Differential pulse pressure and triglycerides predict incident type 2 diabetes in Chinese adults: a BMI- stratified cohort analysis

Objective: to investigate the relationship between differential pulse pressure, triglycerides, and the probability of type 2 diabetes mellitus (T2DM) incidence under different BMI conditions in the Chinese adult population. Methods: This study utilized a retrospective cohort study design, with data from 211,833 adults who underwent physical examinations at Ruicci Healthcare Group in China between 2010 and 2016. Based on the BMI index, the study participants were categorized into the BMI ≤23.9 kg/m² group and the BMI >23.9 kg/m² group. The two groups were matched 1:1 by propensity score matching (PSM) method using first fasting glucose as the matching factor to control for potential confounding bias. After successful matching, Cox proportional risk regression models were developed to analyze the relationship between pulse pressure difference, triglycerides, and the risk of developing T2DM. In addition, the restricted cubic spline curve (RCS) method was applied to fit the non-linear relationship between differential pulse pressure and triglycerides and the probability of developing T2DM. Results: In analyzing the relationship between pulse pressure difference and the risk of developing T2DM, each one mmHg increase in pulse pressure difference significantly increased the risk of developing T2DM in both groups. Specifically, the risk of developing T2DM increased by 1% in the non-obese group (HR=1.01, 95% CI: 1.00-1.02, P<0.05) and by 3% in the obese group (HR=1.03, 95% CI: 1.01-1.05, P<0.001).RCS analysis showed that the non-obese group with a pulse pressure difference of >36 mmHg had a T2DM with a progressively higher probability risk; in the obese group, the relationship was linear, with a more significant risk of developing T2DM with a pulse pressure difference greater than 33 mmHg. In the relationship between triglycerides and the probability of developing T2DM, for every 1 mmol/L increase in triglycerides in the non-obese group, the risk of developing T2DM increased by 21% (HR=1.21, 95% CI: 1.18-1.24); for every 1 mmol/L increase in triglycerides in the obese group, the risk of developing T2DM increased by 13% (HR=1.13, 95% CI: 1.10-1.16). 1.16). The relationship between triglycerides and the probability of developing T2DM in both groups showed a non-linear change in a fast and then a slow manner. At the same triglyceride level, the risk probability of developing T2DM was approximately twice as high in men as in women. Conclusion: The likelihood of incidence of differential pulse pressure and T2DM varies according to BMI, and blood pressure management and control of differential pulse pressure should be more stringent in people with large BMI. In terms of lipid management, the population with lower BMI may have a higher probability of developing T2DM than those with higher BMI, possibly due to differences in lipid tolerance.