School of Public Health, Sun Yat-Sen University, Guangzhou, China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
JMIR Public Health Surveill. 2024 Jun 3;10:e49617. doi: 10.2196/49617.
The metabolic score for insulin resistance (METS-IR) has emerged as a noninsulin-based index for the approximation of insulin resistance (IR), yet longitudinal evidence supporting the utility of METS-IR in the primary prevention of type 2 diabetes mellitus (T2DM) remains limited.
We aimed to investigate the longitudinal association between METS-IR, which combines fasting plasma glucose (FPG), lipid profiles, and anthropometrics that can be routinely obtained in resource-limited primary care settings, and the incidence of new-onset T2DM.
We conducted a closed-cohort analysis of a nationwide, prospective cohort of 7583 Chinese middle-aged and older adults who were free of T2DM at baseline, sampled from 28 out of 31 provinces in China. We examined the characteristics of participants stratified by elevated blood pressure (BP) at baseline and new-onset T2DM at follow-up. We performed Cox proportional hazard regression analysis to explore associations of baseline METS-IR with incident T2DM in participants overall and in participants stratified by baseline BP. We also applied net reclassification improvement and integrated discrimination improvement to examine the incremental value of METS-IR.
During a mean follow-up period of 6.3 years, T2DM occurred in 527 participants, among which two-thirds (332/527, 62.9%; 95% CI 58.7%-67.1%) had baseline FPG<110 mg/dL. A SD unit increase in baseline METS-IR was associated with the first incidence of T2DM (adjusted hazard ratio [aHR] 1.33, 95% CI 1.22-1.45; P<.001) in all participants. We obtained similar results in participants with normal baseline BP (aHR 1.41, 95% CI 1.22-1.62; P<.001) and elevated baseline BP (aHR 1.29, 95% CI 1.16-1.44; P<.001). The predictive capability for incident T2DM was improved by adding METS-IR to FPG. In study participants with new-onset T2DM whose baseline FPG was <126 mg/dL and <110 mg/dL, 62.9% (332/527; 95% CI 60%-65.9%) and 58.1% (193/332; 95% CI 54.3%-61.9%) of participants had baseline METS-IR above the cutoff values, respectively.
METS-IR was significantly associated with new-onset T2DM, regardless of baseline BP level. Regular monitoring of METS-IR on top of routine blood glucose in clinical practice may add to the ability to enhance the early identification of primary care populations at risk for T2DM.
胰岛素抵抗代谢评分（METS-IR）已成为一种非胰岛素基础的胰岛素抵抗（IR）近似指数，但支持 METS-IR 在 2 型糖尿病（T2DM）一级预防中应用的纵向证据仍然有限。
我们旨在研究 METS-IR（结合空腹血糖[FPG]、血脂谱和可在资源有限的基层医疗环境中常规获得的人体测量学）与新诊断的 T2DM 之间的纵向关联，METS-IR 是一个结合了空腹血糖（FPG）、血脂谱和可在资源有限的基层医疗环境中常规获得的人体测量学的非胰岛素为基础的指数。
我们对来自中国 31 个省中的 28 个省的全国性前瞻性队列中的 7583 名中国中老年成年人进行了封闭队列分析，这些成年人在基线时无 T2DM。我们根据基线时的血压（BP）升高和随访时的新诊断 T2DM 对参与者进行分层，分析其特征。我们使用 Cox 比例风险回归分析来探讨基线 METS-IR 与所有参与者和根据基线 BP 分层的参与者中 T2DM 发病的相关性。我们还应用净重新分类改善和综合鉴别改善来检验 METS-IR 的增量价值。
在平均 6.3 年的随访期间，527 名参与者发生了 T2DM，其中三分之二（332/527，62.9%；95%CI 58.7%-67.1%）的基线 FPG<110mg/dL。基线 METS-IR 每增加一个标准差与 T2DM 的首次发病相关（调整后的危险比[aHR] 1.33，95%CI 1.22-1.45；P<.001），所有参与者均如此。在基线 BP 正常的参与者（aHR 1.41，95%CI 1.22-1.62；P<.001）和基线 BP 升高的参与者（aHR 1.29，95%CI 1.16-1.44；P<.001）中，我们也得到了类似的结果。将 METS-IR 添加到 FPG 中可以提高对 T2DM 发病的预测能力。在基线 FPG<126mg/dL 和<110mg/dL 的新诊断 T2DM 参与者中，62.9%（332/527；95%CI 60%-65.9%）和 58.1%（193/332；95%CI 54.3%-61.9%）的参与者基线 METS-IR 均高于截断值。
METS-IR 与新诊断的 T2DM 显著相关，无论基线 BP 水平如何。在临床实践中，除了常规血糖监测外，定期监测 METS-IR 可能有助于提高识别 T2DM 高危人群的能力。
