International journal of endocrinology
Comparative Discriminative Performance of the HbA1c/HDL-C Ratio, Stress Hyperglycemia Ratio, and ZJU Index for HOMA-IR-Defined Insulin Resistance in Patients With Type 2 Diabetes
By Zheng Z, Li Q and Zhang H.
Abstract
Background
Routine assessment of insulin resistance (IR) remains challenging because fasting insulin measurements are not routinely available in many clinical settings. Several readily available metabolic indices, including the HbA1c/HDL-C ratio, stress hyperglycemia ratio (SHR), and Zhejiang University (ZJU) index, have been associated with IR or related metabolic disturbances. However, their relative discriminative performance for HOMA-IR-defined IR in patients with established Type 2 diabetes has not been systematically compared. We aimed to compare their discriminative performance for HOMA-IR-defined IR and to assess whether ZJU provides incremental discrimination beyond conventional clinical and metabolic characteristics.
Methods
This was a single-center retrospective cross-sectional study. We included 1000 hospitalized adults with established T2DM. HOMA-IR was calculated from fasting plasma glucose and fasting insulin, and IR was operationally defined as HOMA-IR ≥ 2.69. Multivariable logistic regression and restricted cubic spline analyses evaluated associations and nonlinear associations. Receiver operating characteristic analyses with paired DeLong tests compared discriminative performance. Additional analyses included TyG and TyG-BMI, comparisons with individual ZJU components, nested-model analysis, decision-curve analysis, bootstrap internal validation, and medication-adjusted sensitivity analyses.