Association between the cholesterol‐high‐density lipoprotein‐glucose index and the incidence of new‐onset diabetes in patients with chronic gastrointestinal diseases: A prospective cohort study

ABSTRACT Aims This study aimed to investigate the association between the cholesterol‐high‐density lipoprotein‐glucose (CHG) index and the incidence of diabetes in patients with chronic gastrointestinal diseases (CGID). Methods This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) for the period 2011–2020. The association between the CHG index and new‐onset diabetes was assessed using Cox proportional hazards models. Restrictive cubic spline (RCS) analysis was used to examine the dose–response relationship, and time‐window analysis assessed the time‐dependence of predictive performance. The independent contributions of individual components of the CHG index were investigated using a two‐axis decomposition (metabolic burden axis and lipid protection axis). Results This study enrolled 1,870 CGID patients who were free of diabetes at baseline. During the follow‐up period, 289 participants (15.5%) developed new‐onset diabetes. CHG index was associated with the risk of new‐onset diabetes (HR per 1‐SD increase = 1.44, 95% CI: 1.28–1.61). RCS analysis showed no nonlinear relationship ( P ‐nonlinear = 0.773). Time‐window analysis showed that the predictive performance of the CHG index increased over time (HR for 0–5 years = 1.33 vs HR for 5–9 years = 1.62, P ‐interaction <0.001). Two‐axis decomposition analysis revealed that the ‘high metabolic burden–low lipid protection’ group had the highest risk of diabetes (HR = 2.00). Conclusions The CHG index is an independent risk factor for new‐onset diabetes in CGID patients, showing a linear dose–response relationship and time‐dependent predictive performance.