National trends in insulin resistance andβ-cell dysfunction among adults with prediabetes:NHANES 2001-2016

摘要

Background::Insulin resistance is the central abnormality and mechanism underlying the progression of cardiometabolic-based chronic diseases.This study aimed to evaluate the trends in insulin resistance andβ-cell dysfunction from 2001 to 2016 among US adults with undiagnosed diabetes,prediabetes,and normal glucose regulation and to provide sex-specific information using data from National Health and Nutrition Examination Surveys(NHANES)2001-2016.Methods::Data from 14,481 participants aged over 20 years from 8 consecutive 2-year cross-sectional cycles of the NHANES from 2001 to 2016 were used.Updated homoeostasis model assessment 2(HOMA2:HOMA2%B forβ-cell function and HOMA2IR for insulin resistance)was used as a surrogate measure.We defined the upper sex-specific tertile of HOMA2IR as insulin resistance and the lower corresponding tertile of HOMA2%B as lowβ-cell function.Results::In both sexes with undiagnosed diabetes,HOMA2%B(men,Ptrend=0.118;women,Ptrend=0.184)and HOMA2IR(men,Ptrend=0.710;women,Ptrend=0.855)remained stable over time.In the prediabetes group,both sexes exhibited significant increasing trends in HOMA2%B(men,Ptrend<0.010;women,Ptrend<0.010)and HOMA2IR(men,Ptrend<0.010;women,Ptrend<0.050).Adjusting for waist circumference mildly attenuated the trend in HOMA2IR and insulin resistance in men(Ptrend<0.010),but it resulted in no significance in women(Ptrend=0.196).In regard to normal glucose regulation,both sexes presented significant decreasing trends in lowβ-cell function(men,Ptrend<0.050;women<0.010)and attenuated trends in insulin resistance(men,Ptrend=0.196;women,Ptrend=0.121).Conclusions::Over 16 years,insulin resistance demonstrated an increasing trend in adult US population with prediabetes,whileβ-cell function showed a compensatory increasing trend.Identifying people with prediabetes early and focusing on reducing insulin resistance as the intervention core,especially controlling central obesity,might increase the opportunity for cardiovascular and diabetes risk reduction.