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OA

[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,P=0.023).Highereducation increased the risk of stable FBG-elevated IR(OR=1.40,95%CI:1.01-1.94,P=0.046).Abnormal blood pressure was associated with lower risks of stable FBG-elevated IR(OR=0.66,95%CI:0.48-0.92,P=0.013)and elevated FBG-IR(OR=0.48,95%CI:0.31-0.74,P=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,P=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.