Armato John, DeFronzo Ralph A, Abdul-Ghani Muhammad, Ruby Ron
Providence Little Company of Mary Cardiometabolic Center, Providence Medical Associates, Torrance, CA 90503, USA.
Diabetes Division, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX 78207, USA.
J Clin Endocrinol Metab. 2025 Apr 22;110(5):e1481-e1487. doi: 10.1210/clinem/dgae540.
Prior studies have demonstrated glycemic and cardiometabolic risk in the prediabetic state.
This work aims to examine if insulin resistance (IR) is associated with markers of glycemic, cardiometabolic, and atherosclerotic risk in nonobese, nonprediabetic individuals compared to insulin-sensitive (IS) individuals matched for body mass index (BMI), sex, and age.
Of 1860 patients from the STOP DIABETES study, 624 had normal fasting plasma glucose, BMI less than 30, and glycated hemoglobin A1c (HbA1c) less than 5.7%. All received an oral glucose tolerance test. Insulin sensitivity was quantitated using the Matsuda index: less than the 25th percentile equals IR (n = 151) and 25th percentile or greater equals IS (n = 473). Measures of dysglycemia and cardiometabolic risk were compared between IR individuals (n = 151) and a subset of IS individuals who were matched for BMI, sex, and age (n = 151). Carotid intima media thickness and carotid plaque were measured in 65 IR and 76 IS individuals.
Compared to matched IS patients, IR nonobese individuals demonstrated increased indicators of glycemic and cardiometabolic risk, including increased 60-minute plasma glucose and percentage of patients with 60-minute plasma glucose greater than 155 mg/dL; increased 120-minute plasma glucose; unrecognized impaired glucose tolerance and type 2 diabetes, decreased disposition index; increased systolic and diastolic blood pressure; elevated plasma triglycerides (TGs); reduced high-density lipoprotein (HDL) cholesterol; increased TGs/HDL ratio, and high-sensitivity C-reactive protein. The presence, size, and number of carotid plaques was greater in the IR group.
Approximately 1 in 4 nonobese patients in this population with normal fasting glucose and HbA1c were IR. In these nonobese participants, IR was associated with multiple indicators of dysglycemia and cardiometabolic risk.
先前的研究已证实糖尿病前期状态下的血糖及心血管代谢风险。
本研究旨在探讨与体重指数（BMI）、性别和年龄相匹配的胰岛素敏感（IS）个体相比，胰岛素抵抗（IR）是否与非肥胖、非糖尿病前期个体的血糖、心血管代谢及动脉粥样硬化风险标志物相关。
在“阻止糖尿病”研究的1860例患者中，624例空腹血糖正常、BMI小于30且糖化血红蛋白A1c（HbA1c）小于5.7%。所有患者均接受口服葡萄糖耐量试验。使用松田指数对胰岛素敏感性进行定量：低于第25百分位数为IR（n = 151），第25百分位数及以上为IS（n = 473）。比较IR个体（n = 151）与BMI、性别和年龄相匹配的IS个体亚组（n = 151）的血糖异常和心血管代谢风险指标。对65例IR个体和76例IS个体测量颈动脉内膜中层厚度和颈动脉斑块。
与匹配的IS患者相比，IR非肥胖个体的血糖和心血管代谢风险指标升高，包括60分钟血浆葡萄糖升高以及60分钟血浆葡萄糖大于155 mg/dL的患者百分比增加；120分钟血浆葡萄糖升高；未被识别的糖耐量受损和2型糖尿病，处置指数降低；收缩压和舒张压升高；血浆甘油三酯（TG）升高；高密度脂蛋白（HDL）胆固醇降低；TG/HDL比值升高，以及高敏C反应蛋白升高。IR组颈动脉斑块的存在、大小和数量更多。
该人群中约四分之一空腹血糖和HbA1c正常的非肥胖患者存在IR。在这些非肥胖参与者中，IR与多种血糖异常和心血管代谢风险指标相关。
