Diabetes Metab J.  2018 Aug;42(4):296-307. 10.4093/dmj.2017.0106.

Insulin Resistance and the Risk of Diabetes and Dysglycemia in Korean General Adult Population

Affiliations
  • 1Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea. taesikjung@gmail.com
  • 2Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea.

Abstract

BACKGROUND
Insulin resistance is a major pathogenic hallmark of impaired glucose metabolism. We assessed the accuracy of insulin resistance and cut-off values using homeostasis model assessment of insulin resistance (HOMA-IR) to classify type 2 diabetes mellitus (T2DM) and dysglycemia according to age and sex.
METHODS
In this cross-sectional study, we analyzed 4,291 anti-diabetic drug-naïve adults (≥20 years) from the 6th Korea National Health and Nutrition Examination Survey in 2015. Metabolic syndrome (MetS) was defined by the modified National Cholesterol Education Program III guideline. Diagnosis of dysglycemia and T2DM were based on fasting glucose and glycosylated hemoglobin levels. The receiver operating characteristic curve and optimal cut-off values of HOMA-IR were assessed to identify T2DM/dysglycemia according to sex and were further analyzed by age.
RESULTS
Sex differences were found in the association of MetS and the different MetS components with T2DM/dysglycemia. The overall optimal cut-off value of HOMA-IR for identifying dysglycemia was 1.6 in both sex. The cut-off values for T2DM were 2.87 in men and 2.36 in women. However, there are differences in diagnostic range of HOMA-IR to distinguish T2DM according to sex and age, and the accuracy of HOMA-IR in identifying T2DM gradually decreased with age especially in women.
CONCLUSION
Insulin resistance is closely associated with the risk for T2DM/dysglycemia. The accuracy of HOMA-IR levels is characterized by sex- and age-specific differences in identifying T2DM. In addition to insulin resistance index, insulin secretory function, and different MetS components should be considered in the detection of early T2DM, especially in elderly.

Keyword

Diabetes mellitus; Hyperglycemia; Insulin resistance; Risk

MeSH Terms

Adult*
Aged
Cholesterol
Cross-Sectional Studies
Diabetes Mellitus
Diabetes Mellitus, Type 2
Diagnosis
Education
Fasting
Female
Glucose
Hemoglobin A, Glycosylated
Homeostasis
Humans
Hyperglycemia
Insulin Resistance*
Insulin*
Korea
Male
Metabolism
Nutrition Surveys
ROC Curve
Sex Characteristics
Cholesterol
Glucose
Insulin

Figure

  • Fig. 1 Prevalence of type 2 diabetes mellitus (T2DM) and dysglycemia in different age groups and sex. aP<0.05, bP<0.01.

  • Fig. 2 Area under the curve (AUC) (95% confidence interval [CI]) for (A) type 2 diabetes mellitus (T2DM) in men, (B) T2DM in women, (C) dysglycemia in men, and (D) dysglycemia in women in different age groups.

  • Fig. 3 Comparison of homeostasis model assessment of β-cell function (HOMA-β) according to sex and age group (distinguished by 50 years) in (A) low tertile of homeostasis model assessment of insulin resistance (HOMA-IR), (B) mid tertile of HOMA-IR, and (C) high tertile of HOMA-IR among those with dysglycemia. White bar, 50 years old or less; gray bar, more than 50 years old. aP<0.05.


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