A higher serum anion gap is associated with the risk of progressing to impaired fasting glucose and diabetes

Abstract Impaired fasting glucose (IFG) is a reversible interim hyperglycemic period in which there is an increasing risk of developing diabetes and related complications. Our study aimed to identify that serum anion gap is related to the risk of IFG and diabetes development. We performed a prospective, population-based study among 1191 Chinese individuals aged 22–87 years who underwent health examinations annually between 2006 and 2012 including determining clinical biochemistry and plasma metabolite parameters. All the participants had no history of diabetes or related chronic complications. We performed logistic regression analysis to examine the association between clinical and metabolomic factors and the risk of developing IFG or diabetes. Among them, 58 subjects whose fasting glucose level was between 6.1 and 7 mmol/L were diagnosed with IFG or diabetes. After adjusting for age, sex, body mass index (BMI), low-density lipoprotein (LDL), high-density lipoprotein (HDL), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels, systolic blood pressure (SBP), diastolic blood pressure (DBP), potassium and albumin(ALB) levels at baseline, the participants in the upper tertiles of serum anion gap (SAG) were more likely to develop IFG or diabetes than those in the lower tertiles. Receiver operating characteristic (ROC) curve analysis was used to predict the incidence of IFG or diabetes. We found the optimal cutoff level for the anion gap was 13.76 mmol/L and the AUC (area under ROC curve) was 0.623. Our data demonstrates that a higher SAG is associated with the risk of developing IFG or diabetes.