2型糖尿病中胰岛素抵抗替代指标对糖尿病肾病的预测价值

The Predictive Value of Insulin Resistance Surrogates for Diabetic Kidney Disease in Type 2 Diabetes Mellitus.

作者信息

Sun Qiuying, Zhao Meiru, Wang Xiaonan, Wang Jiangteng, Yang Yaxi, Liu Lin, Zhu Di, Li Xu, Guan Qingbo, Zhang Xu

机构信息

Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.

Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China.

出版信息

Diabetes Ther. 2025 Jun 15. doi: 10.1007/s13300-025-01765-0.

DOI:10.1007/s13300-025-01765-0

PMID:40517339

Abstract

INTRODUCTION

Insulin resistance (IR) is a major feature of type 2 diabetes mellitus (T2DM) and plays a crucial role in the accelerated progression of diabetic kidney disease (DKD). It has been found that surrogates of IR are of high value in assessing IR status. This study aims to evaluate the associations between surrogates of IR and DKD in T2DM.

METHODS

A total of 1026 patients with T2DM from January 2021 to February 2022 were selected in our final analysis. Logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were performed to assess the correlation between IR surrogates and DKD.

RESULTS

The levels of triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist to height ratio (TyG-WHtR), visceral adiposity index (VAI), and lipid accumulation product (LAP) were significantly higher in the microalbuminuria group and macroalbuminuria group compared with the normoalbuminuria group (P < 0.05). The results of multivariate logistic regression analysis showed that the highest quartile of triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose (TyG) index, TyG-WHtR, TyG-WC, LAP, and VAI were significantly correlated with DKD (all P < 0.05). The ROC curves and results showed that TyG area under the curve (AUC) > VAI AUC > TG/HDL-C AUC > TyG-WHtR AUC > LAP AUC > 0.7 > TyG-WC AUC > metabolic index of insulin resistance (METS-IR) AUC > 0.6 > triglyceride glucose-body mass index (TyG-BMI) AUC > 0.5.

CONCLUSIONS

The predictive value of IR surrogates for DKD in T2DM varies. TG/HDL-C, TyG, TyG-WHtR, LAP, and VAI can effectively predict DKD and are expected to be simple and economic biological indicators of DKD risk.

摘要

引言

胰岛素抵抗（IR）是2型糖尿病（T2DM）的主要特征，在糖尿病肾病（DKD）的加速进展中起关键作用。已发现IR替代指标在评估IR状态方面具有很高价值。本研究旨在评估T2DM中IR替代指标与DKD之间的关联。

方法

我们最终分析选取了2021年1月至2022年2月期间共1026例T2DM患者。进行逻辑回归分析和受试者工作特征（ROC）曲线分析，以评估IR替代指标与DKD之间的相关性。

结果

与正常白蛋白尿组相比，微量白蛋白尿组和大量白蛋白尿组的甘油三酯-血糖-腰围（TyG-WC）、甘油三酯-血糖-腰高比（TyG-WHtR）、内脏脂肪指数（VAI）和脂质蓄积产物（LAP）水平显著更高（P < 0.05）。多因素逻辑回归分析结果显示，甘油三酯/高密度脂蛋白胆固醇比值（TG/HDL-C）、甘油三酯-血糖（TyG）指数、TyG-WHtR、TyG-WC、LAP和VAI的最高四分位数与DKD显著相关（所有P < 0.05）。ROC曲线及结果显示，曲线下面积（AUC）：TyG > VAI AUC > TG/HDL-C AUC > TyG-WHtR AUC > LAP AUC > 0.7 > TyG-WC AUC > 胰岛素抵抗代谢指数（METS-IR）AUC > 0.6 > 甘油三酯-血糖-体重指数（TyG-BMI）AUC > 0.5。