胰岛素抵抗新型评价指标对2型糖尿病患者下肢动脉病变的风险预测

doi:10.3969/j.issn.1006-5725.2025.21.011

Abstract

Abstract:

Objective To investigate the association between novel evaluation indicators of IR and LEAD in patients with T2DM. Methods A total of 1，164 T2DM patients hospitalized in the Department of Endocrinology and Metabolism of Heze Mudan People's Hospital from January 2022 to April 2025 were enrolled. They were divided into the non-LEAD group （694 cases） and the LEAD group （470 cases） according to the presence of LEAD. General data and biochemical indicators were collected， and the triglyceride-glucose index （TyG）， triglyceride-glucose-body mass index （TyG-BMI）， estimated glucose disposal rate （eGDR）， triglyceride-to-high-density lipoprotein cholesterol ratio （TG/HDL-C）， and Metabolic Syndrome Insulin Resistance index （METS-IR） were calculated. Logistic regression analysis was performed to analyze the influencing factors for the development of LEAD in T2DM patients， as well as the correlation between novel IR assessment indices grouped by different quartiles and the risk of LEAD onset. Receiver operating characteristic （ROC） curve analysis was performed to evaluate the predictive value of these indicators for LEAD. Results Compared with non-LEAD group， the LEAD group had significantly higher TyG， TyG-BMI， TG/HDL-C， and METS-IR， but lower eGDR （all P < 0.05）. Logistic regression analysis showed that TyG， TyG-BMI， and METS-IR were identified as risk factors for the development of LEAD in patients with T2DM， while eGDR was a protective factor against it. After adjusting for confounders， compared with the Q1 group， the Q4 groups of TyG （OR = 3.647， 95%CI： 1.082 ~ 7.972， P < 0.001）， TyG-BMI （OR = 3.027， 95%CI： 1.275 ~ 9.753， P < 0.001）， and METS-IR （OR = 4.032， 95%CI： 1.242 ~ 12.385， P < 0.001） had a significantly increased LEAD risk， while the Q4 group of eGDR had a significantly decreased risk （OR = 0.225， 95%CI： 0.118 ~ 0.429， P < 0.001）. ROC curve analysis showed that METS-IR， TyG， TyG-BMI， and eGDR all exhibit predictive value for LEAD， with areas under the curve being 0.823， 0.758， 0.773， and 0.737， respectively. Subgroup analysis indicated that METS-IR was more strongly correlated with LEAD in subgroups of age ≥ 60 years， disease duration ≥ 5 years， HbA?C ≥ 7.0%， smoking history， and hypertension. Conclusion Elevated levels of TyG， TyG-BMI， and METS-IR， along with decreased levels of eGDR， are associated with an increased risk of LEAD onset in patients with T2DM. METS-IR exhibits high predictive efficacy for the development of LEAD in T2DM patients and may serve as a tool for its screening and risk assessment.

Key words: type 2 diabetes mellitus, insulin resistance, lower extremity arterial disease, metabolic syndrome insulin resistance index, disease risk

CLC Number:

R587.1

Xiaomeng YU,Ning. WANG. Association between novel insulin resistance indices and lower extremity atherosclerotic disease in patients with type 2 diabetes mellitus[J]. The Journal of Practical Medicine, 2025, 41(21): 3371-3377.

Figures/Tables 6

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Tab.5

References 28

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组别	T2DM组（n = 694）	LEAD组（n = 470）	χ2/t/Z值	P 值
男性/［例（%）］	364（52.4）	274（58.3）	4.287	0.036
吸烟史/［例（%）］	174（26.2）	223（44.5）	42.280	< 0.001
高血压/［例（%）］	212（30.55）	231（49.15）	42.426	< 0.001
年龄（x ± s）/岁	47.29 ± 13.42	59.64 ± 10.07	-9.589	< 0.001
糖尿病病程/年	5.0（1.0，11.5）	4.0（0.5，9.0）	-1.645	0.100
BMI（x ± s）/（kg/m2）	23.29 ± 3.34	27.43 ± 3.68	-11.580	< 0.001
ALT/（U/L）	20.75（14.20，31.22）	22.65（15.82，34.40）	-1.592	0.111
AST/（U/L）	19.70（16.00，24.20）	22.60（17.90，30.90）	-1.804	0.710
Scr （x ± s）/（μmol/L）	55.78 ± 14.40	53.55 ± 17.68	1.216	0.225
UA （x ± s）/（μmol/L）	252.57 ± 79.93	317.60 ± 95.76	-7.282	< 0.001
TC （x ± s）/（mmol/L）	5.08 ± 1.18	5.40 ± 1.43	-2.401	0.017
TG/（mmol/L）	1.25（0.91，1.74）	2.82（1.87，4.56）	-11.810	< 0.001
HDL-C/（mmol/L）	1.22（1.06，1.43）	0.94（0.83，1.16）	3.845	< 0.001
LDL-C （x ± s）/（mmol/L）	2.84 ± 0.84	2.90 ± 0.88	0.062	0.547
FPG （x ± s）/（mmol/L）	7.59 ± 1.74	8.58 ± 2.02	-5.126	< 0.001
HbA_1C （x ± s）/%	8.57 ± 1.97	9.11 ± 1.99	-2.674	0.004
FINS/（μIU/mL）	5.40（3.34，8.29）	5.09（3.35，9.06）	-0.252	0.801
F-CP/（ng/mL）	1.23（0.70，1.94）	0.87（0.51，1.59）	-8.445	< 0.001
TyG （x ± s）	8.91 ± 0.50	9.87 ± 0.70	-15.714	< 0.001
TyG-BMI （x ± s）	207.72 ± 33.59	270.63 ± 40.19	-16.773	< 0.001
eGDR （x ± s）	7.58 ± 1.92	6.55 ± 2.27	4.812	< 0.001
TG/HDL （x ± s）	1.18 ± 0.70	3.98 ± 1.93	-10.914	< 0.001
METS-IR （x ± s）	36.07 ± 6.10	48.63 ± 7.43	-18.253	< 0.001
HOMA-IR	2.30（1.50，3.50）	2.40（1.60，3.85）	-1.047	0.295

变量	β	SE	Wald χ²	P值	OR（95% CI）
性别	0.527	0.456	1.340	0.247	1.695（0.694 ~ 4.139）
年龄	0.047	0.016	8.290	0.004	1.048（1.015 ~ 1.083）
糖尿病病程	0.142	0.020	48.118	< 0.001	1.153（1.107 ~ 1.200）
高血压	0.170	0.063	7.260	0.007	1.185（1.047 ~ 1.341）
吸烟史	0.064	0.027	5.505	0.019	1.066（1.011 ~ 1.124）
FPG	0.089	0.063	1.958	0.162	1.093（0.965 ~ 1.237）
HbA_1C	0.106	0.051	4.362	0.037	1.112（1.007 ~ 1.229）
TC	0.025	0.153	0.026	0.871	1.025（0.759 ~ 1.384）
TG	0.157	0.085	3.401	0.065	1.170（0.990 ~ 1.383）
HDL-C	-3.712	0.488	57.837	< 0.001	0.024（0.009 ~ 0.064）
LDL-C	-0.244	0.206	1.411	0.235	0.783（0.523 ~ 1.172）
F-CP	0.036	0.367	0.010	0.921	1.037（0.505 ~ 2.130）
TyG	0.501	0.178	7.877	0.005	1.650（1.163 ~ 2.341）
TyG-BMI	0.036	0.159	3.597	0.041	1.372（1.005 ~ 1.872）
eGDR	-0.241	0.050	22.092	< 0.001	0.786（0.711 ~ 0.869）
TG/HDL	0.007	0.062	0.013	0.908	1.007（0.892 ~ 1.138）
METS-IR	0.900	0.304	8.751	0.003	2.460（1.355 ~ 4.466）
HOMA-IR	0.018	0.082	0.046	0.830	1.018（0.866 ~ 1.196）

变量	模型1		模型2		模型3
变量	OR（95% CI）	P值	OR（95% CI）	P值	OR（95% CI）	P值
METS-IR
Q1	-	-	-	-	-	-
Q2	2.492（1.197 ~ 5.191）	0.015	1.300（1.082 ~ 1.562）	0.005	1.024（1.008 ~ 1.040）	0.002
Q3	3.590（1.755 ~ 7.342）	< 0.001	2.283（1.346 ~ 9.623）	< 0.001	1.382（1.296 ~ 1.474）	0.011
Q4	5.701（2.807 ~ 11.579）	< 0.001	4.589（1.274 ~ 16.530）	< 0.001	4.032（1.242 ~ 12.385）	< 0.001
TyG
Q1	-	-	-	-	-	-
Q2	1.786（0.789 ~ 4.046）	0.164	0.916（0.783 ~ 1.072）	0.275	0.995（0.372 ~ 2.569）	0.116
Q3	3.401（1.587 ~ 7.285）	0.002	3.175（1.082 ~ 9.322）	0.001	1.652（1.247 ~ 2.188）	< 0.001
Q4	4.045（1.898 ~ 8.621）	< 0.001	3.462（1.132 ~ 8.162）	< 0.001	3.647（1.082 ~ 7.972）	< 0.001
TyG-BMI
Q1	-	-	-	-	-	-
Q2	2.710（1.124 ~ 6.535）	0.026	1.352（1.141 ~ 1.601）	0.016	1.499（1.342 ~ 1.673）	0.035
Q3	3.458（1.461 ~ 8.184）	0.005	2.801（1.066 ~ 8.721）	< 0.001	1.806（1.066 ~ 3.060）	0.028
Q4	3.863（1.643 ~ 9.079）	0.002	3.541（1.246 ~ 9.167）	< 0.001	3.027（1.275 ~ 9.753）	< 0.001
eGDR
Q1	-	-	-	-	-	-
Q2	0.453（0.225 ~ 0.802）	0.007	0.435（0.244 ~ 0.774）	0.007	0.423（0.234 ~ 0.767）	0.005
Q3	0.388（0.220 ~ 0.685）	0.001	0.324（0.182 ~ 0.579）	< 0.001	0.315（0.147 ~ 0.569）	< 0.001
Q4	0.279（0.151 ~ 0.514）	< 0.001	0.233（0.124 ~ 0.438）	< 0.001	0.225（0.118 ~ 0.429）	< 0.001

变量	AUC	95% CI	灵敏度	特异度	截断值	约登指数
METS-IR	0.823	0.779 ~ 0.866	0.708	0.877	39.53	0.585
TyG	0.758	0.708 ~ 0.807	0.589	0.882	8.27	0.471
TyG-BMI	0.773	0.726 ~ 0.820	0.649	0.813	228.60	0.462
eGDR	0.737	0.688 ~ 0.786	0.703	0.675	7.36	0.378

组别	例数	OR（95% CI）	P值	交互作用P值
整体	1 164	2.026（1.350 ~ 3.309）	< 0.001	-
年龄				0.210
≥ 60岁	491	1.337（1.239 ~ 1.442）	< 0.001
< 60岁	673	1.106（0.948 ~ 1.291）	0.202
病程				0.572
≥ 5年	640	1.689（1.494 ~ 1.910）	< 0.001
< 5年	524	1.180（0.979 ~ 1.422）	0.083
HbA_1C				0.351
≥ 7.0%	749	1.454（1.333 ~ 1.587）	< 0.001
< 7.0%	415	1.005（0.986 ~ 1.024）	0.634
吸烟史				0.492
有	397	1.494（1.339 ~ 1.667）	< 0.001
无	767	1.084（0.910 ~ 1.292）	0.367
高血压				0.627
有	443	1.372（1.219 ~ 1.545）	0.016
无	721	1.116（0.934 ~ 1.334）	0.226

Association between novel insulin resistance indices and lower extremity atherosclerotic disease in patients with type 2 diabetes mellitus

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