Influencing Factors Analysis of the Dynamic Trajectories of Fasting Blood Glucose-Insulin Resistance in Patients With Type 2 Diabetes Mellitus

CUI Xinyuan; XU Bojin; ZHOU Haiping; DU Juan; GE Xiaoxu; TANG Yubin; HUANG Shan; PENG Wenfang

doi:10.11714/jsysu.med.YX20250149

您当前的位置：

首页 >

文章列表页 >

Influencing Factors Analysis of the Dynamic Trajectories of Fasting Blood Glucose-Insulin Resistance in Patients With Type 2 Diabetes Mellitus

Clinical Research | 更新时间：2026-01-30

- Influencing Factors Analysis of the Dynamic Trajectories of Fasting Blood Glucose-Insulin Resistance in Patients With Type 2 Diabetes Mellitus
- Journal of Sun Yat-sen University(Medical Sciences) Vol. 47, Issue 1, Pages: 162-171(2026)
- 作者机构：
  
  上海交通大学医学院附属同仁医院内分泌内科，上海200336
- 作者简介：
  
  PENG Wenfang； E-mail： pwf1826@126.com
- 基金信息：
- DOI：10.11714/jsysu.med.YX20250149
  CLC： R587.1
- Received：12 October 2025，
  
  Revised：2025-11-20，
  
  Accepted：17 December 2025，
  
  Published：20 January 2026
- 稿件说明：
移动端阅览
崔心远,许波进,周海平等.2型糖尿病患者空腹血糖-胰岛素抵抗动态轨迹的影响因素分析[J].中山大学学报（医学科学版）,2026,47(01):162-171.

CUI Xinyuan,XU Bojin,ZHOU Haiping,et al.Influencing Factors Analysis of the Dynamic Trajectories of Fasting Blood Glucose-Insulin Resistance in Patients With Type 2 Diabetes Mellitus[J].Journal of Sun Yat-sen University(Medical Sciences),2026,47(01):162-171.
崔心远,许波进,周海平等.2型糖尿病患者空腹血糖-胰岛素抵抗动态轨迹的影响因素分析[J].中山大学学报（医学科学版）,2026,47(01):162-171. DOI： 10.11714/jsysu.med.YX20250149.

CUI Xinyuan,XU Bojin,ZHOU Haiping,et al.Influencing Factors Analysis of the Dynamic Trajectories of Fasting Blood Glucose-Insulin Resistance in Patients With Type 2 Diabetes Mellitus[J].Journal of Sun Yat-sen University(Medical Sciences),2026,47(01):162-171. DOI： 10.11714/jsysu.med.YX20250149.

摘要

目的

探讨2型糖尿病（T2DM）患者空腹血糖（FBG）与胰岛素抵抗（IR）长期动态轨迹特征及其影响因素。

方法

本研究为回顾性队列研究，纳入2020年5月—2025年5月上海市同仁医院登记的1 896例T2DM患者。基于纵向随访的FBG与空腹胰岛素数据，采用联合潜类别混合模型识别FBG-IR联合演变轨迹，并通过单因素和多因素logistic回归分析探讨人口学特征、生活方式及临床指标对轨迹类型的影响。

结果

共识别出4类FBG-IR轨迹：稳定FBG-IR型（9.76%）、升高FBG-稳定IR型（5.01%）、稳定FBG-升高IR型（75.90%）及升高FBG-IR型（9.34%）。与稳定FBG-IR型相比，年龄≥60岁是升高FBG-稳定IR型的保护因素（OR=0.55，95%CI：0.33～0.92，

=0.023）；高中及以上文化程度增加稳定FBG-升高IR型风险（OR=1.40，95%CI：1.01～1.94，

=0.046）；血压异常与稳定FBG-升高IR型（OR=0.66，95%CI：0.48～0.92，

=0.013）及升高FBG-IR型（OR=0.48，95%CI：0.31～0.74，

=0.001）的风险降低相关；从不饮酒者进入稳定FBG-升高IR型风险较低（OR=0.39，95%CI：0.16～0.95，

=0.038）。

结论

T2DM患者FBG与IR存在显著异质性的演变轨迹，IR恶化先行者占多数。年龄、教育程度、血压和饮酒情况是主要影响因素。联合评估FBG与IR有助于早期识别高危人群并指导个体化干预。

Abstract

Objective

To explore the long-term dynamic trajectories of fasting blood glucose （FBG） and insulin resistance （IR） in patients with type 2 diabetes mellitus （T2DM） and their influencing factors.

Methods

This retrospective cohort study included 1 896 T2DM patients registered at Tongren Hospital from May 2020 to May 2025. Based on longitudinal follow-up data of FBG and fasting insulin， joint latent class mixed models （JLMM） were applied to identify FBG-IR trajectories. Univariate and multinomial logistic regression was used to examine demographic characteristics， lifestyle， and clinical determinants of trajectory type.

Results

Four distinct FBG-IR trajectories were identified： stable FBG-IR （9

.76%）， rising FBG-stable IR （5.01%）， stable FBG-elevated IR （75.90%）， and elevated FBG-IR （9.34%）. Compared with the stable FBG-IR group， age ≥60 years was protective against the elevated FBG-stable IR trajectory （OR=0.55， 95%CI：0.33-0.92，

=0.023）. Highereducation increased the risk of stable FBG-elevated IR （OR=1.40， 95%CI：1.01-1.94，

=0.046）. Abnormal blood pressure was associated with lower risks of stable FBG-elevated IR （OR=0.66， 95%CI：0.48-0.92，

=0.013） and elevated FBG-IR （OR=0.48， 95%CI：0.31-0.74，

=0.001）. Non-drinkers were less likely to belong to the stable FBG-elevated IR trajectory （OR=0.39， 95%CI：0.16-0.95，

=0.038）.

Conclusions

The evolution trajectory of FBG and IR in T2DM patients shows significant heterogeneity. The majority of patients have a deterioration of IR first. Age， education level， blood pressure， and alcohol consumption are the main influencing factors. Joint assessment of FBG and IR is helpful for early identification of high-risk individuals and guiding individualized intervention.

关键词

Keywords

references

Kjærgaard J ， Stocks B ， Henderson J ， et al . Personalized molecular signatures of insulin resistance and type 2 diabetes ［J］. Cell ， 2025 ， 188 （ 15 ）： 4106 - 4122.e16 .

Yang M ， Wei Y ， Liu J ， et al . Contributions of hepatic insulin resistance and islet β-cell dysfunction to the blood glucose spectrum in newly diagnosed type 2 diabetes mellitus ［J］. Diabetes Metab J ， 2025 ， 49 （ 4 ）： 883 - 892 .

Jagannathan R ， Staimez LR ， Narayan KMV . Type 2 diabetes subtypes classification： a global reckoning with heterogeneity ［J］. Lancet Diabetes Endocrinol ， 2025 . doi： 10.1016/S2213-8587（25）00256-6 http://dx.doi.org/10.1016/S2213-8587（25）00256-6 .

Arons ARO ， Pacca L ， Jr Jacobs DR ， et al . Thirty-year glycemic trajectories from young adulthood through middle age ［J］. JAMA Netw Open ， 2025 ， 8 （ 6 ）： e2517455 .

Tabák AG ， Jokela M ， Akbaraly TN ， et al . Trajectories of glycaemia， insulin sensitivity， and insulin secretion before diagnosis of type 2 diabetes： an analysis from the Whitehall II study ［J］. Lancet ， 2009 ， 373 （ 9682 ）： 2215 - 2221 .

于晓濛，王宁 . 胰岛素抵抗新型评价指标对2型糖尿病患者下肢动脉病变的风险预测［J］. 实用医学杂志， 2025 ， 41 （ 21 ）： 3371 - 3377 .

Yu XM ， Wang N . Association between novel insulin resistance indices and lower extremity atherosclerotic disease in patients with type 2 diabetes mellitus ［J］. J Pract Med ， 2025 ， 41 （ 21 ）： 3371 - 3377 .

Kyheng M ， Babykina G ， Ternynck C ， et al . Joint latent class model： simulation study of model properties and application to amyotrophic lateral sclerosis disease ［J］. BMC Med Res Methodol ， 2021 ， 21 （ 1 ）： 198 .

中华医学会糖尿病学分会 . 中国糖尿病防治指南（2024版）［J］. 中华糖尿病杂志， 2025 ， 17 （ 1 ）： 16 - 139 .

Chinese Diabetes Society . Chinese guideline for the prevention and treatment of diabetes mellitus （2024 edition）［J］. Chin J Diabetes Mellitus ， 2025 ， 17 （ 1 ）： 16 - 139 .

Hammel MC ， Stein R ， Kratzsch J ， et al . Fasting indices of glucose-insulin-metabolism across life span and prediction of glycemic deterioration in children with obesity from new diagnostic cut-offs ［J］. Lancet Reg Health Eur ， 2023 ， 30 ： 100652 .

Khalid M ， Alkaabi J ， Khan MAB ， et al . Insulin signal transduction perturbations in insulin resistance ［J］. Int J Mol Sci ， 2021 ， 22 （ 16 ）： 8590 .

Lin WR ， Liu KH ， Ling TC ， et al . Role of antidiabetic agents in type 2 diabetes patients with chronic kidney disease ［J］. World J Diabetes ， 2023 ， 14 （ 4 ）： 352 - 363 .

DeFronzo RA . From the triumvirate to the ominous octet： a new paradigm for the treatment of type 2 diabetes mellitus ［J］. Diabetes ， 2009 ， 58 （ 4 ）： 773 - 795 .

American Diabetes Association Professional Practice Committee . Pharmacologic approaches to glycemic treatment： Standards of Care in Diabetes—2025 ［J］. Diabetes Care ， 2025 ， 48 （ Suppl 1 ）： S181 - S206 .

Lee JH ， Jeon S ， Lee HS ， et al . Trajectories of triglyceride-glucose index changes and their association with all-cause and cardiovascular mortality： a competing risk analysis ［J］. Cardiovasc Diabetol ， 2024 ， 23 （ 1 ）： 364 .

Ahlqvist E ， Storm P ， Käräjämäki A ， et al . Novel subgroups of adult-onset diabetes and their association with outcomes： a data-driven cluster analysis of six variables ［J］. Lancet Diabetes Endocrinol ， 2018 ， 6 （ 5 ）： 361 - 369 .

Proust-Lima C ， Philipps V ， Liquet B . Estimation of extended mixed models using latent classes and latent processes： the R package lcmm ［J］. J Stat Softw ， 2017 ， 78 ： 1 - 56 .

Chang AM ， Halter JB . Aging and insulin secretion ［J］. Am J Physiol Endocrinol Metab ， 2003 ， 284 （ 1 ）： E7 - E12 .

Gu Z ， Du Y ， Liu Y ， et al . Effect of aging on islet beta-cell function and its mechanisms in Wistar rats ［J］. Age （Dordr）， 2012 ， 34 （ 6 ）： 1393 - 1403 .

Ha KH ， Park CY ， Jeong IK ， et al . Clinical characteristics of people with newly diagnosed type 2 diabetes between 2015 and 2016： difference by age and body mass index ［J］. Diabetes Metab J ， 2018 ， 42 （ 2 ）： 137 - 146 .

Esser N ， Utzschneider KM ， Kahn SE . Early beta cell dysfunction vs insulin hypersecretion as the primary event in the pathogenesis of dysglycaemia ［J］. Diabetologia ， 2020 ， 63 （ 10 ）： 2007 - 2021 .

Geer EB ， Shen W . Gender differences in insulin resistance， body composition， and energy balance ［J］. Gend Med ， 2009 ， 6 （ Suppl 1 ）： 60 - 75 .

Steele CJ ， Schöttker B ， Marshall AH ， et al . Educational achievement and type 2 diabetes—what mediates the relationship in older adults？ Data from the ESTHER study： a population-based cohort study ［J］. BMJ Open ， 2017 ， 7 （ 4 ）： e013569 .

Sarafidis PA ， McFarlane SI ， Bakris GL . Antihypertensive agents， insulin sensitivity， and new-onset diabetes ［J］. Curr Diab Rep ， 2007 ， 7 （ 3 ）： 191 - 199 .

Li Z ， Wei H ， Li R ， et al . The effects of antihypertensive drugs on glucose metabolism ［J］. Diabetes Obes Metab ， 2024 ， 26 （ 11 ）： 4820 - 4829 .

Yang C ， Hu Z ， Sa R ， et al . Reducing the risk of developing diabetes： the role of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with hypertension combined prediabetes ［J］. J Clin Hypertens （Greenwich）， 2025 ， 27 （ 5 ）： e70025 .

Kahn BB ， Flier JS . Obesity and insulin resistance ［J］. J Clin Invest ， 2000 ， 106 （ 4 ）： 473 - 481 .

Knott C ， Bell S ， Britton A . Alcohol consumption and the risk of type 2 diabetes： a systematic review and dose-response meta-analysis of more than 1.9 million individuals from 38 observational studies ［J］. Diabetes Care ， 2015 ， 38 （ 9 ）： 1804 - 1812 .

Views

210

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Effect of Precocious Puberty on Glucose and Lipid Metabolism in Female Rats

Risk Factors of Hypogonadism in Male Patients with Hyperuricemia in Xinjiang

Correlation of Abnormal Glucose Metabolism with Clinicopathology and Prognosis of Stage I Endometrioid Adenocarcinoma

Atrial Fibrillation in Patients with Alcoholic Cardiomyopathy：Clinical Characteristics and Risk Factors

Pancreatic Fat Quantification by MRI： Potential Biomarker of Impaired Glucose Tolerance and Type 2 Diabetes

Related Author

CHEN Qiuli

LIN Xiaoya

HUANG Baojiang

ZHANG Jun

GUO Song

MA Huamei

DU Minlian

LI Yanhong

Related Institution

Department of Pediatrics， The First Affiliated Hospital of Sun Yat-sen University

Department of Endocrinology and Metabolism， People′s Hospital of Xinjiang Uygur Autonomous Region//Xinjiang Clinical Research Center for Diabetes

Department of Gynecological Oncology， Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

Department of Cardiovascular Medicine， The Third Affiliated Hospital， Sun Yat-sen University

Department of Radiology， Xinhui Hospital of Traditional Chinese Medicine

Postal code：510080
Tel：020-87690764，87690974，87690694 Email：xbmed@mail.sysu.edu.cn
Technical support is provided by Beijing Founder electronics co., LTD 京ICP备09064830号-19 京公网安备11010802024621
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰