Cholesterol-HDL-Glucose Index Linked to Type 2 Diabetes Prevalence in Adults

An index of cholesterol, high-density lipoprotein (HDL), and glucose (CHG) is associated with the prevalence of type 2 diabetes (T2D) in United States adults, demonstrating its potential as a biomarker candidate for identifying individuals at risk for T2D development, although prospective cohort trials are necessary to validate its utility, according to new data published in the Journal of International Medical Research.¹

About the CHG Index

The CHG index has recently emerged as a potential biomarker for diagnosing T2D. The index integrates total cholesterol (TC), HDL, and fasting blood glucose (FBG) levels, allowing for a comprehensive metabolic marker that reflects both lipid metabolism and glucose disorders. Past research has demonstrated that the index could be utilized in the diagnosis of T2D, though they have mainly featured small, non-United States cohorts.1,2

Elucidating the prognostic value of the index in a US-based population is critical, as varying lifestyle factors and ethnic heterogeneity may impact the diagnostic utility of the index. No past study has systematically evaluated the association between CHG index and the prevalence of T2D in nationally representative US population, until now.¹

The current authors utilized the National Health and Nutrition Examination Survey (NHANES) database to investigate the association while evaluating the broader applicability of the index in early detection and intervention strategies for T2D in diverse populations.¹

Study Details

Data from 5 cycles of NHANES (2009–2010, 2011–2012, 2013–2014, 2015–2016, and 2017–2018 was analyzed, yielding data from 49,693 adult participants. Following the application of exclusion criteria, 11,390 individuals remained eligible for the final analysis, featuring 2710 (23.79%) with T2D and 8680 (76.21%) without T2D.¹

Without adjusting for covariates, the prevalence of T2D increased significantly with higher CHG index variables (odds ratio [OR]: 6.90 [95% CI, 5.57—8.54]; P < .001). Following adjustment for key demographics, including age, sex, race, educational level, the association sustained its strength and statistical significance (OR: 6.89 [95% CI, 5.46—8.69]; P < .001).¹

Adjusting for additional covariates, including hypertension, smoking status, alcohol consumption, triglycerides, and body mass index, did not substantially alter this association. In fact, individuals in the highest quartile of the CHG index demonstrated a 4.30-fold higher prevalence of T2D compared with those in the lowest quartile (OR: 4.30 [95% CI, 3.21—5.77]; P < .001).¹

A subgroup analysis was conducted to elucidate deeper insights into the factors that influence the association between CHG index and T2D prevalence. Data were stratified based on key covariates; despite this stratification, the positive association between the CHG index and T2D prevalence remained consistent across all patient subgroups, with no statistically significant variations observed.¹

Potential of the CHG Index

These insights highlight the great potential for the CHG index to be used as a reliable biomarker of T2D prevalence. Notably, the association remained robust after adjusting for various possible confounders. This is critical, as other indices, including the triglyceride-glucose index or triglyceride to HDL-cholesterol index, are limited by variable predictive power across populations or suboptimal reproducibility in some settings. The integrative quality of the CHG index could enhance its predictive accuracy, according to the investigators.^1,3

Despite the promising nature of these results, the authors acknowledged some limitations of their study. Most prominently, the findings may not be directly generalizable to populations in other regions or countries that vary in racial, socioeconomic, or health care characteristics compared with the NHANES dataset. In addition, because the NHANES data is cross-sectional, a causal relationship between the CHG index and T2D cannot be confirmed.¹

In their discussion, the authors recommend centering future studies on comparisons between the CHG index and other standard metabolic indicators, including the homeostatic model assessment of insulin resistance, to better determine its predictive u tility.¹

REFERENCES

1. Zhang Z, Chen M, Wang Y, et al. Association between the cholesterol, high-density lipoprotein, and glucose index and type 2 diabetes mellitus prevalence in US adults: A cross-sectional study based on National Health and Nutrition Examination Survey 2009–2018. Journ Intl Med Res. 2025;53(9). doi:10.1177/03000605251375557

2. Mansoori A, Nosrati M, Dorchin M, et al. A novel index for diagnosis of type 2 diabetes mellitus: Cholesterol, High density lipoprotein, and Glucose (CHG) index. J Diabetes Investig. 2025;16(2):309-314. doi:10.1111/jdi.14343

3. Park HM, Lee HS, Lee J, Lee J. The triglyceride-glucose index is a more powerful surrogate marker for predicting the prevalence and incidence of type 2 diabetes mellitus than the homeostatic model assessment of insulin resistance. Diabetes Res Clin Pract. 2021:180:109042. doi:10.1016/j.diabres.2021.109042