ZJU index predicts diabetes progression and normoglycemia reversion in 11,243 individuals with impaired fasting glucose.

BackgroundDM is a chronic metabolic disorder with a globally increasing prevalence. IFG, a major subtype of prediabetes, is highly prevalent amongthe Chinese adult population and represents a critical window for therapeutic intervention. The ZJU index is a comprehensive metabolic indicator that reflects systemic insulin resistance and metabolic burden status. However, its association with bidirectional glycemic outcomes specifically in individuals with IFG remains unclear. This study aimed to investigate the impact of the baseline ZJU index on the progression to diabetes, as well as on the reversion to normoglycemia.MethodsThis multicenter retrospective cohort study analyzed data from 11,243 individuals with IFG enrolled in a health screening program between 2010 and 2016. The ZJU index, calculated using a standardized formula, served as the primary exposure variable. We employed Cox proportional hazards regression and logistic regression models to examine the association between the ZJU index and glycemic status transition. RCS was used to explore nonlinear relationships, and a threshold effect analysis was conducted to identify potential inflection points. Subgroup and sensitivity analyses were performed to assess the robustness of the associations.ResultsHigher baseline ZJU index quartiles were significantly associated with a decreased likelihood of reversion to normoglycemia and an increased risk of diabetes progression. In the fully adjusted Cox model, each one-unit increase in the ZJU index was associated with a 3% lower hazard of reversion to normoglycemia and a 12% higher hazard of progression to DM. RCS analysis revealed a linear inverse association with reversion and a nonlinear positive association with progression, with an inflection point at a ZJU index of 38.499. Subgroup and sensitivity analyses confirmed the robustness and consistency of these associations across diverse population strata and data handling methods.ConclusionsIn individuals with IFG, a higher ZJU index demonstrates​ a linear inverse association with reversion to normoglycemia and a non-linear positive association with progression to incident DM. Accordingly, the ZJU index can serve as​ a practical tool for risk stratification and precision management, guiding preventive strategies for those at high risk of DM.