老年糖尿病患者新胰岛素抵抗指数与全因死亡率的关联：一项前瞻性队列研究。

The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study.

作者信息

Yang Yanling, Liu Zhigu, Lin Beisi, Huang Yintong, Deng Hongrong, Yang Xubin, Zeng Longyi, Yan Jinhua, Xu Wen

机构信息

Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.

Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.

出版信息

Diabetol Metab Syndr. 2025 May 30;17(1):181. doi: 10.1186/s13098-025-01732-6.

DOI:10.1186/s13098-025-01732-6

PMID:40442829

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12123982/

Abstract

BACKGROUND

The association between newly developed insulin resistance (IR) indices and all-cause mortality in elderly patients with diabetes has not been investigated.

METHODS

Baseline data and all-cause mortality for 1,248 elderly diabetes patients from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018 were collected. The traditional IR index homeostasis model assessment of insulin resistance (HOMA-IR) and several newly developed indices, including metabolic score for insulin resistance (METS-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose index (TyG), triglyceride glucose combined with body mass index (TyG-BMI), estimated glucose disposal rate (eGDR), and visceral adiposity index (VAI), were calculated for the patients. Cox proportional hazards regression and restricted cubic spline (RCS) regression models assessed the relationship between IR indices and all-cause mortality.

RESULTS

In a median follow-up period of 73.3 months, there were 381 recorded deaths. In the total cohort, METS-IR (p < 0.001), TyG-BMI (p < 0.001), and eGDR (p = 0.011) demonstrated a significant association with all-cause mortality as continuous variables. HOMA-IR, METS-IR, TyG-BMI, and eGDR exhibited significant correlations with all-cause mortality in the Cox regression models (p < 0.05) when analyzed as categorical variables. A U-shaped relationship exists between METS-IR, TyG-BMI, eGDR, and all-cause mortality (p-overall < 0.0001, p-nonlinear < 0.05). No significant associations were found between TyG, TG/HDL-C, VAI, and all-cause mortality. Among male patients, TyG-BMI and HOMA-IR exhibited superior prognostic value, whereas in female patients, METS-IR, TyG-BMI, and eGDR showed better performance.

CONCLUSION

HOMA-IR, TyG-BMI, METS-IR, and eGDR were associated with mortality in elderly diabetic patients, with gender differences in their prognostic values.

摘要

背景

老年糖尿病患者新出现的胰岛素抵抗（IR）指数与全因死亡率之间的关联尚未得到研究。

方法

收集了2001年至2018年期间进行的美国国家健康与营养检查调查（NHANES）中1248例老年糖尿病患者的基线数据和全因死亡率。为患者计算了传统的IR指数胰岛素抵抗稳态模型评估（HOMA-IR）以及几个新出现的指数，包括胰岛素抵抗代谢评分（METS-IR）、甘油三酯与高密度脂蛋白胆固醇比值（TG/HDL-C）、甘油三酯葡萄糖指数（TyG）、甘油三酯葡萄糖联合体重指数（TyG-BMI）、估计葡萄糖处置率（eGDR）和内脏脂肪指数（VAI）。Cox比例风险回归和受限立方样条（RCS）回归模型评估了IR指数与全因死亡率之间的关系。

结果

在中位随访期73.3个月内，有381例死亡记录。在整个队列中，METS-IR（p < 0.001）、TyG-BMI（p < 0.001）和eGDR（p = 0.011）作为连续变量与全因死亡率呈显著关联。当作为分类变量分析时，HOMA-IR、METS-IR、TyG-BMI和eGDR在Cox回归模型中与全因死亡率呈显著相关性（p < 0.05）。METS-IR、TyG-BMI、eGDR与全因死亡率之间存在U型关系（总体p < 0.0001，非线性p < 0.05）。未发现TyG、TG/HDL-C、VAI与全因死亡率之间存在显著关联。在男性患者中，TyG-BMI和HOMA-IR表现出更好的预后价值，而在女性患者中，METS-IR、TyG-BMI和eGDR表现更佳。