胰岛素抵抗在静息心率与 2 型糖尿病之间的关联中的作用：一项前瞻性研究。

Role of insulin resistance in the association between resting heart rate and type 2 diabetes: A prospective study.

机构信息

Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Yufu, Oita, Japan.

Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama, Japan.

出版信息

J Diabetes Complications. 2022 Nov;36(11):108319. doi: 10.1016/j.jdiacomp.2022.108319. Epub 2022 Sep 27.

DOI:10.1016/j.jdiacomp.2022.108319

PMID:36279707

Abstract

BACKGROUND

Elevated resting heart rate (RHR) is a predictor of incident type 2 diabetes (T2D). Insulin resistance is thought to play a role in this association; however, the extent to which insulin resistance mediates this association is unclear.

METHODS

1309 Japanese individuals without diabetes were recruited during 2009-2012 and followed for 5 years, of whom 78 developed T2D, as diagnosed by the 75 g oral glucose tolerance test. Supine RHR was measured by electrocardiography. Using logistic regression analysis, we examined the association between RHR and incident T2D, and interaction with the homeostasis model assessment of insulin resistance (HOMA-IR) index. Causal mediation analysis was applied to decompose the effect of RHR on the outcome and estimate the proportion mediated by the HOMA-IR index.

RESULTS

The sex- and age-adjusted cumulative incidence rate of T2D increased with increasing RHR. After adjustment for sex, age, waist circumference, current smoking status, alcohol use, habitual exercise, and cardiovascular disease medications, individuals with a RHR ≥80 bpm, compared with <60 bpm, showed an increased risk of incident T2D [odds ratio (OR), 2.89; 95 % confidence interval (CI), 1.07 to 7.80]. Multivariate adjusted OR for the total effect per 1 SD increase in RHR on incident T2D was 1.37 (95 % CI, 1.01 to 1.74) in the mediation analysis, and the proportion of the total indirect effect mediated by the HOMA-IR index was 27.5 % (95 % CI, 1.5 to 53.5).

CONCLUSIONS

Approximately 30 % of the effect of RHR on incident T2D was explained by the indirect effect of insulin resistance.

摘要

背景

静息心率（RHR）升高是 2 型糖尿病（T2D）发病的预测指标。胰岛素抵抗被认为在此关联中起作用；然而，胰岛素抵抗在多大程度上介导这种关联尚不清楚。

方法

在 2009 年至 2012 年期间招募了 1309 名无糖尿病的日本个体，并对其进行了 5 年的随访，其中 78 人被诊断为 T2D，采用 75g 口服葡萄糖耐量试验诊断。通过心电图测量仰卧位 RHR。使用逻辑回归分析，我们检查了 RHR 与 T2D 发病之间的关系，以及与胰岛素抵抗稳态模型评估（HOMA-IR）指数的相互作用。因果中介分析用于分解 RHR 对结局的影响，并估计 HOMA-IR 指数介导的比例。

结果

性别和年龄调整后的 T2D 累积发病率随 RHR 的增加而增加。在调整性别、年龄、腰围、当前吸烟状况、饮酒、习惯性运动和心血管疾病药物后，与 RHR<60bpm 的个体相比，RHR≥80bpm 的个体发生 T2D 的风险增加[比值比（OR），2.89；95%置信区间（CI），1.07 至 7.80]。中介分析中，RHR 每增加 1 个标准差对 T2D 发病的多变量调整 OR 为 1.37（95%CI，1.01 至 1.74），HOMA-IR 指数介导的总间接效应比例为 27.5%（95%CI，1.5 至 53.5）。