Association of Non-Insulin-Based Insulin Resistance Indices with Risk of Incident Prediabetes and Diabetes in a Chinese Rural Population: A 12-Year Prospective Study

Abstract

Three non-insulin-based insulin resistance (IR) indices, ie, triglyceride-glucose (TyG) index, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, and metabolic score for IR (METS-IR), were considered powerful and simplified alternatives for IR. However, evidence for the association between the three IR indices and incident type 2 diabetes mellitus (T2DM), especially impaired fasting glucose (IFG), remains limited. Therefore, this study aimed to explore the association among IR indices, incident IFG, and T2DM in a rural population cohort. Methods: We analyzed data from 2209 adults (aged 24-75 years) at baseline and from 1205 normoglycemic participants who were followed up. Cox proportional hazards models were used to evaluate the associations between the three indices and IFG or T2DM. Restricted cubic spline curves based on the Cox regression model were used to examine the association between baseline indices and incident T2DM. Results: For the baseline data, logistic analyses demonstrated that the TyG index, TG/HDL-C ratio, and METS-IR had a significantly positive correlation with IFG or T2DM after multivariable adjustment. During a median follow-up of 12.17 years, 157 incident cases of IFG and 97 incident cases of T2DM were noted. The risk of T2DM, but not IFG, was strongly associated with the baseline TyG index in the adjusted model, and participants with the TyG index in the third tertile had a higher risk of developing T2DM (adjusted hazards ratio, 2.84; 95% confidence intervals, 1.26-6.37; p for trend <0.001) than those in the lowest tertile (reference). Moreover, a linear relationship was observed between the TyG index and T2DM incidence. The TG/HDL-C ratio and METS-IR had no significant relationship with the risk of IFG or T2DM. Conclusion:The TyG index is more useful than the TG/HDL-C ratio and METS-IR in predicting T2DM in the normoglycemic population.

Association between MetS-IR and prediabetes risk and sex differences: a cohort study based on the Chinese population

“…In the current study, we have identified a linear association between MetS-IR and prediabetes based on multivariate Cox regression models, a finding that was consistent with previous epidemiological studies ( 17 ). It should be noted, however, that the linear relationship assessed by Cox regression is more indicative of an overall positive relationship between MetS-IR and prediabetes, while some subtle changes cannot be judged.…”

“…Compared with the research results of Li et al. ( 17 ), the current study believed that there was a longitudinal correlation between MetS-IR and prediabetes, and there were obvious sex differences. For the results of Li et al.…”

“…The value of this parameter has been confirmed in a large number of subsequent epidemiological investigations, including risk assessment and prediction of diabetes, NAFLD, hyperuricemia, prehypertension, and hypertension, hypertension combined with hyperuricemia, metabolic syndrome, and various chronic disease-related complications ( 16 – 25 , 40 ). Also, it is worth noting that in a recent study by Li et al., who included 1,205 baseline normoglycemic subjects and evaluated the association between MetS-IR and prediabetes for the first time, their results showed that, MetS-IR was not significantly associated with prediabetes ( 17 ). And in the current study, based on a longitudinal cohort of more than 100, 000 ordinary people, we found that there was a positive correlation between MetS-IR and prediabetes.…”

“…The hyperinsulinemic-euglycemic clamp is recognized as the gold standard for evaluating IR, but due to the relatively complicated measurement method, it cannot be widely used in large-scale epidemiological investigations; While MetS-IR, as a simple IR surrogate indicator, is considered to be widely used (16). The MetS-IR is a new score to assess cardiometabolic risk in healthy and high-risk subjects and a promising tool to screen for insulin sensitivity, as described by Bello-ChavollaOY et al The value of this parameter has been confirmed in a large number of subsequent epidemiological investigations, including risk assessment and prediction of diabetes, NAFLD, hyperuricemia, prehypertension, and hypertension, hypertension combined with hyperuricemia, metabolic syndrome, and various chronic diseaserelated complications (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)40). Also, it is worth noting that in a recent study by Li et al, who included 1,205 baseline normoglycemic subjects and evaluated the association between MetS-IR and prediabetes for the first time, their results showed that, MetS-IR was not significantly associated with prediabetes (17).…”

“…MetS-IR, a new index for assessing IR, has recently been widely accepted by researchers as a cost-effective predictor of diabetes due to its simple, reliable, and reproducible properties (16). Additionally, observational studies have shown that MetS-IR is not only useful for assessing the risk of diabetes (16)(17)(18)(19), but also has excellent risk assessment ability for a variety of metabolism-related diseases such as nonalcoholic fatty liver disease (NAFLD), hyperuricemia, prehypertension, hypertension, and metabolic syndrome (20)(21)(22)(23)(24)(25). However, current evidence for the association between MetS-IR and prediabetes risk is still very limited; previous experience suggested that the associations between prediabetes risk and IR was significantly different between the sexes (26,27).…”