Associations between the surrogate markers of insulin resistance and the mean blood glucose fluctuation amplitude in type 2 diabetic patients with different BMIs.

Abstract

Background: The mean amplitude of glycemic excursions (MAGE) is considered the "gold standard" for assessing glycemic variability. Surrogate markers for insulin resistance (IR) have been proposed. We aim to explore the associations between surrogate markers of IR and MAGE in type 2 diabetic patients with different body mass indices (BMIs).

Methods: A retrospective analysis of the clinical data of 309 hospitalized patients with type 2 diabetes was conducted. Patients were divided into two groups on the basis of whether their MAGE level was within the target range (< 3.9 mmol/l). Patients were categorized into two subgroups on the basis of BMI (BMI < 23 nonoverweight people and BMI ≥ 23 overweight people). Each surrogate marker of the IR was divided into three groups according to the interthird spacing of our specific research population and the level and achievement rate of MAGE differences among the three groups were compared. Multivariate logistic regression was used to assess the associations between surrogate markers of IR and MAGE.

Results: (1) Compared with the nontargeted MAGE group, the target group presented statistically significant differences in BMI,2-h postprandial blood glucose (2 h-PG), triglyceride(TG), the triglyceride‒glucose index (TyG), and the homeostasis model assessment of IR on the basis of C-peptide (HOMA2‒IR),(all P < 0.01). (2) In the subgroup with BMI < 23, there were statistically significant differences in MAGE levels among all the IR surrogate marker groups(all p < 0.05), and the triglyceride‒glucose‒body mass index (TyG‒BMI) groups presented differences in the achievement rates of the target MAGE(p < 0.001). In the population with BMI ≥ 23, there were statistically significant differences in both MAGE levels and achievement rates among all the IR surrogate marker groups (all P < 0.05). (3) In the subgroup with BMI < 23, the multivariable logistic regression model revealed that, after adjusting for relevant confounding factors, a high TyG-BMI was a favourable factor for achieving the target MAGE(OR = 16.50, 95% CI 2.44-111.66). In the population with BMI ≥ 23, the multivariable logistic regression model indicated that high TyG (OR = 0.20,95% CI 0.09-0.46), TyG-BMI(OR = 0.27,95% CI:0.13-0.58), the metabolic score for IR (METS‒IR) (OR = 0.36,95% CI 0.17-0.77)and HOMA2-IR(OR = 0.01, 95% CI 0.00-0.02) values were adverse factors for achieving the target.

Conclusion: In type 2 diabetic patients with BMI < 23, a high TyG-BMI was a favourable factor for achieving the target MAGE. For BMI ≥ 23, TyG, TyG-BMI, METS-IR and HOMA2-IR were adverse factors for achieving the target MAGE.