Key result
Poor beta-cell function is linked to ~41-fold higher odds of prevalent T2D in obese Indians.
Why the study?
Type 2 diabetes has a disproportionately high burden in obese South Asian populations, but not all obese individuals develop the disease, necessitating identification of associated metabolic and clinical markers.
Which metabolic, inflammatory, and clinical markers are associated with prevalent type 2 diabetes in obese Indian adults, and can they accurately discriminate diabetes status?
Case-Control (n=1,028)
No
Which metabolic, inflammatory, and clinical markers are associated with prevalent type 2 diabetes in obese Indian adults, and can they accurately discriminate diabetes status?
Answers are grounded in this paper and cite their sources.
In obese Indian adults, beta-cell dysfunction (HOMA2%B ≤50) is the primary metabolic marker distinguishing prevalent T2D (OR 40.9), and combining it with insulin resistance, HDL-C, hsCRP, BMI category, and antihypertensive use yields a well-calibrated nomogram (AUC 0.860) for risk stratification.
Introduction: Type 2 diabetes (T2D) is a significant metabolic disorder with disproportionately high burden in obese South Asian populations, yet not all obese individuals develop the disease. This study identified the metabolic, inflammatory, and pharmacological markers associated with prevalent T2D in obese Indians using age- and sex-matched case-control analysis. Methods: A matched-pair analysis was performed on 514 age- and sex-matched pairs with and without T2D. Patients had obesity [body mass index (BMI) 25-45 kg/m², aged 20-75 years] and participated in a one-year lifestyle intervention program in India. Anthropometric, biochemical markers and medical history were analyzed. Homeostatic model assessment for insulin resistance (HOMA2IR) and beta-cell function (HOMA2%B) was calculated. Significant markers were incorporated into a logistic regression model and temporally validated in an independent time-cohort (n=966). Performance was evaluated through discrimination [receiver operating characteristics area under the curve (ROC-AUC)], calibration, and decision curve analysis. A nomogram was constructed based on the logistic regression model. Results: Median age and BMI were 46 (IQR 12) years and 29.7 (IQR 5.5) kg/m². Key markers associated with prevalent T2D were poor beta-cell function (HOMA2%B ≤50; OR = 40.9, 95% CI: 24.5-68.2), insulin resistance (HOMA2IR ≥2; OR = 4.5, 95% CI: 3.0-6.7), low HDL-C (OR = 2.1, 95% CI: 1.5-3.0), elevated hsCRP ≥3 mg/L (OR = 1.9, 95% CI: 1.4-2.7), Obesity Class I (BMI 25.0-29.9 kg/m²; OR = 2.1, 95% CI: 1.5-2.9), and antihypertensive medication use (OR = 1.7, 95% CI: 1.2-2.4). Model discrimination was good (AUC 0.860 development, 0.865 validation, both p<0.001). The Hosmer-Lemeshow test showed good model fit (p=0.562). Isotonic-calibrated Models 1 and 2 had Brier scores 0.14 and 0.162, indicating acceptable calibration. Decision curve analysis confirmed net clinical benefit across threshold probabilities 0.10-0.85. Conclusion: This study identified and temporally validated key metabolic and clinical markers associated with prevalent T2D, demonstrating good discrimination (AUC 0.860) in obese Indian individuals. External validation and prospective evaluation are needed before clinical application.
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VYAWAHARE et al. (2026) conducted a case-control in Obesity and Type 2 Diabetes Mellitus (n=1,028). Poor beta-cell function (HOMA2%B ≤50) and cardiometabolic markers vs. Good beta-cell function (HOMA2%B >50) and normal cardiometabolic profile was evaluated on Prevalent Type 2 Diabetes Mellitus (OR 40.9, 95% CI 24.5-68.2, p=<0.001). Poor beta-cell function was strongly associated with prevalent T2D in obese Indians, driving a 6-marker model with an AUC of 0.860.
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