Association between hemoglobin glycation index and new-onset diabetes mellitus in individuals with chronic liver disease: Findings from a prospective cohort study using CHARLS data

The hemoglobin glycation index (HGI), which measures the difference between observed and predicted glycated hemoglobin, is strongly associated with diabetic complications. However, its relationship with new-onset diabetes in patients with chronic liver disease (CLD) remains unexplored. This study aimed to investigate this association using data from the China Health and Retirement Longitudinal Study database. This study included 329 participants aged ≥45 years with CLD from the China Health and Retirement Longitudinal Study database. HGI was calculated as glycated hemoglobin - (0.013 × fasting plasma glucose + 4.804). Based on baseline HGI levels, participants were categorized into 3 groups (Q1-Q3). The primary endpoint was the occurrence of new-onset diabetes mellitus events. The Kaplan-Meier curves, multivariable Cox proportional hazards models, and restricted cubic spline analysis were applied to explore the association between baseline HGI levels and the risk of diabetes mellitus incidence among individuals with CLD. In the adjusted multivariable Cox regression analysis, HGI was significantly associated with a 53% increased risk of diabetes (hazard ratio = 1.53, 95% confidence interval: 1.17-1.99, P = .002). The Kaplan-Meier curve analysis revealed a significant difference in the occurrence of diabetes mellitus among the HGI groups. Significant risk thresholds were identified at HGI = -0.94, beyond which diabetes mellitus risk increased substantially. Stratified and interaction analyses confirmed the stability of this association. An increase in baseline HGI levels was significantly associated with the risk of diabetes mellitus in individuals with CLD. HGI can be used as a potential indicator for predicting the long-term risk of diabetes incidence in such patients.