Association of insulin resistance and β-cell dysfunction with incident diabetes among adults in China: a nationwide, population-based, prospective cohort study.,The Lancet Diabetes & Endocrinology

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Association of insulin resistance and β-cell dysfunction with incident diabetes among adults in China: a nationwide, population-based, prospective cohort study.
The Lancet Diabetes & Endocrinology ( IF 44.0 ) Pub Date : 2019-12-23 , DOI: 10.1016/s2213-8587(19)30425-5
Tiange Wang ₁ , Jieli Lu ₁ , Lixin Shi ₂ , Gang Chen ₃ , Min Xu ₁ , Yu Xu ₁ , Qing Su ₄ , Yiming Mu ₅ , Lulu Chen ₆ , Ruying Hu ₇ , Xulei Tang ₈ , Xuefeng Yu ₉ , Mian Li ₁ , Zhiyun Zhao ₁ , Yuhong Chen ₁ , Li Yan ₁₀ , Guijun Qin ₁₁ , Qin Wan ₁₂ , Meng Dai ₁ , Di Zhang ₁ , Zhengnan Gao ₁₃ , Guixia Wang ₁₄ , Feixia Shen ₁₅ , Zuojie Luo ₁₆ , Yingfen Qin ₁₆ , Li Chen ₁₇ , Yanan Huo ₁₈ , Qiang Li ₁₉ , Zhen Ye ₇ , Yinfei Zhang ₂₀ , Chao Liu ₂₁ , Youmin Wang ₂₂ , Shengli Wu ₂₃ , Tao Yang ₂₄ , Huacong Deng ₂₅ , Jiajun Zhao ₂₆ , Shenghan Lai ₂₇ , Yufang Bi ₁ , Ralph A DeFronzo ₂₈ , Weiqing Wang ₁ , Guang Ning ₁ ,

Affiliation

Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Affiliated Hospital of Guiyang Medical College, Guiyang, China.
Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.
Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Chinese People's Liberation Army General Hospital, Beijing, China.
Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
The First Hospital of Lanzhou University, Lanzhou, China.
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Dalian Municipal Central Hospital, Dalian, China.
The First Hospital of Jilin University, Changchun, China.
The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Qilu Hospital of Shandong University, Jinan, China.
Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China.
The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Central Hospital of Shanghai Jiading District, Shanghai, China.
Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China.
The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Karamay Municipal People's Hospital, Xinjiang, China.
The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Shandong Provincial Hospital, Shandong First Medical University, Jinan, China.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Diabetes Division, UT Health San Antonio, San Antonio, TX, USA.

BACKGROUND National investigations on the interaction of insulin resistance, β-cell dysfunction, and obesity with the development of diabetes are scarce in China. We aimed to investigate the individual and joint associations of insulin resistance and β-cell dysfunction with incident diabetes, and to examine the modifying effect of BMI and waist circumference on these associations among adults with normal glucose tolerance and with prediabetes. METHODS In this nationwide, population-based, prospective cohort study, we analysed data from the China Cardiometabolic Disease and Cancer Cohort Study, which recruited adults aged 40 years or older during 2011-12 (baseline) and invited participants to attend follow-up visits in 2014-16. Patients with diabetes at baseline, missing data for baseline measures of glucose tolerance status, missing data for baseline homoeostasis model assessment (HOMA) indexes, missing data for baseline covariates, and missing data for measures of glucose tolerance status at follow-up visits were excluded. At baseline and follow-up visits, a comprehensive set of questionnaires, clinical measurements, oral glucose tolerance tests, and laboratory examinations were carried out following standardised protocols. Glucose tolerance status and prediabetes were defined according to the American Diabetes Association 2010 criteria. In the main analysis, we examined the contributions of insulin resistance (HOMA of insulin resistance [HOMA-IR]) and β-cell dysfunction (HOMA of β-cell function [HOMA-B]) to diabetes risk, and evaluated the impact of obesity on these associations. FINDINGS 94 952 participants (31 517 men and 63 435 women) were included in the analysis. High HOMA-IR was associated with a greater hazard of diabetes (quartile 4 vs 1: hazard ratio [HR] 6·70, 95% CI 6·08-7·39; per unit increase in Z score: HR 2·17, 95% CI 2·10-2·24) than low HOMA-B (quartile 1 vs 4: 4·08, 3·72-4·48; per unit decrease in Z score: 1·92, 1·85-2·00). Approximately 24·4% (95% CI 23·6-25·2) of the incident diabetes could be attributed to insulin resistance and 12·4% (11·2-13·7) could be attributed to β-cell dysfunction. The HRs for diabetes were 1·83 (95% CI 1·72-1·95) per unit increase in Z score of HOMA-IR and 2·03 (1·86-2·21) per unit decrease in Z score of HOMA-B among participants with normal weight; the corresponding HRs for diabetes were 2·02 (1·93-2·11) and 1·88 (1·79-1·98) among participants with obesity (pinteraction=0·0091). These associations and interactions were similar for participants with normal glucose tolerance or prediabetes. INTERPRETATION Insulin resistance shows a stronger association with incident diabetes than does β-cell dysfunction in Chinese adults, and this association pattern was more prominent among adults with obesity. Given the limitations of HOMA indexes as surrogate measures of insulin resistance and β-cell dysfunction, these findings should be interpreted with caution. FUNDING National Natural Science Foundation of China.

更新日期：2020-01-22

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