Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, People's Republic of China.
Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, People's Republic of China.
Clin Nutr. 2018 Aug;37(4):1423-1429. doi: 10.1016/j.clnu.2017.06.018. Epub 2017 Jun 22.
A dramatic gap exists between the clinical practice and guidelines for the dyslipidemia control in patients with diabetes. It is still uncertain which routinely available lipid measure is more applicable in estimation of insulin sensitivity and blood glucose control. The present study aims to investigate associations of routine lipid profiles with insulin resistance and diabetes, respectively.
We conducted a population-based study in 9764 Chinese participants. The homeostasis model assessment of insulin resistance was calculated to estimate insulin sensitivity. Diabetes was diagnosed according to the 1999 World Health Organization diagnostic criteria.
Participants with insulin resistance or diabetes presented with significantly higher triglycerides (TG), Non-high-density lipoprotein cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, TG/HDL-C and lower HDL-C when compared with control subjects (all P < 0.0001). Such lipid measures were significantly correlated with fasting insulin, fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) 2 h glucose and Hemoglobin A1c (HbA1c) in Pearson's correlation analysis and multivariate linear regression analysis (all P < 0.0001). In logistic regression analysis, subjects were more likely to have prevalent insulin resistance and diabetes with the elevated quartiles of TG, Non-HDL-C, Non-HDL-C/HDL-C and TG/HDL-C (all P < 0.05). TG/HDL-C ratio, compare with other lipid parameters, have shown the strongest correlation with increased odds of insulin resistance and diabetes.
Our study suggests a discordant association of lipid parameters with blood glucose level and TG/HDL-C is a better marker for evaluating insulin resistance and diabetes in Chinese population when compared with other routine lipid measures.
糖尿病患者血脂控制的临床实践与指南之间存在显著差距。目前仍不确定哪种常规血脂指标更适用于评估胰岛素敏感性和血糖控制。本研究旨在分别探讨常规血脂谱与胰岛素抵抗和糖尿病的相关性。
我们在中国 9764 名参与者中进行了一项基于人群的研究。通过计算稳态模型评估胰岛素抵抗来评估胰岛素敏感性。根据 1999 年世界卫生组织的诊断标准诊断糖尿病。
与对照组相比，胰岛素抵抗或糖尿病患者的甘油三酯（TG）、非高密度脂蛋白胆固醇（Non-HDL-C）、非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇（Non-HDL-C/HDL-C）、TG/HDL-C 显著升高，而高密度脂蛋白胆固醇（HDL-C）显著降低（均 P<0.0001）。在 Pearson 相关分析和多元线性回归分析中，这些血脂指标与空腹胰岛素、空腹血糖（FPG）、口服葡萄糖耐量试验（OGTT）2 小时血糖和糖化血红蛋白（HbA1c）显著相关（均 P<0.0001）。在 logistic 回归分析中，随着 TG、Non-HDL-C、Non-HDL-C/HDL-C 和 TG/HDL-C 四分位数的升高，受试者发生胰岛素抵抗和糖尿病的可能性更高（均 P<0.05）。与其他血脂参数相比，TG/HDL-C 比值与胰岛素抵抗和糖尿病的发生几率增加具有最强的相关性。
本研究表明，血脂参数与血糖水平之间的相关性存在差异，与其他常规血脂指标相比，TG/HDL-C 是评估中国人群胰岛素抵抗和糖尿病的更好标志物。
