Proinsulin-to-C-peptide ratio versus proinsulin-to-insulin ratio in the prediction of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS)
Proinsulin-to-C-peptide ratio versus proinsulin-to-insulin ratio in the prediction of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS)
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DOI：
10.1007/s00125-011-2322-2
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发表时间：
2011-12-01
期刊：
影响因子：
8.2
通讯作者：
Hanley, A. J.
中科院分区：
文献类型：
--
作者：
Loopstra-Masters, R. C.;Haffner, S. M.;Hanley, A. J.
目的 胰岛素原与胰岛素的比率与 2 型糖尿病发病率之间的关联并不一致。使用 C 肽作为比率中的分母可以实现更好的预测，因为 C 肽浓度不受肝脏胰岛素清除率的影响。本文的目的是比较空腹完整和分割胰岛素原与胰岛素比率 (PI/I、SPI/I) 与完整和分割胰岛素原与 C 肽比率 (PI/C-pep、SPI/C-pep) 在 2 型糖尿病预测中的作用。 方法 使用胰岛素抵抗动脉粥样硬化研究 (IRAS) 基线时无糖尿病的 818 名多种族成年人的前瞻性数据。通过频繁采样的静脉内葡萄糖耐量试验测定胰岛素敏感性（SI）和急性胰岛素反应（AIR），并使用基于特定双位点单克隆抗体的免疫放射测定法测量空腹完整胰岛素原和裂解胰岛素原。使用逻辑回归确定胰岛素原比率与 2 型糖尿病的关联，并通过比较接受者操作特征曲线 (AROC) 下的面积来评估预测差异。结果 在逻辑回归分析中，PI/C-pep 和 SPI/C-pep 与 2 型糖尿病发病 (n=128) 的相关性比 PI/I 和 SPI/I 更强，并且在 AROC 分析中是更好的糖尿病预测因子（PI/C-pep=0.662 vs PI/I=0.603，p=0.02；SPI/C-pep=0.690 与 SPI/I=0.631，p=0.01）。调整年龄、性别、种族、腰围、糖耐量受损、血脂和 SI 后，PI/C-pep 和 SPI/C-pep 均与 2 型糖尿病相关。在包含 AIR 的模型中，PI/C-pep 和 SPI/C-pep 均与 2 型糖尿病的发生显着相关。 结论 与胰岛素原与胰岛素比率相比，胰岛素原与 C 肽比率是糖尿病更强的预测因子。这些发现支持使用C肽作为胰岛素原比率的分母，以更准确地反映不成比例的高胰岛素原血症的程度。
Aims Associations of proinsulin-to-insulin ratios with incident type 2 diabetes have been inconsistent. The use of C-peptide as the denominator in the ratio may allow for better prediction because C-peptide concentration is not affected by hepatic insulin clearance. The objective of this paper was to compare fasting intact and split proinsulin-to-insulin ratios (PI/I, SPI/I) with intact and split proinsulin-to-C-peptide ratios (PI/C-pep, SPI/C-pep) in the prediction of type 2 diabetes.Methods Prospective data on 818 multi-ethnic adults without diabetes at baseline from the Insulin Resistance Atherosclerosis Study (IRAS) were used. Insulin sensitivity (SI) and acute insulin response (AIR) were determined from frequently sampled intravenous glucose tolerance tests, and fasting intact and split proinsulin were measured using specific two-site monoclonal antibody-based immunoradiometric assays. Associations of proinsulin ratios with type 2 diabetes were determined using logistic regression and differences in prediction were assessed by comparing areas under the receiver operating characteristic curve (AROCs).Results In logistic regression analyses, PI/C-pep and SPI/C-pep were more strongly associated with incident type 2 diabetes (n=128) than PI/I and SPI/I, and were significantly better predictors of diabetes in AROC analyses (PI/C-pep=0.662 vs PI/I=0.603, p=0.02; SPI/C-pep=0.690 vs SPI/I=0.631, p=0.01). Both PI/C-pep and SPI/C-pep were associated with type 2 diabetes after adjustment for age, sex, ethnicity, waist circumference, impaired glucose tolerance, lipids and SI. Both PI/C-pep and SPI/C-pep were significantly associated with incident type 2 diabetes in models that included AIR.Conclusions Proinsulin-to-C-peptide ratios were stronger predictors of diabetes in comparison with proinsulin-to-insulin ratios. These findings support the use of C-peptide as the denominator for proinsulin ratios, to more accurately reflect the degree of disproportional hyperproinsulinaemia.