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Are low levels of serum bicarbonate associated with risk of progressing to impaired fasting glucose/diabetes? A single-centre prospective cohort study in Beijing, China
  1. Sen Li1,2,
  2. Ying-Ying Wang1,2,
  3. Jing Cui3,
  4. Dong-Ning Chen3,
  5. Yu Li3,
  6. Zhong Xin1,2,
  7. Rong-Rong Xie1,2,
  8. Xi Cao1,2,
  9. Jing Lu1,2,
  10. Fang-Yuan Yang2,
  11. Jin-Kui Yang1,2
  1. 1 Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  2. 2 Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
  3. 3 Health Examination Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Jin-Kui Yang; jkyang{at}


Aims Bicarbonate is involved in many human essential metabolic processes, but little is known about the association between serum bicarbonate and glucose metabolism. This study aims to investigate the association between serum bicarbonate and the risk of progressing to impaired fasting glucose (IFG)/diabetes mellitus (DM).

Setting The data were obtained from a large-scale prospective cohort study in a single health centre in Beijing.

Participants A total of 5318 participants aged 18–70 years who underwent health examinations annually with baseline fasting plasma glucose (FPG) ranging from 3.9 to 5.5 mmol/L, without a history of either diabetes or concomitant chronic diseases, were enrolled in this 6-year observational study.

Primary outcome measures A logistic regression analysis was used to calculate ORs for progressing to IFG/DM by the category of baseline serum bicarbonate. In addition, an analysis of the receiver operating characteristic (ROC) curve for predicting IFG was performed.

Results Of the 5318 participants, 210 developed IFG after a median 2.2 years of follow-up. After adjusting for sex, age, FPG, body mass index, systolic blood pressure, serum creatinine, serum alanine aminotransferase and low-density lipoprotein cholesterol at baseline, the participants in the first (OR 4.18, 95% CI 2.42 to 7.21; p<0.001), second (OR 3.02, 95% CI 1.71 to 5.33; p<0.001) and third (OR 2.12, 95% CI 1.15 to 3.89; p=0.015) quartiles of serum bicarbonate had higher odds for progressing to IFG/DM compared with those in the highest quartile. The area under the ROC curve for predicting IFG/DM was 0.69 (95% CI 0.65 to 0.72; p<0.001).

Conclusions Lower serum bicarbonate is associated with higher risk of the development of IFG/DM.

  • impaired fasting glucose
  • bicarbonate
  • insulin resistance

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  • Contributors JKY designed the study, conducted the experiments and wrote the article. SL, YYW and JC conducted the experiments, performed the data analysis and wrote the article. DNC, YL and ZX conducted the experiments and performed the data analysis. RRX, XC, FYY and JL conducted the experiments. All the authors critically revised or drafted the manuscript for important intellectual content.

  • Funding This work was supported by the National Natural Science Foundation of China (8151101058; 81471014; 81270918), the Beijing Natural Science Foundation (7131005) and the Beijing Municipal Science and Technology Project (D12110000412001) to JKY.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Medical Ethics Committee of Beijing Tongren Hospital, Capital Medical University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All the available data can be obtained by contacting the corresponding author.

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