Relationship Between Cardiometabolic Index and Insulin Resistance in Patients with Type 2 Diabetes

Figures & data

Table 1 Baseline Characteristics of the T2DM Patients Stratified by Insulin Resistance and Gender

	Male		P-value	Female		P-value
	IR positive	IR Negative		IR Positive	IR Negative
N	231	1274		172	816
Age, years	54.6±16.6	55.3±14.1	0.526	66.6±13.8	61.3±13.5	<0.001
Duration of diabetes, year	5.0±6.2	4.2±5.6	0.040	8.8±7.0	8.5±7.1	0.117
Hypertension, n (%)	58.6	42.0	<0.001	67.6	48.3	<0.001
Height, cm	169.8±6.3	169.0±7.3	0.113	155.9±6.0	156.8±6.8	0.116
Weight, kg	76.9±15.3	69.6±11.8	<0.001	62.7±10.4	59.0±10.1	<0.001
Body mass index, Kg/m^2	26.6±4.4	24.5±10.5	<0.001	25.7±3.6	24.1±7.3	0.006
Waist circumference, cm	92.7±12.7	88.2±22.2	0.003	88.5±10.5	84.6±11.1	<0.001
Waist-to-height ratio	0.55±0.07	0.52±0.13	0.009	0.57±±0.07	0.54±0.08	<0.001
Systolic blood pressure, mmHg	146.4±23.6	139.1±26.7	<0.001	149.4±24.5	141.5±27.8	0.001
Diastolic blood pressure, mmHg	87.4±7.2	84.2±25.0	0.051	82.5±1.7	81.7±7.9	0.264
Current smoking, %	40.2	41.8	1.000	0	1.3	0.601
Current drinking, %	11.3	10.2	0.726	1.8	0	0.504
Metformin, %	53.5	37.4	<0.001	66.7	53.5	<0.001
α-glucosidase inhibitors, %	36.1	26.1	<0.001	49.0	29.1	<0.001
Thiazolidinediones, %	8.8	2.1	<0.001	11.8	5.8	<0.001
Hemoglobin A1c, mmol/L	8.9±2.2	9.5±2.3	0.001	8.6±1.7	9.5±2.3	<0.001
FPG, mmol/L	8.1±2.3	6.3±1.7	<0.001	8.3±2.0	6.8±2.1	<0.001
2-h PPG, mmol/L	16.0±3.8	16.4±3.8	0.222	16.9±4.0	17.2±3.9	0.360
FCP, ng/mL	1.99±0.80	0.66±0.37	<0.001	1.94±0.73	0.65±0.37	<0.001
2-h PCP, ng/mL	4.63±2.51	2.53±1.82	<0.001	4.68±2.54	2.42±1.80	<0.001
HOMA-IR	3.32±0.69	2.00±0.29	<0.001	3.34±0.64	2.02±0.30	<0.001
Albumin, g/dl	41.0±5.5	40.4±4.2	0.081	41.4±6.2	39.8±3.6	<0.001
Creatinine, umol/L	100.9±79.1	74.6±28.9	<0.001	73.1±40.6	57.2±32.8	<0.001
Uric acid, umol/L	421.1±117.3	355.9±98.5	<0.001	377.4±123.8	300.4±89.3	<0.001
ALT, U/L	38.8±45.7	30.7±39.0	0.006	29.6±21.7	23.3±28.0	0.007
AST, U/L	31.9±40.7	25.1±19.6	<0.001	27.6±16.3	22.4±13.6	<0.001
GGT, U/L	66.2±83.9	51.5±117.3	0.076	50.1±60.1	29.6±49.4	<0.001
Total cholesterol, mmol/L	4.60±1.49	4.56±1.36	0.629	4.58±1.37	4.68±1.20	0.315
Triglycerides, mmol/L	2.88±3.24	1.98±1.98	<0.001	2.57±1.98	1.74±1.15	<0.001
HDL-cholesterol, mmol/L	0.94±0.33	0.99±0.28	0.019	1.00±0.29	1.14±0.31	<0.001
LDL-cholesterol, mmol/L	2.65±1.03	2.84±1.08	0.013	2.66±1.15	2.90±1.06	0.007
CMI	1.78±1.68	1.18±1.23	<0.001	1.63±1.42	0.93±0.76	<0.001

Notes: Values are mean±SD or number (%). P<0.05 was deemed significant (comparison between IR positive and IR negative).

Abbreviations: FPG, fasting plasma glucose; HDL-c, High density lipoprotein cholesterol; ALT, alanine aminotransferase; GGT, glutamyl transpeptidase; AST, aspartate transaminase; LDL-c, Low density lipoprotein cholesterol; 2-h PPG, 2-h postprandial plasma glucose; 2h PCP, 2-hour postprandial C-peptide; FCP, fasting C-peptide; HOMA, homeostatic model assessment of insulin resistance; CMI, cardiometabolic index.

Table 2 Spearmen’s Correlation of CMI Levels with Clinical and Biochemical Parameters

Variable	Male		Female
	r	P	r	p
BMI	0.429	<0.001	0.322	<0.001
WC	0.388	<0.001	0.344	<0.001
SBP	0.033	0.201	0.076	0.017
DBP	0.166	<0.001	0.141	<0.001
HbA1c	0.094	0.001	0.024	0.503
TC	0.228	<0.001	0.152	<0.001
LDL-C	−0.002	0.946	0.038	0.231
FPG	0.098	<0.001	0.141	<0.001
FCP	0.363	<0.001	0.397	<0.001
HOMA-IR	0.346	<0.001	0.391	<0.001

Abbreviations: BMI, body weight index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, glycosylated hemoglobin; TC, total cholesterol; LDL-C, low density lipoprotein cholesterol; FPG, fasting plasma glucose; FCP, fasting C-peptide; HOMA, homeostatic model assessment of insulin resistance; CMI, cardiometabolic index.

Table 3 Association of the Insulin Resistance with CMI Quartiles

	Crude Model		Model I		Model II
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Male
Q1	Ref		Ref		Ref
Q2	1.70 (0.98–2.96)	0.060	1.67 (0.96–2.91)	0.068	1.65(0.89–3.07)	0.112
Q3	2.75 (1.63–4.63)	<0.001	2.72 (1.61–4.58)	<0.001	2.97(1.68–5.25)	<0.001
Q4	4.70 (2.91–7.59)	<0.001	4.67 (2.87–7.61)	<0.001	3.91(2.19–6.98)	<0.001
Female
Q1	Ref		Ref		Ref
Q2	2.14 (1.12–4.08)	0.021	1.99 (1.04–3.82)	0.039	1.16(0.59–2.26)	0.668
Q3	4.02 (2.20–7.38)	<0.001	3.54 (1.92–6.54)	<0.001	2.56(1.40–4.68)	0.002
Q4	6.87 (3.82–12.38)	<0.001	6.45 (3.55–11.71©)	<0.001	2.87 (1.49–5.52)	0.002

Notes: Crude model: adjusted for none. Model I: adjusted for age and BMI. Model II: adjusted for age, BMI, DD, hypoglycemic drugs, SBP, DBP, HbA1c, serum creatinine, serum albumin, uric acid, ALT, AST, GGT, drinking, smoking.

Abbreviations: BMI, body mass index; DD, duration of diabetes mellitus; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, glycosylated hemoglobin; ALT, alanine aminotransferase; GGT, glutamyl transpeptidase; AST, aspartate transaminase; CMI, cardiometabolic index.

Figure 1 The smooth curve fit for the association between CMI and prevalence of IR. Solid redline represents the smooth curve fit between variables. Blue bands represent the 95% of confidence interval from the fit. Adjusted for: age, BMI, DD, hypoglycemic drugs, SBP, DBP, HbA1c, serum creatinine, serum albumin, uric acid, ALT, AST, GGT, drinking and smoking.

Table 4 Association Between CMI and Insulin Resistance Stratified by Age, BMI and Hypertension

	OR (95% CI) p Value	P for Interaction
Stratified by gender		0.029
Male	1.30 (1.15–1.47), <0.001
Female	1.62 (1.32–1.99), <0.001
Stratified by age		0.016
Age<60 years old	1.23 (1.08, 1.41), 0.003
Age≥60 years old	1.74 (1.43, 2.12), <0.001
Stratified by BMI		0.142
BMI<24kg/m2	1.65 (1.33, 2.03), <0.001
BMI≥24kg/m2	1.26 (1.11, 1.42), <0.001
Stratified by HbA1c		0.020
HbA1c<7%	2.33 (1.43, 3.80), 0.001
HbA1c≥7%	1.35 (1.21, 1.50), <0.001

Notes: Gender, age, BMI, hypertension (not adjusted for in the subgroup analyses), DD, hypoglycemic drugs, serum creatinine, serum albumin, uric acid, ALT, AST, GGT, drinking, smoking were adjusted.

Abbreviations: BMI, body mass index; DD, duration of diabetes mellitus; ALT, alanine aminotransferase; GGT, glutamyl transpeptidase; AST, aspartate transaminase; CMI, cardiometabolic index.

Figure 2 Subgroups analysis for the association between CMI and prevalence of IR by gender, age, BMI and HbA1c level.

Table 5 The Results of ROC Analysis of CMI, TG/HDL, WHtR, VAI, DAI, BMI, WC and Uric Acid for the Diagnosis of IR

Nutritional Indices	Cut-off	Sensitivity (%)	Specificity (%)	AUC	95% CI
Male
CMI	0.77	77.5	53.3	0.702	0.665–0.738
TG/HDL	1.49	76.6	48.4	0.652	0.615–0.688
WHtR	0.55	42.4	76.6	0.612	0.571–0.653
VAI	1.93	77.4	48.0	0.664	0.615–0.689
DAI	1.30	76.5	48.3	0.659	0.610–0.684
BMI	24.6	68.0	57.7	0.658	0.620–0.697
WC	98.8	69.3	88.0	0.616	0.574–0.658
UA	368.5	67.7	61.1	0.674	0.634–0.714
Female
CMI	0.89	74.8	61.9	0.733	0.690–0.777
TG/HDL	1.63	66.3	62.1	0.688	0.645–0.731
WHtR	0.52	79.7	40.4	0.612	0.568–0.656
VAI	3.09	68.6	61.8	0.689	0.642–0.729
DAI	1.79	68.6	61.2	0.685	0.638–0.725
BMI	23.7	73.3	50.6	0.638	0.595–0.681
WC	81.8	79.1	40.7	0.599	0.555–0.643
UA	347.5	55.2	74.7	0.689	0.642–0.737

Abbreviations: CMI, cardiometabolic index; TG/HDL, triglycerides/ high density lipoprotein cholesterol; WhtR, waist-to-height ratio; VAI, visceral Adiposity Index; DAI, dysfunctional Adiposity Index; BMI, body mass index; WC, waist circumference; UA, uric acid.

Figure 3 Receiver operating characteristic curves of TG/HDL, WHtR, VAI, DAI, BMI, WC and uric acid to identify IR.