Abstract
The present study evaluated the ability of the visceral adiposity index (VAI), the lipid accumulation product (LAP), and product of triglycerides and glucose (TyG), three novel, insulin resistance-related markers, to discriminate prediabetes/diabetes in the general German population. Altogether 2,045 Germans (31–72 years, 53.3% women) without known diabetes and a history of Myocardial Infarction (MI)/stroke from the Cooperative Health Research in the Region of Augsburg (KORA) F4 Study were eligible. The discriminatory accuracy of the markers for oral glucose tolerance test (OGTT)-defined prediabetes/diabetes according to the American Diabetes Association (ADA) criteria was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The Youden Index (YI) was used to determine optimal cut-off values, and a non-parametric ROC regression was used to examine whether the discriminatory accuracy varied by sex and age. 365 men (38.2%) and 257 women (23.6%) were newly diagnosed with prediabetes/diabetes. AUCs for TyG, LAP and VAI were 0.762 (95% CI 0.740–0.784), 0.743 (95% CI 0.720–0.765), and 0.687 (95% CI 0.662–0.712), respectively. The optimal cut-off values for the LAP and TyG were 56.70 and 8.75 in men, and 30.40 and 8.53 in women. In conclusion, TyG and LAP provide good discrimination of persons with prediabetes/diabetes.
Highlights
The incidence and prevalence of type 2 diabetes are increasing rapidly worldwide due to aging of the population and the Western lifestyle[1,2]
Several studies have suggested that novel indices, such as the visceral adiposity index (VAI), a model computed by both anthropometric and laboratory parameters, and the lipid accumulation product (LAP), a model based on a combination of TG and WC, might be accurate markers of IR8–10
BMI, WC, waist-to-hip ratio, fasting serum glucose (FSG), serum glucose 2 hours post oral glucose tolerance test (OGTT) (2h-serum glucose), TG, Hemoglobin A1C (HbA1c), use of statins, hypertension, parents’ history of diabetes, HOMA-Insulin resistance (IR), VAI, LAP, and triglycerides and glucose (TyG) were higher in the group of prediabetes/newly diagnosed diabetes compared to persons without diabetes
Summary
The incidence and prevalence of type 2 diabetes (hereafter, diabetes) are increasing rapidly worldwide due to aging of the population and the Western lifestyle[1,2]. The oral glucose tolerance test (OGTT) is currently the gold standard for the diagnosis of prediabetes/diabetes, but it is costly and inconvenient. Homeostatic model assessment of insulin resistance (HOMA-IR) has been used as a robust surrogate marker for defining IR because of the practical, ethical and economic issues of the hyperinsulinemic euglycemic clamp, which is the gold standard test for measurement of IR7. Given that IR is the critical pathophysiologic mechanism of diabetes and is already present ahead of the diagnosis, the novel surrogate indices of IR might be useful in the identification of prediabetes/diabetes[5,6]. To the best of our knowledge, limited evidence is available that provides data regarding the discriminatory accuracy of the three previously mentioned novel lipid indices for detecting prediabetes/diabetes. Previous reports have not tested whether discriminatory accuracy varies by sex and age[13,14]
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