ArticleInternational journal of endocrinology2026
Comparative Discriminative Performance of the HbA1c/HDL-C Ratio, Stress Hyperglycemia Ratio, and ZJU Index for HOMA-IR-Defined Insulin Resistance in Patients With Type 2 Diabetes.
Article in International journal of endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Routine assessment of insulin resistance (IR) remains challenging because fasting insulin measurements are not routinely available in many clinical settings. Several readily available metabolic indices, including the HbA1c/HDL-C ratio, stress hyperglycemia ratio (SHR), and Zhejiang University (ZJU) index, have been associated with IR or related metabolic disturbances. However, their relative discriminative performance for HOMA-IR-defined IR in patients with established Type 2 diabetes has not been systematically compared. We aimed to compare their discriminative performance for HOMA-IR-defined IR and to assess whether ZJU provides incremental discrimination beyond conventional clinical and metabolic characteristics. Methods: This was a single-center retrospective cross-sectional study. We included 1000 hospitalized adults with established T2DM. HOMA-IR was calculated from fasting plasma glucose and fasting insulin, and IR was operationally defined as HOMA-IR ≥ 2.69. Multivariable logistic regression and restricted cubic spline analyses evaluated associations and nonlinear associations. Receiver operating characteristic analyses with paired DeLong tests compared discriminative performance. Additional analyses included TyG and TyG-BMI, comparisons with individual ZJU components, nested-model analysis, decision-curve analysis, bootstrap internal validation, and medication-adjusted sensitivity analyses. Results: All three indices were significantly associated with HOMA-IR-defined IR after multivariable adjustment. Compared with the lowest quartile, the adjusted odds ratios in the highest quartile were 3.16 (95% CI 1.95-5.18) for the HbA1c/HDL-C ratio, 6.86 (4.11-11.84) for SHR, and 18.36 (10.21-34.79) for ZJU. Significant nonlinear associations were observed for all three indices. Among the evaluated composite indices, ZJU had the highest AUC (0.777, 95% CI 0.742-0.812), followed by TyG (0.749, 0.712-0.785), TyG-BMI (0.733, 0.695-0.770), SHR (0.698, 0.659-0.738), and HbA1c/HDL-C (0.615, 0.573-0.657). ZJU did not significantly outperform FPG alone (AUC 0.766; Conclusions: In hospitalized patients with established T2DM, ZJU demonstrated moderate discrimination for HOMA-IR-defined IR and provided incremental discrimination beyond basic clinical characteristics.
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