PMID- 33788827 OWN - NLM STAT- MEDLINE DCOM- 20211013 LR - 20211013 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 16 IP - 3 DP - 2021 TI - Value of simple clinical parameters to predict insulin resistance among newly diagnosed patients with type 2 diabetes in limited resource settings. PG - e0248469 LID - 10.1371/journal.pone.0248469 [doi] LID - e0248469 AB - BACKGROUND: Insulin resistance (IR) has been considered as a therapeutic target in the management of type 2 diabetes mellitus (T2DM). Readily available, simple and low cost measures to identify individuals with IR is of utmost importance for clinicians to plan optimal management strategies. Research on the associations between surrogate markers of IR and routine clinical and lipid parameters have not been carried out in Sri Lanka, a developing country with rising burden of T2DM with inadequate resources. Therefore, we aimed to study the utility of readily available clinical parameters such as age, body mass index (BMI), waist circumference (WC) and triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) in the fasting lipid profile in predicting IR in a cohort of patients with newly diagnosed T2DM in Sri Lanka. METHODS AND FINDINGS: We conducted a community based cross sectional study involving of 147 patients (age 30-60 years) with newly diagnosed T2DM in a suburban locality in Galle district, Sri Lanka. Data on age, BMI, WC, fasting plasma glucose (FPG) concentration, fasting insulin concentration and serum lipid profile were collected from each subject. The indirect IR indices namely homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI) and McAuley index (MCA) were estimated. Both clinical and biochemical parameters across the lowest and the highest fasting insulin quartiles were compared using independent sample t-test. Linear correlation analysis was performed to assess the correlation between selected clinical parameters and indirect IR indices. The area under the receiver operating characteristic (ROC) curve was obtained to calculate optimal cut-off values for the clinical markers to differentiate IR. BMI (p<0.001) and WC (p = 0.01) were significantly increased whereas age (p = 0.06) was decreased and TG/HDL-C (p = 0.28) was increased across the insulin quartiles. BMI and WC were significantly correlated (p<0.05) with HOMA, QUICKI and MCA. Out of the clinical parameters, age showed a borderline significant correlation with QUICKI and TG/HDL-C showed a significant correlation only with MCA. The area under ROC of BMI was 0.728 (95% CI 0.648-0.809; p<0.001) and for WC, it was 0.646 (95% CI 0.559-0.734; p = 0.003). The optimized cut-off value for BMI and WC were 24.91 kg/m2 and 81.5 cm respectively to differentiate the patients with IR or ID. Study limitations include small sample size due to recruitment of patients only from a limited geographical locality of the country and not totally excluding of the possibility of inclusion of some patients with slowly progressive type 1 DM or Latent onset diabetes of adulthood from the study population. CONCLUSIONS: The results revealed that there was a significant positive correlation between BMI, WC and HOMA while a significant negative correlation with QUICKI and MCA among the cohort of patients with newly diagnosed T2DM. The cut-off values of BMI and WC as 24.91 kg/m2 and 81.5 cm respectively could be used as simple clinical parameters to identify IR in newly diagnosed patients with T2DM. Our results could be beneficial in rational decision making in the management of newly diagnosed patients with T2DM in limited resource settings. FAU - Wasana, Keddagoda Gamage Piyumi AU - Wasana KGP AD - Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. FAU - Attanayake, Anoja Priyadarshani AU - Attanayake AP AD - Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. FAU - Weerarathna, Thilak Priyantha AU - Weerarathna TP AUID- ORCID: 0000-0003-0047-6669 AD - Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. FAU - Jayatilaka, Kamani Ayoma Perera Wijewardana AU - Jayatilaka KAPW AD - Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210331 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Biomarkers) RN - 0 (Blood Glucose) RN - 0 (Cholesterol, HDL) RN - 0 (Insulin) RN - 0 (Triglycerides) SB - IM MH - Adult MH - Biomarkers/blood MH - Blood Glucose/analysis MH - *Body Mass Index MH - Cholesterol, HDL/*blood MH - Cohort Studies MH - Cross-Sectional Studies MH - Diabetes Mellitus, Type 2/*blood/*diagnosis/epidemiology MH - Fasting/blood MH - Female MH - Humans MH - Insulin/blood MH - *Insulin Resistance MH - Male MH - Middle Aged MH - Obesity/epidemiology MH - Sri Lanka/epidemiology MH - Suburban Population MH - Triglycerides/*blood MH - *Waist Circumference PMC - PMC8011789 COIS- The authors have declared that no competing interests exist. EDAT- 2021/04/01 06:00 MHDA- 2021/10/14 06:00 PMCR- 2021/03/31 CRDT- 2021/03/31 17:16 PHST- 2020/04/14 00:00 [received] PHST- 2021/02/09 00:00 [accepted] PHST- 2021/03/31 17:16 [entrez] PHST- 2021/04/01 06:00 [pubmed] PHST- 2021/10/14 06:00 [medline] PHST- 2021/03/31 00:00 [pmc-release] AID - PONE-D-20-10709 [pii] AID - 10.1371/journal.pone.0248469 [doi] PST - epublish SO - PLoS One. 2021 Mar 31;16(3):e0248469. doi: 10.1371/journal.pone.0248469. eCollection 2021.