{
  "abstract": "Objectives: To explore the association between urine pH (uPH) and the progression of pre-diabetes.\n\nDesign: Retrospective observational cohort study.\n\nSetting: A health examination centre at the Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China, 2019–2023.\n\nParticipants: A total of 6165 individuals with pre-diabetes were enrolled in the study. The diagnosis of pre-diabetes was based on the 2023 criteria of the American Diabetes Association. Individuals with normal blood glucose, diabetes mellitus (DM), abnormal renal function or conditions affecting urine test results were excluded.\n\nPrimary outcome measures: The primary outcome was progression to diabetes. uPH was measured using semiquantitative dipstick testing and categorised as <6.0, ≥6.0 to <6.5 or ≥6.5 at baseline. Repeated measurements were used to classify five longitudinal patterns: sustained ≥6.0, sustained <6.0, rise, drop and fluctuation.\n\nResults: Over a median follow-up of 1.95 years (IQR 1.04–3.00), 616 participants (9.9%) progressed to DM. Baseline low uPH (<6.0) was independently associated with a significantly increased risk of progression (HR 3.15, 95% CI 2.33 to 4.25, p<0.001) compared with high uPH (≥6.5). Sustained low uPH over time conferred the highest risk (HR 1.97, 95% CI 1.31 to 2.96, p=0.001). The corresponding subdistribution HRs in the competing risk analysis were 2.25 (95% CI 1.63 to 3.09) and 1.81 (95% CI 1.24 to 2.65), respectively. Subgroup analyses revealed stronger associations in males, individuals with non-alcoholic fatty liver disease and those without hypertension.\n\nConclusions: Low and sustained acidic uPH are independently associated with an increased risk of progression from pre-diabetes to diabetes in Chinese adults. As a routinely available, non-invasive marker, uPH may offer additional information for risk assessment in individuals with pre-diabetes.",
  "abstract_shown": true,
  "affiliations": [
    "VIP Medical Service Center, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China",
    "Department of Endocrinology and Metabolic Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China",
    "Guangdong Provincial Key Laboratory of Diabetology & Guangzhou Municipal Key Laboratory of Mechanistic and Translational Obesity Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China",
    "Health Management Center, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China",
    "Department of Cardiovascular Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Sijing Luo"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Zheyao Wen"
    },
    {
      "affs": [
        3
      ],
      "name": "Weilan Huang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xinyao Xu"
    },
    {
      "affs": [
        4
      ],
      "name": "Yemin Li"
    },
    {
      "affs": [
        4
      ],
      "name": "Ji Luo"
    },
    {
      "affs": [
        4
      ],
      "name": "Hongxing Wu"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Ying Tan"
    },
    {
      "affs": [
        3
      ],
      "name": "Xiumei Tang"
    },
    {
      "affs": [
        0
      ],
      "name": "Xixiang Tang",
      "orcid": "0009-0008-6993-5150"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9grgt6fy1v4y5.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjopen-2026-123363",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13723853/",
  "id": "9grgt6fy1v4y5",
  "issns": [
    "2044-6055",
    "2044-6055"
  ],
  "landing_url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123363",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "1843"
    ],
    [
      "heading",
      "Diabetes and Endocrinology"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2727|Chronic Kidney Disease and Diabetes"
    ]
  ],
  "openalex": "W7223870058",
  "pdf_url": null,
  "pmcid": "PMC13723853",
  "pmid": "42946369",
  "published": "2026-10-27",
  "publisher": "BMJ",
  "ris": "https://research.draconitic.com/paper/9grgt6fy1v4y5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:44Z",
      "native_id": "10.1136/bmjopen-2026-123363",
      "source": "crossref",
      "url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123363"
    },
    {
      "first_seen": "2026-11-04T12:22:25Z",
      "native_id": "PMC13723853",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjopen-2026-123363"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Chronic Kidney Disease and Diabetes",
      "subfield": "general"
    }
  ],
  "title": "Association of urine pH with the progression in the individuals with prediabetes: a population-based cohort study in China",
  "title_text": "Association of urine pH with the progression in the individuals with prediabetes: a population-based cohort study in China",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:35Z",
  "url": "https://research.draconitic.com/paper/9grgt6fy1v4y5",
  "venue": "BMJ Open",
  "versions": []
}