甘油三酯与高密度脂蛋白比值对检测早期胰岛素抵抗的诊断准确性有限

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American journal of preventive cardiology Pub Date : 2024-09-01 DOI:10.1016/j.ajpc.2024.100764
Caleb Park BSA
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引用次数: 0

摘要

治疗领域糖尿病背景2型糖尿病(T2DM)及其并发症对全球健康构成重大挑战,影响着全球 5.37 亿人。早期识别胰岛素抵抗(IR)对于控制风险和预防 T2DM 至关重要。现有文献支持将甘油三酯与高密度脂蛋白的比率(TG/HDL)作为胰岛素抵抗的实用标记和代谢综合征(MetS)的组成部分。然而,代谢综合征和糖尿病前期的代偿性高胰岛素血症可能会抑制该比率,掩盖隐性内分泌失调。假设:对于早期代谢失衡(EMI)的个体,TG/HDL 缺乏检测代偿性胰岛素抵抗的诊断能力。方法利用 2015-2018 年美国国家健康及营养检查调查(National Health & Nutrition Examination Survey)的数据,我们将每位研究参与者分配到四组中的一组:(1) 健康平衡代谢组;(2) EMI(包括早期 IR)组;(3) 糖尿病前期和/或血脂异常组;(4) T2DM 和/或心血管疾病(CVD)组。胰岛素抵抗的稳态模型评估 v.2(HOMA2-IR)是参考标准,以第 1 组和第 2 组的中位数作为切点。使用人群加权接收者操作特征曲线(ROC)评估预测准确性,以曲线下面积(AUC)和 95% 置信区间(CI)来衡量:AUC=0.720(95% 置信区间:0.701,0.739)。分析 2 仅包括 1-3 组:AUC=0.704(95% CI:0.683,0.726)。结论本研究强调了 TG/HDL 比值作为早期代谢失衡患者胰岛素抵抗标志物的诊断准确性有限。这种情况包括没有糖尿病前期、MetS、T2DM 和心血管疾病的代偿性胰岛素抵抗。需要更有效的标志物来筛查 EMI,这是 T2DM 和心血管疾病的隐性风险因素。
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TRIGLYCERIDE-TO-HIGH-DENSITY-LIPOPROTEIN RATIO HAS LIMITED DIAGNOSTIC ACCURACY FOR DETECTING EARLY INSULIN RESISTANCE

Therapeutic Area

Diabetes

Background

Type 2 diabetes mellitus (T2DM) and its complications pose a significant global health challenge, affecting 537 million individuals worldwide. Early identification of insulin resistance (IR) is crucial for managing the risk and preventing T2DM. Existing literature supports the use of the triglyceride-to-high-density lipoprotein ratio (TG/HDL) as a practical marker of IR and a component of metabolic syndrome (MetS). However, the compensatory hyperinsulinemia that precedes MetS and prediabetes may suppress this ratio and mask hidden IR. Hypothesis: For individuals with early metabolic imbalance (EMI), TG/HDL lacks the diagnostic power to detect compensated insulin resistance.

Methods

Leveraging data from the 2015-2018 U.S. National Health & Nutrition Examination Survey, we assigned each study participant to one of four groups: (1) healthy balanced metabolism, (2) EMI (includes early IR), (3) prediabetes and/or dyslipidemia and (4) T2DM and/or cardiovascular disease (CVD). The homeostatic model assessment of insulin resistance v.2 (HOMA2-IR) was the reference standard, with the median of groups 1 and 2 serving as the cut point. Population-weighted receiver operating characteristic (ROC) curves were used to assess predictive accuracy, measured by area-under-the-curve (AUC) with the 95% confidence interval (CI).

Results

ROC analysis 1 included all 4 groups: AUC=0.720 (95% CI: 0.701, 0.739). Analysis 2 included only groups 1-3: AUC=0.704 (95% CI: 0.683, 0.726). Analysis 3 included only groups 1 and 2: AUC=0.663 (95% CI: 0.621, 0.704).

Conclusions

This study highlights the limited diagnostic accuracy of TG/HDL ratio as a marker of insulin resistance for individuals with early metabolic imbalance. This condition includes compensated insulin resistance in the absence of prediabetes, MetS, T2DM and CVD. More effective markers are needed to screen for EMI, a hidden risk factor for T2DM and CVD.
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来源期刊
American journal of preventive cardiology
American journal of preventive cardiology Cardiology and Cardiovascular Medicine
CiteScore
6.60
自引率
0.00%
发文量
0
审稿时长
76 days
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