Association of creatinine to body weight ratio with glycemic progression and remission in Chinese adults with prediabetes: a large-scale retrospective cohort study

The creatinine-to-body weight ratio (Cre/BW) has been proposed as a practical surrogate marker of skeletal muscle mass. Emerging evidence highlights a notable correlation connecting Cre/BW to diabetes alongside various metabolic dysfunctions; however, its role in glycemic worsening and the restoration of normoglycemia in individuals with prediabetes has not been well defined. This study, therefore, examined the effect of Cre/BW on glycemic remission and progression among Chinese adults with prediabetes. A total of 24,506 adults with prediabetes from 11 cities in China were included in this retrospective cohort study based on health examination data. Cox proportional hazards models and subgroup analyses were used to estimate associations of Cre/BW with incident diabetes and remission to normoglycemia. Potential nonlinearity in these relationships was assessed by RCS analyses. During an observation period spanning 2.9 years (median), 11,170 participants (45.58%) achieved remission to normoglycemia, and 2,641 (10.78%) progressed to diabetes. In multivariable-adjusted Cox models, higher Cre/BW was linked to a greater likelihood of remission (HR = 1.41, 95% CI: 1.28–1.55, p < 0.0001) and lower hazard of progression to diabetes (HR = 0.42, 95% CI: 0.35–0.52, p < 0.0001). RCS analyses indicated a nonlinear association between Cre/BW and diabetes progression: the HR was 0.29 (95% CI: 0.20–0.40) when Cre/BW was < 1.07 μmol/L/kg and increased to 0.66 (95% CI: 0.46–0.95) when Cre/BW was ≥ 1.07 μmol/L/kg. Subgroup analyses suggested that the effect of Cre/BW on glycemic remission was more pronounced in men and in participants aged 40–50 years; a stronger effect of Cre/BW on glycemic progression was also observed among those aged < 30 years (all interaction p < 0.05). In adults with prediabetes, Cre/BW was linked to bidirectional changes in glycemic status: higher Cre/BW was linked to a lower hazard of progression to diabetes and a greater likelihood of remission to normoglycemia. Not applicable.