The relationship of changes in insulin demand and insulin adequacy over the life course
Authors' conclusion
The relationship between insulin demand and insulin adequacy changed throughout the life course. Adolescents had an imbalanced relationship between insulin demand and insulin adequacy, while, in general, children and adults had a balanced relationship. RAD is a novel index that was used to efficiently describe this relationship and evaluate the risk of AGT.
Study context
- Population
- Three independent Chinese cohorts recruited 1998–2013 who underwent OGTTthree cohorts
- Participants
- 204 / 214 / 605
- Exposure
- Children vs adolescents vs adults
- Childrenn = 204
- Adolescentsn = 214
- Adultsn = 605
- Outcome
- Life course relationships between insulin demand and insulin adequacy (RAD index)
Methodological detailsthree independent cohorts, OGTT-based indices, standardised major axis regression
- Three independent cohorts
- OGTT-based indices
- Standardised major axis regression
Main finding
As reported in the abstract
Insulin demand, adequacy and RAD index across age groups
- Adolescents had the lowest insulin sensitivity and highest insulin secretion in all OGTT phases vs children and adults
- all p<0.001
- Adolescents had the highest insulin demand in all phases and lowest insulin adequacy in the fasting phase
- p<0.001
- Adults generally had the lowest insulin adequacy in the early phase (p>0.05) and late phase
- p<0.001
- Adolescents had negative RAD values irrespective of overweight and obesity; children and adults generally positive (between age groups, each phase)
- p<0.001
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Risk of AGT with RAD <25th percentile vs >25th percentileRAD <25th percentilevs RAD >25th percentile | OR (fasting phase) 1.86 (95% CI 1.18–2.91) | |
| Risk of AGT with RAD <25th percentile vs >25th percentileRAD <25th percentilevs RAD >25th percentile | OR (early phase) 1.99 (95% CI 1.24–3.19) | |
| Risk of AGT with RAD <25th percentile vs >25th percentileRAD <25th percentilevs RAD >25th percentile | OR (late phase) 2.49 (95% CI 1.57–3.97) | |
| 0.20.5125Ratio (log scale) |
Discrimination of abnormal glucose tolerance (AGT) risk by late-phase RAD index (best vs fasting- and early-phase)
- Late-phase AUC-ROC
- 0.635 (95% CI 0.583, 0.687)
- Late-phase net reclassification improvement (NRI)
- 0.350 (95% CI 0.190, 0.510)
- Late-phase integrated discrimination improvement (IDI)
- 0.033 (95% CI 0.015, 0.050)
Original publication
The relationship of changes in insulin demand and insulin adequacy over the life course. Diabetologia. Published 29 November 2024. doi:10.
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