Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Diabetes Care. 2022 Sep 1;45(9):2111-2117. doi: 10.2337/dc22-0272.
The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods.
Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients.
Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong.
Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks.
针对冠心病（CAD）患者的糖代谢异常（包括 2 型糖尿病和糖耐量受损），最佳的筛查策略仍存在争议。本研究旨在检验假设，即通过 HOMA 指数评估胰岛素抵抗的方法可能是一种较好的筛查手段。
本研究纳入了来自第五次欧洲心血管疾病预防和糖尿病调查（EUROASPIRE V）的 3534 例无已知糖代谢异常的 CAD 患者，对其进行了集中评估，评估指标包括胰岛素、C 肽、糖化血红蛋白 A1c 和口服葡萄糖耐量试验（OGTT）。共计算了三种不同的 HOMA 指数：HOMA 胰岛素抵抗指数（HOMA-IR）、基于胰岛素的 HOMA2 指数（HOMA2-ins）和基于 C 肽的 HOMA2 指数（HOMA2-Cpep）。根据 OGTT 中 2 小时血糖值诊断糖代谢异常。通过标准化访谈获得研究参与者的信息。通过受试者工作特征曲线下最大 Youden 指数 J 统计量获得三种 HOMA 指数诊断糖代谢异常的最佳阈值，并通过 Spearman 系数评估其与临床参数的相关性。
在 3534 例 CAD 患者中（平均年龄 63 岁，25%为女性），41%的患者存在新诊断的糖代谢异常。与未新诊断出糖代谢异常的患者相比，糖代谢异常患者的胰岛素、C 肽和 HOMA 指数均显著升高（均 P<0.0001）。三种 HOMA 指数诊断糖代谢异常的敏感性和特异性均较低，但与 BMI 和腰围的相关性较强。
通过 HOMA-IR、HOMA2-ins 和 HOMA2-Cpep 筛查 CAD 患者的糖代谢异常，其诊断效能不足以通过 OGTT 检测出糖代谢异常，尽管 OGTT 存在实际缺陷，但仍应优先考虑。
