Abstract
BACKGROUND: The hs-CRP/HDL-C ratio is a novel marker reflecting inflammation and lipid metabolism disorders, but systematic investigations regarding its association with prediabetes and diabetes are still lacking. This study aimed to explore the association between the hs-CRP/HDL-C ratio and the presence of prediabetes and diabetes, thereby providing a theoretical basis for identifying individuals with dysglycemia at an earlier stage. METHODS: A total of 18,472 eligible adult participants were included based on NHANES data from 2015 to 2023. The hs-CRP/HDL-C ratio was divided into quartiles, and its association with the odds of prediabetes and diabetes was evaluated using multivariable logistic regression and restricted cubic spline (RCS) analysis. Subgroup analyses were performed to explore the predictive value of the ratio across different population subgroups. All statistical analyses were weighted to enhance the representativeness of the findings. RESULTS: A significant positive association was observed between the hs-CRP/HDL-C ratio and the odds of prediabetes and diabetes. Compared to individuals with normal glucose levels, those with prediabetes and diabetes had significantly elevated hs-CRP/HDL-C ratios (both p < 0.001). An increasing trend in the prevalence of prediabetes and diabetes was observed with rising hs-CRP/HDL-C ratio (28.72-44.10% and 4.38-17.34%, respectively). In Model 3, after full adjustment, each unit increase in the hs-CRP/HDL-C ratio was associated with a 13.3% higher odds of prediabetes (OR = 1.133, 95% CI: 1.082-1.184, p < 0.001) and a 26.9% higher odds of diabetes (OR = 1.269, 95% CI: 1.186-1.351, p < 0.001). The RCS analysis revealed a significant nonlinear association between the hs-CRP/HDL-C ratio and the risks of prediabetes and diabetes, with apparent inflection points near 0.614 and 1.168 (Model 3). Additionally, receiver operating characteristic (ROC) analysis showed that the hs-CRP/HDL-C ratio had better discriminatory performance than either hs-CRP or HDL-C alone in predicting prediabetes (AUC = 0.751) and diabetes (AUC = 0.857). Subgroup analyses further demonstrated notable heterogeneity in the predictive value of this indicator across various demographic and clinical strata. CONCLUSION: Our findings suggest that the hs-CRP/HDL-C ratio is significantly associated with the presence of prediabetes and diabetes in a nonlinear dose-response pattern, indicating its potential as a marker associated with glycemic disorders. CLINICAL TRIAL NUMBER: Not applicable.