Value of simple clinical parameters to predict insulin resistance among newly diagnosed patients with type 2 diabetes in limited resource settings

Abstract

Background Insulin resistance (IR) has been considered as a therapeutic target in the management of type 2 diabetes mellitus (T2DM). Readily available, simple and low cost measures to identify individuals with IR is of utmost importance for clinicians to plan optimal management strategies. Research on the associations between surrogate markers of IR and routine clinical and lipid parameters have not been carried out in Sri Lanka, a developing country with rising burden of T2DM with inadequate resources. Therefore, we aimed to study the utility of readily available clinical parameters such as age, body mass index (BMI), waist circumference (WC) and triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) in the fasting lipid profile in predicting IR in a cohort of patients with newly diagnosed T2DM in Sri Lanka. Methods and findings We conducted a community based cross sectional study involving of 147 patients (age 30–60 years) with newly diagnosed T2DM in a suburban locality in Galle district, Sri Lanka. Data on age, BMI, WC, fasting plasma glucose (FPG) concentration, fasting insulin concentration and serum lipid profile were collected from each subject. The indirect IR indices namely homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI) and McAuley index (MCA) were estimated. Both clinical and biochemical parameters across the lowest and the highest fasting insulin quartiles were compared using independent sample t-test. Linear correlation analysis was performed to assess the correlation between selected clinical parameters and indirect IR indices. The area under the receiver operating characteristic (ROC) curve was obtained to calculate optimal cut-off values for the clinical markers to differentiate IR. BMI (p<0.001) and WC (p = 0.01) were significantly increased whereas age (p = 0.06) was decreased and TG/HDL-C (p = 0.28) was increased across the insulin quartiles. BMI and WC were significantly correlated (p<0.05) with HOMA, QUICKI and MCA. Out of the clinical parameters, age showed a borderline significant correlation with QUICKI and TG/HDL-C showed a significant correlation only with MCA. The area under ROC of BMI was 0.728 (95% CI 0.648–0.809; p<0.001) and for WC, it was 0.646 (95% CI 0.559–0.734; p = 0.003). The optimized cut-off value for BMI and WC were 24.91 kg/m2 and 81.5 cm respectively to differentiate the patients with IR or ID. Study limitations include small sample size due to recruitment of patients only from a limited geographical locality of the country and not totally excluding of the possibility of inclusion of some patients with slowly progressive type 1 DM or Latent onset diabetes of adulthood from the study population. Conclusions The results revealed that there was a significant positive correlation between BMI, WC and HOMA while a significant negative correlation with QUICKI and MCA among the cohort of patients with newly diagnosed T2DM. The cut-off values of BMI and WC as 24.91 kg/m2 and 81.5 cm respectively could be used as simple clinical parameters to identify IR in newly diagnosed patients with T2DM. Our results could be beneficial in rational decision making in the management of newly diagnosed patients with T2DM in limited resource settings.

Pancreatic Beta-cell function and degree of Insulin resistance among newly detected type 2 diabetics and their correlation with anthropometric, glucose, and lipid parameters: An Observational cross-sectional study

“…These values are low in our study cohort compared to study done by Chen et al, 17 who reported a mean fasting insulin level of 10.37 µIU/mL in their study population. Wasana et al, 11 did a similar kind of study among newly detected type 2 diabetic patients and found mean fasting plasma insulin level of 18.15±10.81 µIU/mL. This could be due to low beta-cell reserve in our ethnicity as a result of low birth weight, prematurity, and malnutrition.…”

“…18 The mean value of HOMA-IR was found to be 2.22±1.75 in the present study. Wasana et al, 11 reported mean HOMA-IR 5.51±3.85 in their study cohort. In the present study, HOMA-B% showed significant negative correlation with all plasma glucose indices, namely, FPG, 2 h PPG, and HbA1c.…”

“…10 Wasana et al, in their study, calculated HOMA-IR, HOMA-B% values among newly diagnosed diabetic patients. 11 There are only few clinical studies done on this field particularly in Indian setting. In the previously published studies, no one had tried to find out clinical surrogate markers of these parameters.Hence,this present study was carried out to assess these parameters in diabetic patients at the time of diabetes diagnosis.…”

Computational Study of Phytopharmaceutical Antidiabetic Potential of Gorontalo Traditional Medicine Plants

“…Traditional medicinal plants contained various compounds that had the potential as candidates for antidiabetic drugs. Studies have shown that traditional medicinal plants had strong antidiabetic activity, both in in vitro and in vivo research settings [3]. A review of traditional medicinal plants with antidiabetic activity indicated that these plants had multiple therapeutic dynamics in combating inflammation and diabetes that could be explored for the discovery of therapeutic preparations or co-treatment agents for both diseases [4].…”