in the UK Biobank
Xiaoyan Liu, Huizhi Zhan, Yi Ou, Yuwen Shangguan, Jingbo Zhang
European Journal of Preventive Cardiology.2026;[Epub] CrossRef
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Low creatinine to cystatin C ratio is associated with lower muscle volumes and poorer gait speeds in the longitudinal Integrated Women's Health Program cohort
Darren Yuen Zhang Tan, Beverly Wen Xin Wong, Liang Shen, Ling-Jun Li, Eu-Leong Yong
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Honglin Sun, Zhenyu Wu, Guang Wang, Jia Liu
Diabetes & Metabolism Journal.2025; 49(3): 448. CrossRef
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Clinical Rheumatology.2025; 44(7): 2993. CrossRef
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Xiaohui Li, Guirong Song, Jiaqi Ding, Dongmei Hu, Ying Zhang, Guorong Li, Xiao Tang
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Sarcopenia defined by serum creatinine and cystatin C predicts poor survival outcomes in patients with cancers
Rongqiang Liu, Jianguo Wang, Wenxuan Liu, Jing Ye, Xinyi Li, Chen Chen, Kailiang Zhao, Weixing Wang
BMC Geriatrics.2025;[Epub] CrossRef
Muscle Quality in Relation to Prediabetes Phenotypes: A Population-Based Study With Mediation Analysis
Shanhu Qiu, Xue Cai, Xiaoying Zhou, Jinshui Xu, Zilin Sun, Haijian Guo, Tongzhi Wu
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