Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Endocrinology, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.
PLoS One. 2020 Sep 3;15(9):e0238095. doi: 10.1371/journal.pone.0238095. eCollection 2020.
Diabetes mellitus is a kind of highly prevalent chronic disease in the world. The intervention measures on the risk factors of prediabetes contribute to control and reduce the occurrence of diabetes. This study aimed to investigate the correlation between proinsulin (PI), true insulin (TI), PI/TI, 25(OH) D3, waist circumference (WC), and risk of prediabetes.
In this cross-sectional study, 1662 subjects including 615 prediabetes and 1047 non-prediabetes were recruited. Spearman's correlation analysis was used to explore the association of PI, TI, PI/TI, 25(OH) D3, and waist circumference with prediabetes. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by logistic regression. Receiver-Operator Characteristic (ROC) curve was used to evaluate the risk of prediabetes.
Our study showed that FPI, 2hPI, FTI, 2hTI, FPI/FTI, and WC could enhance the risk of prediabetes (OR 1.034; OR 1.007; OR 1.005; OR 1.002; OR 3.577, OR 1.053, respectively; all p< 0.001). Stratified analyses indicated that FPI/FTI associated with an increased risk of prediabetes in men (OR 2.080, p = 0.042). FTI have a weak association with prediabetes risk in men and women (OR 0.987, p = 0.001; OR 0.994, p = 0.004, respectively). 2hPI could decrease prediabetes in women (OR 0.995, p = 0.037). Interesting, the sensitivity (86.0%) and AUC (0.942, p< 0.001) of combination (FPI+FTI+2hPI+2hTI+25(OH) D3+WC) were higher than the diagnostic value of these alone diagnoses. The optimal cutoff point of FPI, FTI, 2hPI, 2hTI, 25(OH) D3, and WC for indicating prediabetes were 15.5 mU/l, 66.5 mU/l, 71.5 mU/l, 460.5 mU/l, 35.5 ng/ml, and 80.5 cm, respectively. What's more, the combination (FPI+FTI+2hPI+2hTI+25(OH) D3+WC) significantly improved the diagnostic value beyond the alone diagnoses of prediabetes in men and women (AUC 0.771; AUC 0.760, respectively).
The FPI, 2hPI, FTI, 2hTI, FPI/FTI, and WC significantly associated with an increased risk of prediabetes. The combination of FPI, FTI, 2hPI, 2hTI, 25(OH) D3, and WC might be used as diagnostic indicators for prediabetes.
糖尿病是一种在全球范围内高度流行的慢性疾病。针对糖尿病前期危险因素的干预措施有助于控制和减少糖尿病的发生。本研究旨在探讨胰岛素原（PI）、真胰岛素（TI）、PI/TI、25-羟维生素 D3（25（OH）D3）、腰围（WC）与糖尿病前期的相关性。
本横断面研究共纳入 1662 名受试者，包括 615 名糖尿病前期患者和 1047 名非糖尿病前期患者。采用 Spearman 相关分析探讨 PI、TI、PI/TI、25（OH）D3 和 WC 与糖尿病前期的相关性。采用 logistic 回归计算比值比（OR）和 95%置信区间（CI）。采用受试者工作特征（ROC）曲线评估糖尿病前期的风险。
本研究表明，空腹 PI（FPI）、2 小时 PI（2hPI）、空腹 TI（FTI）、2 小时 TI（2hTI）、FPI/FTI 和 WC 均能增加糖尿病前期的发病风险（OR 1.034；OR 1.007；OR 1.005；OR 1.002；OR 3.577，OR 1.053，均 P<0.001）。分层分析表明，FPI/FTI 与男性糖尿病前期的发病风险增加相关（OR 2.080，P=0.042）。FTI 与男性和女性糖尿病前期风险呈弱相关（OR 0.987，P=0.001；OR 0.994，P=0.004）。2hPI 可降低女性糖尿病前期的发病风险（OR 0.995，P=0.037）。有趣的是，FPI+FTI+2hPI+2hTI+25（OH）D3+WC 联合检测的敏感性（86.0%）和 AUC（0.942，P<0.001）均高于各指标单独诊断的诊断价值。FPI、FTI、2hPI、2hTI、25（OH）D3 和 WC 预测糖尿病前期的最佳截断点分别为 15.5 mU/L、66.5 mU/L、71.5 mU/L、460.5 mU/L、35.5 ng/ml 和 80.5 cm。此外，FPI+FTI+2hPI+2hTI+25（OH）D3+WC 联合检测在男性和女性糖尿病前期的诊断价值均优于各指标单独诊断（AUC 0.771；AUC 0.760）。
FPI、2hPI、FTI、2hTI、FPI/FTI 和 WC 与糖尿病前期的发病风险显著相关。FPI、FTI、2hPI、2hTI、25（OH）D3 和 WC 的联合检测可能可作为糖尿病前期的诊断指标。
