背景:尽管是糖尿病发病率的主要驱动因素之一,2型糖尿病(T2D)患者的胰岛素抵抗程度通常不在临床实践或大型流行病学研究中进行评估.
目的:使用广泛可用的临床和实验室参数确定T2D患者的胰岛素敏感性模型,并评估其与全因死亡率和心血管死亡率的关系。
方法:140例T2D患者接受了正常血糖高胰岛素钳夹术,以测量总血糖处置率(mgkg-1min-1)。我们用人口统计,通过逐步线性回归评估85例患者的胰岛素敏感性(IS)的临床和常用实验室参数(训练队列),并在其余55例患者(验证队列)中进行验证.然后将确定的方程应用于国家健康和营养检查调查(NHANES)1999-2010周期的3553名T2D患者,以评估其与截至2015年12月的全因和心血管死亡率的关联。
结果:最佳模型包括甘油三酯,γ-谷氨酰转肽酶,白蛋白排泄率和体重指数。在训练(r=0.77,p<0.001)和验证(r=0.74,p<0.001)队列中,鉴定的IS得分与钳夹衍生的葡萄糖处置率良好相关。在NHANES队列中,经过8.3年的中位随访,1054名患者死亡,265个心血管原因。在根据年龄调整的多变量Cox比例风险模型中,性别,种族-种族,教育,香烟烟雾,总胆固醇,慢性肾病,血压,普遍的心血管疾病和饮酒,较高的IS估计值与较低的全因死亡率和心血管死亡率风险相关.
结论:我们基于现成的临床和实验室数据,提出了一种新的T2D患者IS模型。它的潜在应用是在诊断和预测。
BACKGROUND: Despite being one of the major drivers of diabetes incidence, the degree of insulin resistance in patients with type 2 diabetes (T2D) is not usually evaluated in clinical practice or in large epidemiologic studies.
OBJECTIVE: To identify a model of insulin sensitivity using widely available clinical and laboratory parameters in patients with T2D and evaluate its association with all-cause and cardiovascular mortality.
METHODS: One hundred forty patients with T2D underwent a euglycemic hyperinsulinemic
clamp to measure total body glucose disposal rate (mg kg-1 minute-1). We used demographic, clinical, and common laboratory parameters to estimate insulin sensitivity (IS) via stepwise linear regression on 85 patients (training cohort) and validated it in the remaining 55 (validation cohort). The identified equation was then applied to 3553 patients with T2D from the 1999-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to evaluate its association with all-cause and cardiovascular mortality up to December 2015.
RESULTS: The best model included triglycerides, gamma glutamyl transpeptidase, albumin excretion rate, and body mass index. The identified IS score correlated well with the
clamp-derived glucose disposal rate in both the training (r = 0.77, P < .001) and the validation (r = 0.74, P < .001) cohorts. In the NHANES cohort, after a median follow-up of 8.3 years, 1054 patients died, 265 of cardiovascular causes. In a multivariable Cox proportional hazard model adjusted for age, sex, race-ethnicity, education, cigarette smoke, total cholesterol, chronic kidney disease, blood pressure, prevalent cardiovascular disease, and alcohol consumption, a higher estimated IS was associated with a lower risk of both all-cause and cardiovascular mortality.
CONCLUSIONS: We propose a new model of IS in patients with T2D based on readily available clinical and laboratory data. Its potential applications are in both diagnosis as well as prognostication.