Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand.
Int J Obes (Lond). 2009 Nov;33(11):1274-9. doi: 10.1038/ijo.2009.169. Epub 2009 Sep 1.
To compare the ability of biochemical indices of insulin resistance (IR) with metabolic syndrome (MetS) classifications to predict changes in blood glucose control over a 3-year period in overweight and obese subjects.
This was a longitudinal, prospective study, with data collected at baseline, 18 and 36 months.
A total of 175 overweight (body mass index (BMI)>25 kg m(-2)) and obese (BMI>30 kg m(-2)) subjects were enrolled in the study. The IR indices assessed included fasting insulin concentration, the insulin/glucose-derived indices, homeostasis assessment model of insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI), the insulin/triglyceride-derived McAuley index, plasma adiponectin concentration and the triglyceride (trig) and high-density lipoprotein (HDL)-cholesterol ratio (trig:HDL). The two MetS classifications were assessed according to the definitions of the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATPIII) and the International Diabetes Federation (IDF). The potential of the IR indices and MetS classifications at baseline to predict the development of impaired fasting glucose (IFG) was examined using receiver-operator characteristic (ROC) curve analysis and analysis of variance.
Complete data were collected on 158 subjects. In all, 51 (32%) subjects developed IFG during the study. The analysis of variance showed significant differences between the IFG and normoglycaemic group in the baseline values of the McAuley index, trig:HDL, plasma adiponectin concentration and prevalence of the MetS. The ROC curve analysis confirmed this result and showed that the strongest predictors of IFG were baseline trig:HDL and IDF MetS classification, followed in order by the McAuley index, plasma adiponectin concentration and NCEP-ATPIII MetS classification. In contrast, the baseline values of fasting insulin, HOMA-IR and QUICKI did not predict IFG.
This study showed that the IR indices, derived, in part, from plasma triglyceride concentration, were sensitive predictors for the development of IFG in normoglycaemic overweight and obese subjects. Indices derived from glucose and insulin did not identify this at-risk group. The study also showed that the presence of MetS and its abnormalities of an increased trig:HDL ratio and low plasma adiponectin concentration were all sensitive predictors of IFG.
比较胰岛素抵抗（IR）的生化指标与代谢综合征（MetS）分类对超重和肥胖患者 3 年内血糖控制变化的预测能力。
这是一项纵向前瞻性研究，数据在基线、18 个月和 36 个月时收集。
共纳入 175 名超重（体重指数（BMI）>25kg/m²）和肥胖（BMI>30kg/m²）患者。评估的 IR 指标包括空腹胰岛素浓度、胰岛素/葡萄糖衍生指标、稳态模型胰岛素抵抗评估（HOMA-IR）和定量胰岛素敏感性检查指数（QUICKI）、胰岛素/三酰甘油衍生的 McAuley 指数、血浆脂联素浓度以及三酰甘油（trig）和高密度脂蛋白（HDL）胆固醇比值（trig：HDL）。根据美国国家胆固醇教育计划-第三成人治疗专家组（NCEP-ATPIII）和国际糖尿病联盟（IDF）的定义评估两种 MetS 分类。使用受试者工作特征（ROC）曲线分析和方差分析检查基线时 IR 指标和 MetS 分类对空腹血糖受损（IFG）发展的预测能力。
共收集了 158 名受试者的完整数据。在研究期间，共有 51 名（32%）患者发生 IFG。方差分析显示，IFG 组和血糖正常组的基线 McAuley 指数、trig：HDL、血浆脂联素浓度和 MetS 患病率存在显著差异。ROC 曲线分析证实了这一结果，结果显示 IFG 的最强预测因子是基线 trig：HDL 和 IDF MetS 分类，其次是 McAuley 指数、血浆脂联素浓度和 NCEP-ATPIII MetS 分类。相反，空腹胰岛素、HOMA-IR 和 QUICKI 的基线值不能预测 IFG。
本研究表明，部分源自血浆三酰甘油浓度的 IR 指标是血糖正常超重和肥胖患者发生 IFG 的敏感预测因子。源自葡萄糖和胰岛素的指标无法识别出这一高危人群。该研究还表明，MetS 的存在及其异常的 trig：HDL 比值升高和血浆脂联素浓度降低都是 IFG 的敏感预测因子。
