美国糖尿病协会针对印度2型糖尿病患者的糖尿病ABC目标、胰岛素抵抗指数和血脂异常之间的相互作用
Interplay Between the American Diabetes Association's ABC Targets for Diabetes, Insulin Resistance Indices, and Dyslipidemia in Indian Type 2 Diabetes Patients.
作者信息
Tripathi Pramod, Tiwari Diptika, Kathrikolly Thejas, Vyawahare Anagha, Sharma Baby, Ganla Malhar, K Maheshkumar, Vijayakumar Venugopal, Saboo Banshi, Kadam Nidhi S
机构信息
Department of Research, Freedom from Diabetes Research Foundation, Pune, IND.
Department of Management and Exercise Science, Freedom from Diabetes Clinic, Pune, IND.
出版信息
Cureus. 2024 May 14;16(5):e60268. doi: 10.7759/cureus.60268. eCollection 2024 May.
Background The increasing incidence of type 2 diabetes (T2D) in India underscores the pressing need for effective management strategies. Meeting the American Diabetes Association (ADA) ABC targets for diabetes (glycated hemoglobin (HbA1c), blood pressure, and serum low-density lipoprotein cholesterol (LDL-C)) is crucial for effectively managing T2D, as it reflects the optimal control of key metabolic parameters. Insulin resistance (IR) and impaired beta cell function (BCF) have been found to have a significant impact on glycemic control, lipid metabolism, and hypertension, contributing to the complex cardiovascular risk profile of patients with T2D. This study aimed to explore the association between ABC targets for diabetes, IR, BCF, and dyslipidemia in a cross-sectional cohort of T2D patients. Methods This retrospective study examined data from 681 T2D patients with comorbid hypertension and dyslipidemia. The patients were part of a one-year online lifestyle intervention program for diabetes management at the Freedom from Diabetes Clinic in Pune, India, between January 2021 and December 2022. Baseline data (at the time of enrollment in the program) on medical history and anthropometric and biochemical parameters were retrospectively extracted from medical records and used to assess ABC targets and other clinical parameters. The ABC targets for diabetes include three goals: an HbA1c level of less than 7.0%, a blood pressure level of less than 140/90 mmHg, and an LDL-C level of less than 100 mg/dL. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Homeostatic Model Assessment of Beta Cell Function (HOMA-B), and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated using standard formulas. Results Cross-sectional analysis at baseline showed that 152 (22.3%) participants met all three ABC targets, 306 (45.0%) and 183 (26.8%) participants met two or one targets, respectively, and 40 (5.9%) did not meet any of the ABC targets. Participants meeting all three targets showed significantly lower IR, higher sensitivity (HOMA-IR, median 2.1; QUICKI, median 0.34), higher BCF (HOMA-B, median 62.9), and healthier lipid profiles (mg/dL) (total cholesterol, median 126; triglycerides, median 114; and non-high-density lipoprotein (HDL), median 84) than those who did not meet any of the ABC targets (HOMA-IR, median 3.4; QUICKI, median 0.31; HOMA-B, median 31.7; total cholesterol, median 221; triglycerides, median 187; and non-HDL, median 182) (p < 0.01). A significant association was observed between lower BMI (< 25 kg/m), lower IR (HOMA-IR <2.5), and meeting all three ABC targets (p < 0.01). No significant association was observed between the duration of diabetes and ABC target status (p > 0.1). Lower IR was identified as a predictor of achievement of all three ABC targets (p < 0.01). Conclusion This study highlights the significance of meeting ABC targets for diabetes in relation to not only a better lipid profile but also lower IR and higher BCF. These preliminary findings provide novel insights into the interplay between IR, BCF, dyslipidemia, and meeting ABC targets in an Indian T2D population. These findings highlight the need for effective diabetes management strategies and improved patient outcomes, considering factors such as BMI and IR indices.
背景 印度2型糖尿病(T2D)发病率的不断上升凸显了对有效管理策略的迫切需求。实现美国糖尿病协会(ADA)针对糖尿病的ABC目标(糖化血红蛋白(HbA1c)、血压和血清低密度脂蛋白胆固醇(LDL-C))对于有效管理T2D至关重要,因为它反映了关键代谢参数的最佳控制情况。已发现胰岛素抵抗(IR)和β细胞功能受损(BCF)对血糖控制、脂质代谢和高血压有重大影响,导致T2D患者出现复杂的心血管风险状况。本研究旨在探讨T2D患者横断面队列中糖尿病ABC目标、IR、BCF和血脂异常之间的关联。
方法 这项回顾性研究检查了681例合并高血压和血脂异常的T2D患者的数据。这些患者是2021年1月至2022年12月期间印度浦那“摆脱糖尿病诊所”为期一年的糖尿病管理在线生活方式干预项目的一部分。回顾性地从病历中提取基线数据(项目入组时),包括病史、人体测量和生化参数,用于评估ABC目标和其他临床参数。糖尿病的ABC目标包括三个:HbA1c水平低于7.0%、血压水平低于140/90 mmHg以及LDL-C水平低于100 mg/dL。使用标准公式计算胰岛素抵抗稳态模型评估(HOMA-IR)、β细胞功能稳态模型评估(HOMA-B)和定量胰岛素敏感性检查指数(QUICKI)。
结果 基线时的横断面分析显示,152名(22.3%)参与者达到了所有三个ABC目标,306名(45.0%)和183名(26.8%)参与者分别达到了两个或一个目标,40名(5.9%)未达到任何ABC目标。达到所有三个目标的参与者的IR显著更低,敏感性更高(HOMA-IR,中位数2.1;QUICKI,中位数0.34),BCF更高(HOMA-B,中位数62.9),脂质谱更健康(mg/dL)(总胆固醇,中位数126;甘油三酯,中位数114;非高密度脂蛋白(HDL),中位数84),而未达到任何ABC目标的参与者(HOMA-IR,中位数3.4;QUICKI,中位数0.31;HOMA-B,中位数31.7;总胆固醇,中位数221;甘油三酯,中位数187;非HDL,中位数182)则不然(p < 0.01)。观察到较低的体重指数(<25 kg/m)、较低的IR(HOMA-IR <2.5)与达到所有三个ABC目标之间存在显著关联(p < 0.01)。未观察到糖尿病病程与ABC目标状态之间存在显著关联(p > 0.1)。较低的IR被确定为达到所有三个ABC目标的预测因素(p < 0.01)。
结论 本研究强调了实现糖尿病ABC目标的重要性,这不仅与更好的脂质谱有关,还与更低的IR和更高的BCF有关。这些初步发现为印度T2D人群中IR、BCF、血脂异常与实现ABC目标之间的相互作用提供了新的见解。这些发现凸显了考虑体重指数和IR指数等因素制定有效糖尿病管理策略和改善患者结局的必要性。