Fig. 1Prevalence of type 2 diabetes mellitus (T2DM) and dysglycemia in different age groups and sex. aP<0.05, bP<0.01.
Fig. 2Area under the curve (AUC) (95% confidence interval [CI]) for (A) type 2 diabetes mellitus (T2DM) in men, (B) T2DM in women, (C) dysglycemia in men, and (D) dysglycemia in women in different age groups.
Fig. 3Comparison of homeostasis model assessment of β-cell function (HOMA-β) according to sex and age group (distinguished by 50 years) in (A) low tertile of homeostasis model assessment of insulin resistance (HOMA-IR), (B) mid tertile of HOMA-IR, and (C) high tertile of HOMA-IR among those with dysglycemia. White bar, 50 years old or less; gray bar, more than 50 years old. aP<0.05.
Table 1Baseline clinical and demographic characteristics
Characteristic |
Men |
Women |
P value |
Number |
1,851 |
2,440 |
|
Age, yr |
50.5±16.5 |
50.5±15.8 |
0.992 |
BMI, kg/m2
|
24.4±3.3 |
23.5±3.5 |
<0.001 |
SBP, mm Hg |
122±16 |
116±18 |
<0.001 |
DBP, mm Hg |
78±10 |
74±10 |
<0.001 |
FPG, mg/dL |
100±20 |
95±14 |
0.462 |
HbA1c, % |
5.6±0.6 |
5.5±0.5 |
0.015 |
T2DM |
120 (6.5) |
95 (3.9) |
<0.001 |
TG, mg/dL |
125 (86–188) |
96 (66–139) |
<0.001 |
HDL-C, mg/dL |
46 (39–54) |
53 (44–62) |
<0.001 |
Current smoker |
524 (28.8) |
73 (3.0) |
<0.001 |
Heavy alcoholics |
907 (59.3) |
443 (28.1) |
<0.001 |
Regular aerobic exercise |
944 (52.6) |
1,061 (44.3) |
<0.001 |
Educational state, ≤HS |
928 (51.5) |
1,492 (62.3) |
<0.001 |
Fasting insulin, µIU/mL |
6.45 (4.30–9.70) |
6.30 (4.40–9.30) |
0.495 |
HOMA-IR |
1.56 (0.99–2.41) |
1.44 (0.97–2.22) |
0.003 |
HOMA-β |
68.8 (45.9–102.2) |
76.5 (54.0–108.0) |
<0.001 |
Metabolic syndrome |
|
|
|
Abdominal obesity |
587 (31.7) |
683 (28.0) |
0.008 |
TG |
689 (37.2) |
516 (21.1) |
<0.001 |
HDL-C |
482 (26.0) |
977 (40.0) |
<0.001 |
Blood pressure |
868 (46.9) |
844 (34.6) |
<0.001 |
Table 2Multivariate OR (95% CI) of T2DM/dysglycemia according to metabolic syndrome components
Variable |
Men |
Women |
OR (95% CI) |
P value |
Multivariate OR (95% CI)a
|
P value |
OR (95% CI) |
P value |
Multivariate OR (95% CI)a
|
P value |
T2DM |
|
|
|
|
|
|
|
|
WC criteria |
0.90 (0.58–1.41) |
0.658 |
0.74 (0.45–1.24) |
0.254 |
4.97 (3.24–7.64) |
<0.001 |
1.58 (0.85–3.37) |
0.240 |
TG criteria |
2.04 (1.33–3.14) |
0.001 |
2.14 (1.31–3.50) |
0.003 |
1.51 (0.95–2.41) |
0.084 |
1.18 (0.58–2.38) |
0.649 |
HDL criteria |
0.77 (0.49–1.20) |
0.248 |
0.85 (0.51–1.42) |
0.541 |
1.61 (0.99–2.63) |
0.056 |
2.40 (1.13–5.07) |
0.022 |
BP criteria |
0.99 (0.64–1.53) |
0.952 |
1.10 (0.67–1.80) |
0.702 |
1.48 (0.88–2.48) |
0.139 |
1.57 (0.72–3.44) |
0.260 |
Dysglycemia |
|
|
|
|
|
|
|
|
WC criteria |
1.12 (0.74–1.68) |
0.601 |
1.44 (1.09–1.90) |
0.009 |
3.83 (3.18–4.61) |
<0.001 |
1.26 (0.92–1.72) |
0.159 |
TG criteria |
1.93 (1.28–2.90) |
0.002 |
1.61 (1.24–2.08) |
<0.001 |
1.62 (1.03–2.55) |
0.037 |
1.25 (0.89–1.74) |
0.196 |
HDL criteria |
0.81 (0.53–1.23) |
0.320 |
0.81 (0.60–1.08) |
0.144 |
1.56 (0.97–2.52) |
0.068 |
1.22 (0.92–1.62) |
0.160 |
BP criteria |
1.06 (0.70–1.62) |
0.782 |
1.07 (0.83–1.38) |
0.611 |
1.56 (0.94–2.59) |
0.084 |
1.01 (0.73–1.37) |
0.957 |
Table 3Assessment of dysglycemia and T2DM based on AUC and optimal cut-off points for HOMA-IR
|
Men |
Women |
AUC (95% CI) |
Cut-off |
Sensitivity, % |
Specificity, % |
PPV, % |
NPV, % |
AUC (95% CI) |
Cut-off |
Sensitivity, % |
Specificity, % |
PPV, % |
NPV, % |
Dysglycemia |
0.685 (0.671–0.719) |
1.6 |
64.3 |
64.5 |
65.0 |
63.6 |
0.728 (0.708–0.748) |
1.6 |
63.3 |
70.0 |
58.6 |
73.5 |
T2DM |
0.774 (0.730–0.818) |
2.9 |
56.7 |
85.4 |
21.2 |
96.6 |
0.837 (0.794–0.879) |
2.4 |
72.6 |
79.9 |
12.8 |
98.6 |
Table 4Association between metabolic syndrome components and the cut-off point of HOMA-IR (1.6) for dysglycemia
|
OR (95% CI)a
|
Men |
Women |
TG criteria |
2.61 (2.09–3.26) |
4.03 (3.05–5.33) |
HDL criteria |
2.75 (2.13–3.55) |
3.08 (2.46–3.84) |
BP criteria |
2.63 (2.08–3.32) |
2.03 (1.56–2.64) |
WC criteria |
7.61 (5.85–9.90) |
5.62 (4.31–7.34) |
Table 5Sex distribution of HOMA-IR cut-off levels based on sensitivity and specificity for T2DM in different age groups
Age, yr |
Incidence |
AUC (95% CI) |
P valuea
|
ROC coefficientsb
|
Youden index criteria |
Sensitivity, % |
Specificity, % |
Men |
|
|
|
|
|
|
20–30s |
9 (1.7) |
0.804 (0.646–0.962) |
.020 |
−0.035 |
66.7 |
82.7 |
40s |
20 (5.9) |
0.842 (0.764–0.919) |
|
|
70.0 |
81.8 |
50s |
33 (8.2) |
0.869 (0.814–0.925) |
|
|
72.7 |
87.3 |
60s |
37 (11.1) |
0.704 (0.614–0.794) |
|
|
40.5 |
81.2 |
70s |
21 (8.1) |
0.736 (0.628–0.844) |
|
|
42.9 |
90.3 |
Women |
|
|
|
|
|
|
20–30s |
11 (1.7) |
0.991 (0.982–1.000) |
<0.001 |
−0.092c
|
100 |
82.3 |
40s |
12 (2.5) |
0.946 (0.898–0.993) |
|
|
91.7 |
86.1 |
50s |
19 (3.4) |
0.839 (0.748–0.930) |
|
|
73.7 |
81.9 |
60s |
25 (6.2) |
0.760 (0.648–0.872) |
|
|
68.0 |
76.6 |
70s |
28 (8.3) |
0.736 (0.656–0.816) |
|
|
57.1 |
70.8 |