Evaluating the link between insulin resistance and cognitive impairment using estimated glucose disposal rate in a non-diabetic aging population: results from the CHARLS.

IF 3.1 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Frontiers in Medicine Pub Date : 2025-06-05 eCollection Date: 2025-01-01 DOI:10.3389/fmed.2025.1522028

Bingqing Wang, Fei Xu, Minheng Zhang

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Abstract

Background: Emerging evidence suggests insulin resistance may contribute to neurodegeneration, yet its role in non-diabetic populations remains unclear. This study explores the relationship between estimated glucose disposal rate (eGDR), a measure of insulin sensitivity, and incident cognitive dysfunction in non-diabetic adults.

Methods: Our longitudinal analysis utilized data from 5,178 CHARLS participants (age ≥ 45 years). Insulin sensitivity was quantified using eGDR, calculated from waist circumference, hypertension status, and hemoglobin A1c levels. Participants were stratified by eGDR quartiles for comparative analysis. We employed multivariable Cox models, survival curves, restricted cubic splines, and sensitivity testing to evaluate associations with cognitive outcomes.

Results: Over an 8.7-year follow-up, cognitive dysfunction developed in 36.9% of participants. Analyses revealed significant metabolic-cognitive associations, with each standard deviation increase in eGDR linked to a 15.8% reduction in risk (adjusted hazard ratio [HR] = 0.792, 95% confidence interval [CI]: 0.793-0.881). Restricted cubic spline analysis identified non-linear threshold effects, with risk accelerating below certain eGDR levels (P < 0.05). Kaplan-Meier survival analysis demonstrated significant differences in cognitive impairment incidence across eGDR quartiles (P = 0.003). Additionally, both eGDR and metabolic score for insulin resistance (METS-IR) showed comparable predictive value for cognitive impairment risk, outperforming other metabolic indices, including the atherogenic index of plasma (AIP), and the triglyceride glucose index (TyG).

Conclusion: These findings position eGDR as a promising biomarker for cognitive risk stratification in non-diabetic adults. However, further multi-database studies should validate these associations and explore the underlying mechanisms.

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评估胰岛素抵抗和认知障碍之间的联系，使用非糖尿病老年人群中估计的葡萄糖处置率：CHARLS的结果

背景：越来越多的证据表明胰岛素抵抗可能导致神经退行性变，但其在非糖尿病人群中的作用尚不清楚。本研究探讨了非糖尿病成人中估计的葡萄糖处置率（eGDR）（胰岛素敏感性的测量指标）与认知功能障碍之间的关系。方法：我们的纵向分析使用了5178名CHARLS参与者（年龄≥45岁）的数据。使用eGDR定量胰岛素敏感性，根据腰围、高血压状态和血红蛋白A1c水平计算。参与者按eGDR四分位数分层进行比较分析。我们采用多变量Cox模型、生存曲线、受限三次样条和敏感性测试来评估与认知结果的关联。结果：在8.7年的随访中，36.9%的参与者出现认知功能障碍。分析显示显著的代谢-认知关联，eGDR每增加一个标准差，风险降低15.8%（校正风险比[HR] = 0.792, 95%可信区间[CI]: 0.793-0.881）。限制三次样条分析发现了非线性阈值效应，在一定的eGDR水平下，风险加速（P < 0.05）。Kaplan-Meier生存分析显示，eGDR四分位数中认知障碍发生率存在显著差异（P = 0.003）。此外，eGDR和胰岛素抵抗代谢评分（METS-IR）对认知障碍风险的预测价值相当，优于其他代谢指标，包括血浆动脉粥样硬化指数（AIP）和甘油三酯葡萄糖指数（TyG）。结论：这些发现表明eGDR是一种很有希望的非糖尿病成人认知风险分层的生物标志物。然而，进一步的多数据库研究应该验证这些关联并探索潜在的机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Medicine Medicine-General Medicine

CiteScore

5.10

自引率

5.10%

发文量

3710

审稿时长

12 weeks

期刊介绍： Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate - the use of patient-reported outcomes under real world conditions - the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines - the scientific bases for guidelines and decisions from regulatory authorities - access to medicinal products and medical devices worldwide - addressing the grand health challenges around the world