Predictive value of MetS-IR for the glucose status conversion in prediabetes: a multi-center retrospective cohort study.

Background: The metabolic score for insulin resistance (METS-IR), a surrogate parameter for insulin resistance, is closely correlated with glucose metabolism. This study aims to investigate the impact of METS-IR in the progression from prediabetes to diabetes, as well as the reversion to normoglycemia in individuals with prediabetes.

Methods: This retrospective cohort study comprised 15,424 prediabetes patients from 32 sites across 11 cities in China. We monitored changes in the glycemic status of these patients over the follow-up period, including the reversion from prediabetes to normoglycemia, progression to diabetes, or maintenance of the prediabetic condition. Cox proportional hazard regression analysis and restricted cubic splines (RCS) were conducted to investigate the correlation between METS-IR and the progression to diabetes or reversion to normoglycemia. Additionally, the predictive value of MetS-IR for changes in glucose status was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: During the median follow-up of 2.92 years, 6682 individuals (43.3%) reverted from prediabetes to normoglycemia, 6992 individuals (45.3%) remained in prediabetes status, and 1750 individuals (11.3%) progressed to diabetes. Notably, an increase in the baseline METS-IR quartile was associated with a heightened risk of diabetes development and a reduced likelihood of reverting to normoglycemia (both P for trend < 0.001). Multivariate Cox regression and RCS analysis showed that METS-IR was significantly associated with both the progression to diabetes and the reversion to normoglycemia, exhibiting a non-linear relationship in both cases. Compared with the lowest METS-IR quartile, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for diabetes progression and normoglycemic reversion in the highest METS-IR quartile was 2.11 (1.78, 2.50) and 0.57 (0.53, 0.62), respectively. The ROC curves analysis showed that METS-IR was the most effective predictor of glycemic status transition in individuals with prediabetes, with an area under the curve (AUC) surpassing those of triglyceride glucose (TyG), atherogenic index of plasma (AIP), and body mass index (BMI).

Conclusion: Our study reveals a significant correlation between METS-IR and prediabetes reversion/progression. Regular monitoring of METS-IR in clinical practice may help predict the conversion of glucose status in prediabetes patients and enhance the early identification of populations at elevated risk for diabetes.