Association of Non-Insulin-Based Insulin Resistance Indices with Risk of Incident Prediabetes and Diabetes in a Chinese Rural Population: A 12-Year Prospective Study

Xiaoxia Li; Yixuan Xue; Yuanyuan Dang; Wanlu Liu; Qingan Wang; Yi Zhao; Yuhong Zhang

doi:10.2147/DMSO.S385906

Association of Non-Insulin-Based Insulin Resistance Indices with Risk of Incident Prediabetes and Diabetes in a Chinese Rural Population: A 12-Year Prospective Study

Diabetes Metab Syndr Obes. 2022 Dec 12:15:3809-3819. doi: 10.2147/DMSO.S385906. eCollection 2022.

Authors

Xiaoxia Li^#^{1

2}, Yixuan Xue^#¹, Yuanyuan Dang¹, Wanlu Liu¹, Qingan Wang^{1

2}, Yi Zhao^{1

2}, Yuhong Zhang^{1

2}

Affiliations

¹ Department of Epidemiology and Health Statistics, School of Public Health and Management of Ningxia Medical University, Yinchuan, People's Republic of China.
² Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health and Management of Ningxia Medical University, Yinchuan, People's Republic of China.

^# Contributed equally.

Abstract

Objective: Three non-insulin-based insulin resistance (IR) indices, ie, triglyceride-glucose (TyG) index, triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, and metabolic score for IR (METS-IR), were considered powerful and simplified alternatives for IR. However, evidence for the association between the three IR indices and incident type 2 diabetes mellitus (T2DM), especially impaired fasting glucose (IFG), remains limited. Therefore, this study aimed to explore the association among IR indices, incident IFG, and T2DM in a rural population cohort.

Methods: We analyzed data from 2209 adults (aged 24-75 years) at baseline and from 1205 normoglycemic participants who were followed up. Cox proportional hazards models were used to evaluate the associations between the three indices and IFG or T2DM. Restricted cubic spline curves based on the Cox regression model were used to examine the association between baseline indices and incident T2DM.

Results: For the baseline data, logistic analyses demonstrated that the TyG index, TG/HDL-C ratio, and METS-IR had a significantly positive correlation with IFG or T2DM after multivariable adjustment. During a median follow-up of 12.17 years, 157 incident cases of IFG and 97 incident cases of T2DM were noted. The risk of T2DM, but not IFG, was strongly associated with the baseline TyG index in the adjusted model, and participants with the TyG index in the third tertile had a higher risk of developing T2DM (adjusted hazards ratio, 2.84; 95% confidence intervals, 1.26-6.37; p for trend <0.001) than those in the lowest tertile (reference). Moreover, a linear relationship was observed between the TyG index and T2DM incidence. The TG/HDL-C ratio and METS-IR had no significant relationship with the risk of IFG or T2DM.

Conclusion: The TyG index is more useful than the TG/HDL-C ratio and METS-IR in predicting T2DM in the normoglycemic population.

Keywords: impaired fasting glucose; metabolic score for insulin resistance; triglyceride-glucose index; triglyceride-to-high-density lipoprotein cholesterol; type 2 diabetes mellitus.

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant number 81860603, 2019), the Natural Science Foundation of Ningxia Hui Autonomous Region (grant number 2020AAC03167, 2020), the Natural Science Foundation of Ningxia Province (grant number 2021AAC03128, 2021), and the university-level project of Ningxia Medical University (grant number XT2019010, 2019).