| BackgroundAlong with the development of national economy and the improvement of living standards,the prevalence rate of type 2 diabetes mellitus is rising continuously.The vast majority of patients with type 2 diabetes mellitus have insulin resistance,which runs through the entire course of the occurrence and development of type 2 diabetes mellitus.HOMA-IR is commonly used clinically to evaluate insulin resistance,which is closely related to obesity,dyslipidemia,inflammation and so on.Early detection and active intervention of risk factors for insulin resistance is of great significance to protect the function of pancreatic isletsβcells and delay the progression of the disease.Objective1.To analyse the clinical characteristics and risk factors of insulin resistance in type 2 diabetes patients,and provide clues for early recognition of insulin resistance in type 2 diabetes.2.To explore the relationship between diabetic duration and insulin resistance in people with different characteristics,so as to provide ideas for studying the temporal and spatial characteristics of insulin resistance.3.To construct and validate the prediction model of insulin resistance in type 2diabetes through clinical indicators,providing strategies for early intervention and comprehensive management of type 2 diabetes patients.MethodsA retrospective analysis was carried out on 3,309 patients with T2DM who were enrolled in the Endocrinology Department in Shenzhen Second People’s Hospital from January 2017 to May 2022,and HOMA-IR was adopted as an assessment indicator for insulin resistance.(1)HOMA-IR≥2.31 was defined as insulin resistance,which was divided into non IR group and IR group according to the cut-off point value.The differences in baseline data,glycemic and lipid metabolism indicators,diabetes complications,inflammatory indicators,liver and kidney functions,fatty liver and hypoglycemic drugs were analyzed and compared between the two groups.(2)The patients were divided into duration≤10 years and duration>10 years according to the diabetic duration,and comparison was made on the clinical features of the two groups.Single factor analysis and multiple linear regression analysis were used to explore the relationship between diabetic duration and HOMA-IR in different type 2 diabetes patients,and stratified analysis and interaction test were conducted.(3)The subjects were randomly divided into a training set(n=2311)and a validation set(n=998).Using Lasso regression analysis,the best predictor of HOMA-IR was selected for the training set,and the regression equation was established by stepwise multiple linear regression analysis.Using the determination coefficients R~2,AIC,and BIC to evaluate the validity of the equation and select the best regression equation.The predictive performance of the equation was evaluated using T-test,intraclass correlation coefficient,scatter plots,Bland-Altman plots,and diagnostic test potency indicators in the validation set and the complete data set,respectively.Results1.Comparison of clinical characteristics between the two groups:there were statistically significant differences in gender,history of hypertension,history of coronary heart disease,duration of diabetes,BMI,waist circumference,hip circumference,waist-to-hip ratio,Hb A1c,FPG,FINS,Ty G index,TG,TC,LDL-C,HDL-C,CRP,WBC,NEUT,LYM,ALT,GGT,DR,DPN,DN,fatty liver,sulfonylureas,glinides,thiazolidinediones,SGLT-2 inhibitors,DPP-IV inhibitors,GLP-1 receptor agonists and insulin between IR and non IR groups(P<0.05).There was no significant difference in age,Hcy,NLR,UA,Scr,PAD,arteriosclerosis,alpha-glucosidase inhibitors and biguanides between the two groups(P>0.05).2.Relationship between diabetic duration and HOMA-IR:in the whole population of T2DM patients,the diabetic duration is an independent influencing factor of HOMA-IR after adjusting for confounding factors(β=0.04;95%CI:0.03,0.05;P<0.0001).The results of subgroup analysis and interaction test showed that when the Ty G index was≥8.984,the effect of diabetic duration on HOMA-IR was more significant(β=0.06;95%CI:0.04,0.08;P<0.0001).Compared with T2DM patients without DR,T2DM patients with DR had a greater impact on HOMA-IR due to their diabetic duration(β=0.05;95%CI:0.03,0.07;P<0.0001).The use of insulin could enhance the impact of diabetic duration on HOMA-IR(β=0.06;95%CI:0.05,0.08;P<0.0001).In the IR group,diabetic duration was still an independent risk factor of HOMA-IR after adjusting for confounding factors(β=0.04;95%CI:0.02,0.06;P=0.0005),and when the Ty G index was≥9.187,the effect of diabetic duration on HOMA-IR was more significant(β=0.07;95%CI:0.04,0.10;P<0.0001).In the T2DM patients without IR,the effect size of diabetic duration on HOMA-IR after adjusting for confounders was 0.00(95%CI:0.00,0.01;P=0.0450),and the effect of diabetic duration on HOMA-IR increased when age≥60 years(β=0.01;95%CI:0.00,0.01;P=0.0019).3.The best predictors of HOMA-IR were identified by LASSO regression analysis,including gender,BMI,diabetic duration,Hb A1c,FPG,Ty G index and waist circumference.The best prediction model of HOMA-IR was obtained through stepwise multiple linear regression analysis as follows:HOMA-IR=-7.907+0.383×FPG+0.287×Hb A1c+0.051×Waist+0.056×diabetic duration+0.668×Gender(R2=0.290).In the validation set and the complete data set,the intraclass correlation coefficients between the predicted and measured values of HOMA-IR were 0.624(95%CI:0.574,0.668;P=0.000)and 0.625(95%CI:0.598,0.651;P=0.000),respectively.The Bland-Altman analysis results indicated that the mean difference between the predicted and measured values of HOMA-IR were 0.02±2.36 and 0.01±2.39,respectively,and the 95%consistency limits were(-4.71,4.76)and(-4.77,4.78),respectively.The sensitivity were 88.25%and 90.18%,and the specificity were40.26%and 42.74%,respectively.In the diagnostic test,the sensitivity were 88.25%and 90.18%,and the specificity were 40.26%and 42.74%,respectively,and the overall accuracy rate is 66.03%and 68.05%,respectively.Conclusion1.The clinical characteristics of T2DM patients with IR were as follows:large number of male patients,high age of female patients,long diabetic duration,severe obesity,obvious deterioration of glycolipid parameters,deterioration of inflammatory indicators and liver function,prone to diabetes complications and fatty liver,more complex hypoglycemic drug regimen,and more common use of insulin for hypoglycemia.2.In the whole population of T2DM patients,diabetic duration was closely correlated with HOMA-IR.There was a positive correlation between diabetic duration and HOMA-IR,and diabetic duration was an independent influencing factor of HOMA-IR.Ty G index,DR and using insulin modified the relationship between diabetic duration and HOMA-IR,and diabetic duration had a more significant effect on HOMA-IR in the population with high Ty G index,DR and using insulin.In the IR group of T2DM,high Ty G index could enhance the influence of diabetic duration on HOMA-IR.In T2DM patients without IR,there was little increase in HOMA-IR with the diabetic duration,even after adjusting the relevant confounding factors,and age could enhance the relationship between them.3.The main predictors of HOMA-IR linear regression model in this study included FPG,Hb A1c,waist circumference,diabetic duration and gender.The model has good consistency and accuracy in the validation data set and the complete data set,respectively,which could provide an effective tool for clinical evaluation of insulin resistance in patients with type 2 diabetes.SuggestionThis study provides the following suggestions for the recognition,prevention and treatment of insulin resistance in type 2 diabetes in Shenzhen area:1.To strengthen the knowledge popularization of type 2 diabetes among Shenzhen residents,pay attention to the prevention and management of diabetes in the early stage,strengthen the health education of T2DM patients and improve their self-management awareness.2.We should pay more attention to the early identification of risk factors for insulin resistance in T2DM patients,especially FPG,Hb A1c,waist circumference,diabetic duration and gender,and attach importance to the complications of diabetes.3.To strengthen standardized and comprehensive diagnosis and treatment of T2DM.It is recommended that T2DM patients actively control blood glucose and lipids,maintain a reasonable weight,appropriately reduce abdominal circumference,and take regular medication to reduce insulin resistance. |
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