{"title":"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","authors":"Caleb Park BSA","doi":"10.1016/j.ajpc.2024.100764","DOIUrl":null,"url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Diabetes</div></div><div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100764"},"PeriodicalIF":4.3000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"TRIGLYCERIDE-TO-HIGH-DENSITY-LIPOPROTEIN RATIO HAS LIMITED DIAGNOSTIC ACCURACY FOR DETECTING EARLY INSULIN RESISTANCE\",\"authors\":\"Caleb Park BSA\",\"doi\":\"10.1016/j.ajpc.2024.100764\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Therapeutic Area</h3><div>Diabetes</div></div><div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":72173,\"journal\":{\"name\":\"American journal of preventive cardiology\",\"volume\":\"19 \",\"pages\":\"Article 100764\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of preventive cardiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666667724001326\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of preventive cardiology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666667724001326","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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.