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Insulin resistance is associated with incident prediabetes and type 2 diabetes in normoglycemic individuals

Louie, Judy Z. ; Shiffman, Dov ; Meigs, James B. ; Taylor, Steven W. ; Melander, Olle LU orcid ; Abbasi, Fahim and McPhaul, Michael J. (2026) In Diabetes and Metabolic Syndrome: Clinical Research and Reviews 20(1).
Abstract

Aims: Testing insulin resistance could help improve physician assessment of patients’ risk of prediabetes or type 2 diabetes (T2D), even among normoglycemic individuals. Methods: The longitudinal study followed 16,333 normoglycemic participants in a nation-wide employer-sponsored health assessment program starting in August 2020 with a median follow-up time of 2.9 years for incident prediabetes or T2D. The probability of insulin resistance (IRRS) was calculated from fasting intact insulin and C-peptide serum levels. Incident events had fasting plasma glucose level ≥100 mg/dL (≥5.6 mmol/L), HbA1c ≥ 5.7 % (≥38.8 mmol/mol), or a self-reported physician diagnosis of T2D. Results: The study population had a median age of 43 years at baseline... (More)

Aims: Testing insulin resistance could help improve physician assessment of patients’ risk of prediabetes or type 2 diabetes (T2D), even among normoglycemic individuals. Methods: The longitudinal study followed 16,333 normoglycemic participants in a nation-wide employer-sponsored health assessment program starting in August 2020 with a median follow-up time of 2.9 years for incident prediabetes or T2D. The probability of insulin resistance (IRRS) was calculated from fasting intact insulin and C-peptide serum levels. Incident events had fasting plasma glucose level ≥100 mg/dL (≥5.6 mmol/L), HbA1c ≥ 5.7 % (≥38.8 mmol/mol), or a self-reported physician diagnosis of T2D. Results: The study population had a median age of 43 years at baseline (31 % men). IRRS was <8 % for participants in the bottom tertile of the distribution compared with >20 % for those in the top tertile. Participants in the top tertile of IRRS had 43 % greater risk of incident prediabetes or T2D (adjusted hazard ratio, aHR = 1.43 [95 % CI, 1.31–1.57], P < 0.001) compared with those in the bottom tertile, in a model that adjusted for age, sex, BMI, and HbA1c. Conclusions: Elevated IRRS is associated with incident prediabetes or T2D regardless of established risk factors. Evaluating insulin resistance in normoglycemic patients may improve T2D prevention efforts.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Insulin resistance, Prediabetes, Risk, Type 2 diabetes
in
Diabetes and Metabolic Syndrome: Clinical Research and Reviews
volume
20
issue
1
article number
103372
publisher
Diabetes India
external identifiers
  • scopus:105026862418
  • pmid:41485462
ISSN
1871-4021
DOI
10.1016/j.dsx.2025.103372
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025
id
15dcf22a-591a-4bd6-8087-b693fa7f26ab
date added to LUP
2026-03-19 14:44:50
date last changed
2026-05-28 22:18:06
@article{15dcf22a-591a-4bd6-8087-b693fa7f26ab,
  abstract     = {{<p>Aims: Testing insulin resistance could help improve physician assessment of patients’ risk of prediabetes or type 2 diabetes (T2D), even among normoglycemic individuals. Methods: The longitudinal study followed 16,333 normoglycemic participants in a nation-wide employer-sponsored health assessment program starting in August 2020 with a median follow-up time of 2.9 years for incident prediabetes or T2D. The probability of insulin resistance (IRRS) was calculated from fasting intact insulin and C-peptide serum levels. Incident events had fasting plasma glucose level ≥100 mg/dL (≥5.6 mmol/L), HbA1c ≥ 5.7 % (≥38.8 mmol/mol), or a self-reported physician diagnosis of T2D. Results: The study population had a median age of 43 years at baseline (31 % men). IRRS was &lt;8 % for participants in the bottom tertile of the distribution compared with &gt;20 % for those in the top tertile. Participants in the top tertile of IRRS had 43 % greater risk of incident prediabetes or T2D (adjusted hazard ratio, aHR = 1.43 [95 % CI, 1.31–1.57], P &lt; 0.001) compared with those in the bottom tertile, in a model that adjusted for age, sex, BMI, and HbA1c. Conclusions: Elevated IRRS is associated with incident prediabetes or T2D regardless of established risk factors. Evaluating insulin resistance in normoglycemic patients may improve T2D prevention efforts.</p>}},
  author       = {{Louie, Judy Z. and Shiffman, Dov and Meigs, James B. and Taylor, Steven W. and Melander, Olle and Abbasi, Fahim and McPhaul, Michael J.}},
  issn         = {{1871-4021}},
  keywords     = {{Insulin resistance; Prediabetes; Risk; Type 2 diabetes}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Diabetes India}},
  series       = {{Diabetes and Metabolic Syndrome: Clinical Research and Reviews}},
  title        = {{Insulin resistance is associated with incident prediabetes and type 2 diabetes in normoglycemic individuals}},
  url          = {{http://dx.doi.org/10.1016/j.dsx.2025.103372}},
  doi          = {{10.1016/j.dsx.2025.103372}},
  volume       = {{20}},
  year         = {{2026}},
}