Suboptimal health status as an independent risk factor for type 2 diabetes mellitus in a community-based cohort: the China suboptimal health cohort study
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The prevalence of diabetes, constituted chiefly by type 2 diabetes mellitus (T2DM), is a global public health threat. Suboptimal health status (SHS), a physical state between health and disease, might contribute to the progression or development of T2DM.
We conducted a prospective cohort study, based on the China Suboptimal Health Cohort Study (COACS), to understand the impact of SHS on the progress of T2DM. We examined associations between SHS and T2DM outcomes using multivariable logistic regression models and constructed predictive models for T2DM onset based on SHS.
A total of 61 participants developed T2DM after an average of 3.1 years of follow-up. Participants with higher SHS scores had more T2DM outcomes (p = 0.036). Moreover, compared with the lowest quartile of SHS scores, participants with fourth, third, and second quartile SHS scores were found to be associated with a 1.7-fold, 1.6-fold, and 1.5-fold risk of developing T2DM, respectively. The predictive model constructed with SHS had higher discriminatory power (AUC = 0.848) than the model without SHS (AUC = 0.795).
The present study suggests that a higher SHS score is associated with a higher incidence of T2DM. SHS is a new independent risk factor for T2DM and has the capability to act as a predictive tool for T2DM onset. The evaluation of SHS combined with the analysis of modifiable risk factors for SHS allows the risk stratification of T2DM, which may consequently contribute to the prevention of T2DM development. These findings might require further validation in a longer-term follow-up study.
KeywordsSuboptimal health status Type 2 diabetes mellitus Risk factor Predictive preventive personalized medicine
suboptimal health status
Suboptimal Health Status Questionnaire-25
type 2 diabetes mellitus
China Suboptimal Health Cohort Study
noncommunicable chronic diseases
body mass index
systolic blood pressure
diastolic blood pressure
fasting plasma glucose
low-density lipoprotein cholesterol
high-density lipoprotein cholesterol
analysis of variance
receiver operating characteristic
area under the ROC curve
YW, YZ, and WW conceived the study. SG, XX, JZ, and MS performed the investigation and collected the data. SG, HW, DL, and XZ performed the statistical analysis. SG, XX, HH, and YZ wrote the paper. All authors read and approved the final manuscript.
This work was supported by grants from the National Natural Science Foundation of China (NSFC) (81673247, 81872682, and 81773527), the Joint Project of the Australian National Health & Medical Research Council (NHMRC), and the NSFC (NHMRC APP1112767, NSFC 81561128020), Beijing Nova Program (Z141107001814058), and China Scholarship Council (CSC-2017).
Compliance with ethical standards
The authors declare that they have no competing interests.
Consent for publication
Ethical approval and consent to participate
The study was conducted according to the guidelines of Helsinki Declaration. Approvals have been obtained from Ethical Committees of the Staff Hospital of Jidong Oil-field of Chinese National Petroleum, and Capital Medical University. Written informed consent has also been obtained from each of the participants.
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