Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Diabetes Res Clin Pract. 2020 Mar;161:108050. doi: 10.1016/j.diabres.2020.108050. Epub 2020 Feb 5.
Insulin resistance (IR) changes over time during the development of type 2 diabetes. Some reports showed that obesity was associated with progression of IR. However, no study has explored if change of IR predicts incident diabetes, and no study has investigated other factors associated with the change.
In this study, 1184 subjects without diabetes at baseline were enrolled in 2006-2016 with a median follow-up period of 4.5 years. Diabetes was diagnosed by oral glucose tolerance test and hemoglobin A1c, or if anti-diabetic agents were used. HOMA2-IR and ISI were used to estimate IR.
The annual changes of HOMA2-IR(ΔHOMA2-IR/year) and ISI(ΔISI/year) were associated with BMI, waist circumference(WC), glucose, HbA1c, triglyceride and HDL-cholesterol. Subjects with pre-diabetes or metabolic syndrome were associated with a more rapid increase of IR. ΔHOMA2-IR/year and ΔISI/year were correlated with annual changes of BMI and WC. The hazard ratios for ΔHOMA2-IR/year and ΔISI/year to predict incident diabetes were 1.39 (95% CI 1.22-1.59, p < 0.001) and 0.13 (95% CI 0.09-0.19, p < 0.001) in adjusted models, respectively.
Change of IR can be used as a surrogate marker of incident diabetes. The progression of IR is an important pathophysiologic link between risk factors and the incidence of diabetes.
在 2 型糖尿病的发展过程中，胰岛素抵抗（IR）会随时间发生变化。一些报告显示肥胖与 IR 的进展有关。然而，尚无研究探讨 IR 的变化是否可预测糖尿病的发生，也没有研究调查与 IR 变化相关的其他因素。
本研究纳入了 1184 名基线时无糖尿病的受试者，随访时间中位数为 4.5 年（2006-2016 年）。糖尿病的诊断依据为口服葡萄糖耐量试验和糖化血红蛋白（HbA1c），或使用降糖药物。使用 HOMA2-IR 和 ISI 来评估 IR。
HOMA2-IR（ΔHOMA2-IR/年）和 ISI（ΔISI/年）的年变化与 BMI、腰围（WC）、血糖、HbA1c、甘油三酯和高密度脂蛋白胆固醇有关。患有糖尿病前期或代谢综合征的受试者，IR 增加更为迅速。ΔHOMA2-IR/年和 ΔISI/年与 BMI 和 WC 的年度变化相关。调整模型中，ΔHOMA2-IR/年和 ΔISI/年预测糖尿病发生的危险比分别为 1.39（95%CI 1.22-1.59，p<0.001）和 0.13（95%CI 0.09-0.19，p<0.001）。
IR 的变化可用作糖尿病发生的替代标志物。IR 的进展是危险因素与糖尿病发病之间的一个重要病理生理联系。
