Department of Medicine and Rehabilitation, Policlinico di Monza, Monza 20900, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milan 20126, Italy.
J Clin Endocrinol Metab. 2024 Apr 19;109(5):1308-1317. doi: 10.1210/clinem/dgad682.
Despite being one of the major drivers of diabetes incidence, the degree of insulin resistance in patients with type 2 diabetes (T2D) is not usually evaluated in clinical practice or in large epidemiologic studies.
To identify a model of insulin sensitivity using widely available clinical and laboratory parameters in patients with T2D and evaluate its association with all-cause and cardiovascular mortality.
One hundred forty patients with T2D underwent a euglycemic hyperinsulinemic clamp to measure total body glucose disposal rate (mg kg-1 minute-1). We used demographic, clinical, and common laboratory parameters to estimate insulin sensitivity (IS) via stepwise linear regression on 85 patients (training cohort) and validated it in the remaining 55 (validation cohort). The identified equation was then applied to 3553 patients with T2D from the 1999-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to evaluate its association with all-cause and cardiovascular mortality up to December 2015.
The best model included triglycerides, gamma glutamyl transpeptidase, albumin excretion rate, and body mass index. The identified IS score correlated well with the clamp-derived glucose disposal rate in both the training (r = 0.77, P < .001) and the validation (r = 0.74, P < .001) cohorts. In the NHANES cohort, after a median follow-up of 8.3 years, 1054 patients died, 265 of cardiovascular causes. In a multivariable Cox proportional hazard model adjusted for age, sex, race-ethnicity, education, cigarette smoke, total cholesterol, chronic kidney disease, blood pressure, prevalent cardiovascular disease, and alcohol consumption, a higher estimated IS was associated with a lower risk of both all-cause and cardiovascular mortality.
We propose a new model of IS in patients with T2D based on readily available clinical and laboratory data. Its potential applications are in both diagnosis as well as prognostication.
尽管是导致 2 型糖尿病（T2D）发病的主要因素之一，但在临床实践或大型流行病学研究中，通常不会评估 T2D 患者的胰岛素抵抗程度。
确定一种使用 T2D 患者广泛可用的临床和实验室参数来测量胰岛素敏感性的模型，并评估其与全因和心血管死亡率的相关性。
140 例 T2D 患者接受了正葡萄糖高胰岛素钳夹试验，以测量全身葡萄糖处置率（mg/kg·min-1）。我们使用人口统计学、临床和常见实验室参数，通过逐步线性回归，对 85 例患者（训练队列）进行胰岛素敏感性（IS）的估计，并在其余 55 例患者（验证队列）中进行验证。然后，将该方程应用于来自 1999-2010 年国家健康和营养检查调查（NHANES）的 3553 例 T2D 患者，以评估其与全因和心血管死亡率的相关性，截止到 2015 年 12 月。
最佳模型包括甘油三酯、γ-谷氨酰转肽酶、白蛋白排泄率和体重指数。在训练队列（r = 0.77，P <.001）和验证队列（r = 0.74，P <.001）中，确定的 IS 评分与钳夹试验中获得的葡萄糖处置率相关性良好。在 NHANES 队列中，中位随访 8.3 年后，有 1054 例患者死亡，265 例死于心血管疾病。在调整年龄、性别、种族、教育、吸烟、总胆固醇、慢性肾脏病、血压、已患心血管疾病和饮酒后，多变量 Cox 比例风险模型显示，估计的 IS 越高，全因和心血管死亡率的风险越低。
我们提出了一种基于 T2D 患者易得的临床和实验室数据的新的 IS 模型。其潜在应用既可以用于诊断，也可以用于预后。
