The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study

Abstract Background The association between newly developed insulin resistance (IR) indices and all-cause mortality in elderly patients with diabetes has not been investigated. Methods Baseline data and all-cause mortality for 1,248 elderly diabetes patients from the National Health and Nutrition Ex...

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Main Authors: Yanling Yang, Zhigu Liu, Beisi Lin, Yintong Huang, Hongrong Deng, Xubin Yang, Longyi Zeng, Jinhua Yan, Wen Xu
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Diabetology & Metabolic Syndrome
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Online Access:https://doi.org/10.1186/s13098-025-01732-6
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author Yanling Yang
Zhigu Liu
Beisi Lin
Yintong Huang
Hongrong Deng
Xubin Yang
Longyi Zeng
Jinhua Yan
Wen Xu
author_facet Yanling Yang
Zhigu Liu
Beisi Lin
Yintong Huang
Hongrong Deng
Xubin Yang
Longyi Zeng
Jinhua Yan
Wen Xu
author_sort Yanling Yang
collection DOAJ
description Abstract Background The association between newly developed insulin resistance (IR) indices and all-cause mortality in elderly patients with diabetes has not been investigated. Methods Baseline data and all-cause mortality for 1,248 elderly diabetes patients from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018 were collected. The traditional IR index homeostasis model assessment of insulin resistance (HOMA-IR) and several newly developed indices, including metabolic score for insulin resistance (METS-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose index (TyG), triglyceride glucose combined with body mass index (TyG-BMI), estimated glucose disposal rate (eGDR), and visceral adiposity index (VAI), were calculated for the patients. Cox proportional hazards regression and restricted cubic spline (RCS) regression models assessed the relationship between IR indices and all-cause mortality. Results In a median follow-up period of 73.3 months, there were 381 recorded deaths. In the total cohort, METS-IR (p < 0.001), TyG-BMI (p < 0.001), and eGDR (p = 0.011) demonstrated a significant association with all-cause mortality as continuous variables. HOMA-IR, METS-IR, TyG-BMI, and eGDR exhibited significant correlations with all-cause mortality in the Cox regression models (p < 0.05) when analyzed as categorical variables. A U-shaped relationship exists between METS-IR, TyG-BMI, eGDR, and all-cause mortality (p-overall < 0.0001, p-nonlinear < 0.05). No significant associations were found between TyG, TG/HDL-C, VAI, and all-cause mortality. Among male patients, TyG-BMI and HOMA-IR exhibited superior prognostic value, whereas in female patients, METS-IR, TyG-BMI, and eGDR showed better performance. Conclusion HOMA-IR, TyG-BMI, METS-IR, and eGDR were associated with mortality in elderly diabetic patients, with gender differences in their prognostic values.
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spelling doaj-art-c16b0a7398f14207bf01b5647215dccc2025-08-20T03:16:41ZengBMCDiabetology & Metabolic Syndrome1758-59962025-05-0117111810.1186/s13098-025-01732-6The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort studyYanling Yang0Zhigu Liu1Beisi Lin2Yintong Huang3Hongrong Deng4Xubin Yang5Longyi Zeng6Jinhua Yan7Wen Xu8Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen UniversityAbstract Background The association between newly developed insulin resistance (IR) indices and all-cause mortality in elderly patients with diabetes has not been investigated. Methods Baseline data and all-cause mortality for 1,248 elderly diabetes patients from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018 were collected. The traditional IR index homeostasis model assessment of insulin resistance (HOMA-IR) and several newly developed indices, including metabolic score for insulin resistance (METS-IR), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose index (TyG), triglyceride glucose combined with body mass index (TyG-BMI), estimated glucose disposal rate (eGDR), and visceral adiposity index (VAI), were calculated for the patients. Cox proportional hazards regression and restricted cubic spline (RCS) regression models assessed the relationship between IR indices and all-cause mortality. Results In a median follow-up period of 73.3 months, there were 381 recorded deaths. In the total cohort, METS-IR (p < 0.001), TyG-BMI (p < 0.001), and eGDR (p = 0.011) demonstrated a significant association with all-cause mortality as continuous variables. HOMA-IR, METS-IR, TyG-BMI, and eGDR exhibited significant correlations with all-cause mortality in the Cox regression models (p < 0.05) when analyzed as categorical variables. A U-shaped relationship exists between METS-IR, TyG-BMI, eGDR, and all-cause mortality (p-overall < 0.0001, p-nonlinear < 0.05). No significant associations were found between TyG, TG/HDL-C, VAI, and all-cause mortality. Among male patients, TyG-BMI and HOMA-IR exhibited superior prognostic value, whereas in female patients, METS-IR, TyG-BMI, and eGDR showed better performance. Conclusion HOMA-IR, TyG-BMI, METS-IR, and eGDR were associated with mortality in elderly diabetic patients, with gender differences in their prognostic values.https://doi.org/10.1186/s13098-025-01732-6Insulin resistanceDiabetes mellitusAll-cause mortalityGender interactionElderly patients
spellingShingle Yanling Yang
Zhigu Liu
Beisi Lin
Yintong Huang
Hongrong Deng
Xubin Yang
Longyi Zeng
Jinhua Yan
Wen Xu
The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study
Diabetology & Metabolic Syndrome
Insulin resistance
Diabetes mellitus
All-cause mortality
Gender interaction
Elderly patients
title The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study
title_full The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study
title_fullStr The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study
title_full_unstemmed The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study
title_short The association between new insulin resistance indices and all-cause mortality in elderly patients with diabetes: a prospective cohort study
title_sort association between new insulin resistance indices and all cause mortality in elderly patients with diabetes a prospective cohort study
topic Insulin resistance
Diabetes mellitus
All-cause mortality
Gender interaction
Elderly patients
url https://doi.org/10.1186/s13098-025-01732-6
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