METS-IR, a Novel Score to Evaluate Insulin Sensitivity, is Associated with the Urinary Albumin–Creatinine Ratio in Chinese Adults: A Cross-sectional REACTION Study

Abstract Background: The metabolic score for insulin resistance (METS-IR) is a novel noninsulin-based metabolic index used as a substitution marker of insulin resistance and for cardiovascular disease evaluation. However, whether METS-IR is associated with the urinary albumin–creatinine ratio (UACR) is not well known. Therefore, we explored the age- and sex-related associations between METS-IR and UACR and compared the discriminative ability of the METS-IR index and its components for elevated UACR. Methods: This study included 37,290 subjects from the REACTION study (Risk Evaluation of cAncers in Chinese diabeTic Individuals: a IONgitudinal study). METS-IR was calculated as follows:(Ln[2×fasting blood glucose{mg/dL}+fasting triglyceride level{mg/dL}]×body mass index)/(Ln [high-density lipoprotein cholesterol{mg/dL}]). Participants were divided into four groups on the basis of METS-IR: <25%, 25%–49%, 50%–74%, and ≥75%. Logistic regression analyses were conducted to determine the associations between METS-IR vs. its components{(fasting blood glucose(FBG), fasting triglyceride level, body mass index, and high-density lipoprotein cholesterol} with UACR. Results: Participants with the highest quartile METS-IR, particularly men,presented a more significant trend towards elevated UACR than towards its components (odds ratio [OR]: 1.260, 95% confidence interval [CI]:1.152–1.378, P<0.001 in all subjects; OR: 1.321, 95% CI: 1.104–1.579, P=0.002 in men; OR: 1.201, 95% CI: 1.083–1.330, P < 0.001 in women). There were significant associations between METS-IR and UACR in younger participants (<65 years for women and 55–64 years for men) and those with an estimated glomerular filtration rate ≥ 90 mL/min/1.73 m2. Increased METS-IR was significantly associated with UACR in men with FBG ≥ 5.6 mmol/L or postprandial blood glucose ≥ 7.8 mmol/L and systolic blood pressure ≥ 120mmHg or diastolic blood pressure ≥ 80 mmHg. The relationships were significant in women with diabetes and hypertension. Conclusions: Increased METS-IR was significantly associated with elevated UACR, and its discriminative power for elevated UACR was superior to that of its components. The findings support the clinical significance of METS-IR for evaluating the cardiometabolic risk and renal function damage among Chinese adults.