基于糖尿病前期亚型的分层揭示了2型糖尿病明显的长期风险

IF 10.4 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetologia Pub Date : 2026-10-17 DOI:10.1007/s00125-026-06866-4

Hun Jee Choe,Wonsuk Choi,Howard H. Chang,Dimple Kondal,K. M. Venkat Narayan,Joon Ho Moon,Nam H. Cho

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Cox regression was used to estimate diabetes risk, and multistate Markov models were used to assess annual transition probabilities and time spent in each state. Results Compared with normoglycaemia, the adjusted hazard ratios (aHRs) were 5.84 (95% CI 5.03, 6.79) for IFG, 4.60 (95% CI 4.17, 5.07) for IGT, and 4.68 (95% CI 4.22, 5.19) for HbA 1c -defined prediabetes. The risk increased stepwise with the number of criteria met: the aHRs were 3.10 (95% CI 2.81, 3.41) for one criterion, 7.33 (95% CI 6.50, 8.28) for two criteria, and 15.3 (95% CI 12.2, 19.3) for all three. Markov models showed the shortest prediabetes duration (1.7 years) and lowest regression probability (5.4%) in those meeting all three criteria. Low IGI or ISI predicted higher diabetes risk, and dual impairment conferred greatest risk (aHR 4.06; 95% CI 3.37, 4.90). Even normoglycaemic individuals with low IGI or ISI had an elevated risk of diabetes compared to those with high IGI or ISI. 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引用次数: 0

摘要

前驱糖尿病是异质性的，其亚型由空腹血糖受损（IFG）、糖耐量受损（IGT）或HbA 1c定义，每种亚型都有不同的进展为2型糖尿病的风险。我们比较了这些亚型的进展情况，并评估了增加胰岛素分泌的益处和对风险分层的敏感性。方法：我们分析了来自社区韩国基因组和流行病学研究的7186名年龄在40-69岁之间的韩国成年人，对他们进行了长达20年的随访，每两年进行一次口服葡萄糖耐量试验和HbA 1c。前驱糖尿病分为IFG、IGT或HbA 1c，并根据胰岛素原指数（IGI）和胰岛素敏感性指数（ISI）进一步分层。使用Cox回归估计糖尿病风险，使用多状态马尔可夫模型评估年转移概率和在每个状态花费的时间。结果与正常血糖相比，IFG的校正危险比（aHRs）为5.84 (95% CI 5.03, 6.79)， IGT的校正危险比（aHRs）为4.60 (95% CI 4.17, 5.07)， HbA 1c定义的前体糖尿病的校正危险比（aHRs）为4.68 （95% CI 4.22, 5.19）。风险随着满足标准的数量而逐步增加：一个标准的ahr为3.10 (95% CI 2.81, 3.41)，两个标准的ahr为7.33 (95% CI 6.50, 8.28)，三个标准的ahr为15.3 （95% CI 12.2, 19.3）。马尔可夫模型显示，满足所有三个标准的患者糖尿病前期病程最短（1.7年），回归概率最低（5.4%）。低IGI或ISI预示着更高的糖尿病风险，双重损害带来最大的风险（aHR 4.06; 95% CI 3.37, 4.90）。即使是血糖正常、IGI或ISI较低的个体，与IGI或ISI较高的个体相比，患糖尿病的风险也较高。结论/解释血糖型和生理型糖尿病的进展不同。将IGI和ISI与传统定义相结合，可以增强风险分层，并有助于识别高风险个体，以便进行早期有针对性的干预。

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Prediabetes subtype-based stratification reveals distinct long-term risks for type 2 diabetes

Abstract Aims/hypothesis Prediabetes is heterogeneous, with subtypes defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or HbA 1c , each with different risks of progression to type 2 diabetes. We compared progression across these subtypes, and evaluated the benefit of adding insulin secretion and sensitivity to risk stratification. Methods We analysed 7186 Korean adults aged 40–69 years from the community-based Korean Genome and Epidemiology Study, who were followed for up to 20 years with biennial (every 2 years) oral glucose tolerance tests and HbA 1c . Prediabetes was classified as IFG, IGT or HbA 1c -defined, and further stratified by insulinogenic index (IGI) and insulin sensitivity index (ISI). Cox regression was used to estimate diabetes risk, and multistate Markov models were used to assess annual transition probabilities and time spent in each state. Results Compared with normoglycaemia, the adjusted hazard ratios (aHRs) were 5.84 (95% CI 5.03, 6.79) for IFG, 4.60 (95% CI 4.17, 5.07) for IGT, and 4.68 (95% CI 4.22, 5.19) for HbA 1c -defined prediabetes. The risk increased stepwise with the number of criteria met: the aHRs were 3.10 (95% CI 2.81, 3.41) for one criterion, 7.33 (95% CI 6.50, 8.28) for two criteria, and 15.3 (95% CI 12.2, 19.3) for all three. Markov models showed the shortest prediabetes duration (1.7 years) and lowest regression probability (5.4%) in those meeting all three criteria. Low IGI or ISI predicted higher diabetes risk, and dual impairment conferred greatest risk (aHR 4.06; 95% CI 3.37, 4.90). Even normoglycaemic individuals with low IGI or ISI had an elevated risk of diabetes compared to those with high IGI or ISI. Conclusions/interpretation Diabetes progression differs based on both glycaemic subtype and physiological subtype. Integrating IGI and ISI with conventional definitions enhances risk stratification and may help to identify high-risk individuals for earlier targeted intervention.

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来源期刊

Diabetologia 医学-内分泌学与代谢

CiteScore

18.10

自引率

2.40%

发文量

193

审稿时长

1 months

期刊介绍： Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.