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Peer-reviewedCC BY-NC 4.0BMJ Open

Association of urine pH with the progression in the individuals with prediabetes: a population-based cohort study in China

  • Sijing Luo1,2
  • Zheyao Wen2,3
  • Weilan Huang4
  • Xinyao Xu1,2
  • Yemin Li5
  • Ji Luo5
  • Hongxing Wu5
  • Ying Tan2,3
  • Xiumei Tang4
  • Xixiang Tang1
5 affiliations
  1. 1VIP Medical Service Center, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
  2. 2Department of Endocrinology and Metabolic Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
  3. 3Guangdong 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
  4. 4Health Management Center, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
  5. 5Department of Cardiovascular Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Abstract

Objectives: To explore the association between urine pH (uPH) and the progression of pre-diabetes.

Design: Retrospective observational cohort study.

Setting: A health examination centre at the Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China, 2019–2023.

Participants: 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.

Primary 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.

Results: 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.

Conclusions: 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.

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Cite

BibTeXRIS
BibTeX
@article{luo2026association,
  title = {{Association of urine pH with the progression in the individuals with prediabetes: a population-based cohort study in China}},
  author = {Sijing Luo and Zheyao Wen and Weilan Huang and Xinyao Xu and Yemin Li and Ji Luo and Hongxing Wu and Ying Tan and Xiumei Tang and Xixiang Tang},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2026-123363},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123363},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Association of urine pH with the progression in the individuals with prediabetes: a population-based cohort study in China
AU  - Sijing Luo
AU  - Zheyao Wen
AU  - Weilan Huang
AU  - Xinyao Xu
AU  - Yemin Li
AU  - Ji Luo
AU  - Hongxing Wu
AU  - Ying Tan
AU  - Xiumei Tang
AU  - Xixiang Tang
PY  - 2026
DA  - 2026/10/27
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-123363
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123363
AB  - Objectives: To explore the association between urine pH (uPH) and the progression of pre-diabetes.  Design: Retrospective observational cohort study.  Setting: A health examination centre at the Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China, 2019–2023.  Participants: 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.  Primary 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.  Results: 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.  Conclusions: 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.
SN  - 2044-6055
SN  - 2044-6055
ER  -