Association between intrinsic capacity transitions and the risk of diabetes in middle-aged and older adults

Intrinsic capacity (IC) is a person-centered comprehensive assessment framework that focuses on optimizing individuals’ functional ability and resilience to environmental challenges, defined as the sum of all physical and mental capacities of an individual. Based on cohort data from the CHARLS, this study investigated the associations of baseline IC and its dynamic transition patterns with the risk of incident diabetes in middle-aged and older adults, aiming to provide evidence for precise diabetes prevention and control. Five waves of CHARLS data (2011–2020) were included, with 2011 as the baseline. IC transition patterns were assessed using 2011–2013 data, and participants were followed up to 2020 for incident diabetes. Cox proportional hazards regression was performed to evaluate these associations. 15.6% of participants developed diabetes. Compared with the low IC group, moderate and high IC groups had an 18.8% and 26.7% lower risk of diabetes, respectively. Four IC patterns were identified: Improved IC, Stable IC Impairment, Declined IC, and Stable Non-IC Impairment. Compared with Stable Non-IC Impairment, the Improved IC (HR 1.272, 95% CI: 1.019,1.588) and Stable IC Impairment (HR 1.474, 95% CI: 1.167,1.863) groups had significantly higher risks, whereas the Declined IC group showed no significant association. Baseline IC and its dynamic transition patterns are differentially associated with diabetes risk in middle-aged and older adults. IC should be integrated into diabetes prevention and control systems, with dynamic monitoring and individualized interventions to reduce disease risk. Based on nearly 10 years of follow-up data from the nationally representative CHARLS cohort, this study examines the dynamic characteristics of IC in middle-aged and older adults. It overcomes the limitations of traditional static IC assessment and confirms the negative correlation between baseline IC and incident diabetes risk. It identifies four dynamic IC transition patterns (Stable without IC impairment, Declined IC, Improved IC, and Stable IC Impairment) and clarifies their differential impacts on diabetes risk, providing empirical evidence for precise diabetes prevention and control.