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

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.