CONTEXT 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 140 patients with T2D underwent a euglycemic hyperinsulinemic clamp to measure total body glucose disposal rate (mg kg-1 min-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 < 0.001) and the validation (r = 0.74, p < 0.001) 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. CONCLUSION We propose a new model of IS in patients with T2D based on readily available clinical and laboratory data. Its potential applications are in in both diagnosis as well as prognostication.

中文翻译：

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开发 2 型糖尿病患者胰岛素敏感性新模型及其与死亡率的关系。

背景 尽管胰岛素抵抗是糖尿病发病的主要驱动因素之一，但临床实践或大型流行病学研究中通常不会评估 2 型糖尿病 (T2D) 患者的胰岛素抵抗程度。目的 利用广泛可用的 T2D 患者临床和实验室参数确定胰岛素敏感性模型，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 患者接受正常血糖高胰岛素钳夹测量全身葡萄糖消耗率 (mg kg-1 min-1)。我们使用人口统计、临床和常见实验室参数，通过逐步线性回归对 85 名患者（训练队列）估计胰岛素敏感性 (IS)，并在其余 55 名患者（验证队列）中进行验证。然后将确定的方程应用于 1999-2010 年国家健康和营养检查调查 (NHANES) 周期中的 3553 名 T2D 患者，以评估其与截至 2015 年 12 月的全因死亡率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。在训练组（r = 0.77，p < 0.001）和验证组（r = 0.74，p < 0.001）中，确定的 IS 评分与钳夹衍生的葡萄糖处理率密切相关。在 NHANES 队列中，中位随访 8.3 年后，1054 名患者死亡，其中 265 名死于心血管原因。在根据年龄、性别、种族、教育、吸烟、总胆固醇、慢性肾病、血压、流行的心血管疾病和饮酒进行调整的多变量 Cox 比例风险模型中，较高的估计 IS 与较低的风险相关。全因死亡率和心血管死亡率。结论 我们根据现成的临床和实验室数据提出了一种新的 T2D 患者 IS 模型。它的潜在应用在于诊断和预测。