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June 7, 2026Diabetes

OGTT-based insulin resistance measures perform best among 17 indexes for predicting incident type 2 diabetes.

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Why the study?

Identifying simple surrogate indexes of insulin resistance may improve prevention of type 2 diabetes.

Which surrogate index of insulin resistance best predicts incident type 2 diabetes in diverse US cohorts?

Population

Participants from 5 US cohorts (ARIC, CARDIA, SAMAFS) with OGTT data

Comparison

17 surrogate indexes of insulin resistance to predict T2D

Design

Cohort study

Follow-up

118K years of follow-up

Key result

Surrogate measures of insulin resistance based on OGTTs performed best among 17 indexes for predicting type 2 diabetes (1,628 cases over 118,000 person-years of follow-up).

Authors

LVLAURA M. VAZQUEZEAElsa Vazquez ArreolaRDRAVINDRANATH A. DUGGIRALA

Discussion

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Overview

OGTT-based indexes may aid T2D prediction in diverse cohorts; hypothesis-generating and should not yet change practice.

Key Points

  • This research aims to identify effective surrogate indexes of insulin resistance for predicting type 2 diabetes across multiple cohorts.
  • Analyzed data from 5 US cohorts with oral glucose tolerance tests (OGTTs) involving diverse populations.
  • Calculated 17 indexes of insulin resistance based on fasting and 2-hour glucose and insulin levels.
  • Evaluated predictive performance using hazard ratios (HR), area under the receiver operating characteristic curve (ΔAUC), and net reclassification information (NRI).
  • Identified 1628 new cases of type 2 diabetes over 118K years of follow-up.
  • Indexes derived from OGTTs showed superior predictive capabilities, with Gutt index exhibiting the highest predictive properties.
  • QUICKI and HOMA-IR achieved nearly identical NRI and ΔAUC in fasting insulin-only indexes, while SPISE was best among those not requiring insulin.

Study Design

Type

Cohort (n=7,545)

Multicenter

Yes

Structured PICO

Which surrogate index of insulin resistance best predicts incident type 2 diabetes in diverse US cohorts?

P
Population
7,545 participants from 5 diverse US cohorts with oral glucose tolerance test data, followed for 118,000 person-years to assess incident type 2 diabetes.
E
Exposure
17 surrogate indexes of insulin resistance (including OGTT-based, fasting insulin-based, and non-insulin-based measures)
C
Comparator
Comparison among the 17 different surrogate indexes
O
Outcome
Incident type 2 diabetes (assessed by hazard ratios per SD, change in AUC, and net reclassification information)hard clinical

Surrogate measures of insulin resistance based on OGTTs are superior to fasting or non-insulin measures for predicting incident type 2 diabetes.

Cite This Study

VAZQUEZ et al. (2026) conducted a cohort in Type 2 diabetes (n=7,545). Surrogate indexes of insulin resistance was evaluated on Type 2 diabetes incidence. Surrogate measures of insulin resistance based on OGTTs performed best among 17 indexes for predicting type 2 diabetes (1,628 cases over 118,000 person-years of follow-up).

synapsesocial.com/papers/6a250c027def13d035e1c118https://doi.org/10.2337/db26-2235-p
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