Diabetes, metabolic syndrome and obesity : targets and therapy · 2025
The Role of METS-IR in Early Screening for Gestational Diabetes Mellitus in Chinese Women: A Two-Center Prospective Study.
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Gao Junxiang, Song Shuoning, Duo Yanbei, Wang Shihan, Qiao Xiaolin, Zhang Yuemei, Xu Jiyu, Zhang Jing, Nie Xiaorui, Sun Qiujin, Yang Xianchun, Wang Ailing, Sun Wei, Fu Yong, Zhang Mengmeng, Dong Yingyue, Lu Zechun, Yuan Tao, Zhao Weigang
Аннотация
OBJECTIVE: This two-center prospective cohort study aimed to evaluate the predictive value of the Metabolic Score for Insulin Resistance (METS-IR) for gestational diabetes mellitus (GDM) in Chinese women during early pregnancy and compare its performance with conventional insulin resistance (IR) indices.
METHODS: This prospective investigation evaluated 1450 Chinese gravidas (<12 gestational weeks) without pregestational diabetes from two obstetrical institutions. Baseline clinical-biochemical profiling occurred during the first trimester (6-12 weeks), with GDM confirmation via standardized 75g oral glucose tolerance testing at 24-28 weeks' gestation. Analytical methodologies incorporated multivariable regression modeling and ROC curve optimization to quantify the predictive validity of five metabolic indices (METS-IR, TyG index, TG/HDL-C ratio, HOMA-IR, TyG-BMI) for GDM risk stratification.
RESULTS: Among participants, 378 (26.1%) developed GDM. The GDM group (n=378, 26.1%) was older (median age 31.0 vs 30.0 years, p<0.0001) and had higher prepregnancy BMI (22.62 vs 21.32 kg/m², p<0.0001), fasting glucose (4.7 vs 4.5 mmol/L, p<0.0001) compared to NGT. The GDM group exhibited significantly higher METS-IR (31.14 vs 29.03, p <0.001) and other IR indices (p <0.001). In unadjusted models, METS-IR quartile 4 (Q4) was strongly associated with GDM (OR=3.33, 95% CI:2.38-4.70), but this association attenuated after adjusting for age, weight gain, lipids, and insulin (adjusted OR=1.56, 95% CI:1.04-2.35). Comparatively, the TyG index (adjusted OR=3.06, 95% CI:2.03-4.66) and TG/HDL-C ratio (adjusted OR=2.02, 95% CI:1.38-2.99) retained robust predictive power. ROC analysis revealed a moderate discriminative capacity for METS-IR (AUC=0.629 unadjusted; 0.676 fully adjusted), outperformed by HOMA-IR (AUC=0.699) and TyG (AUC=0.699). METS-IR demonstrated high specificity (76.2%) in unadjusted screening but showed dependency on metabolic confounders in adjusted models.
CONCLUSION: METS-IR shows promise for early GDM screening and is outperformed by TyG and HOMA-IR in predictive value. METS-IR in early pregnancy reflects metabolic dysregulation linked to GDM risk, yet its predictive utility is partially mediated by lipid and insulin abnormalities. While METS-IR offers clinical feasibility through routine measurements, TyG and HOMA-IR exhibit superior independent predictive value. These findings highlight the importance of context-specific IR indices for early GDM risk stratification and underscore METS-IR's role as a composite marker of metabolically unhealthy obesity in pregnancy.
METHODS: This prospective investigation evaluated 1450 Chinese gravidas (<12 gestational weeks) without pregestational diabetes from two obstetrical institutions. Baseline clinical-biochemical profiling occurred during the first trimester (6-12 weeks), with GDM confirmation via standardized 75g oral glucose tolerance testing at 24-28 weeks' gestation. Analytical methodologies incorporated multivariable regression modeling and ROC curve optimization to quantify the predictive validity of five metabolic indices (METS-IR, TyG index, TG/HDL-C ratio, HOMA-IR, TyG-BMI) for GDM risk stratification.
RESULTS: Among participants, 378 (26.1%) developed GDM. The GDM group (n=378, 26.1%) was older (median age 31.0 vs 30.0 years, p<0.0001) and had higher prepregnancy BMI (22.62 vs 21.32 kg/m², p<0.0001), fasting glucose (4.7 vs 4.5 mmol/L, p<0.0001) compared to NGT. The GDM group exhibited significantly higher METS-IR (31.14 vs 29.03, p <0.001) and other IR indices (p <0.001). In unadjusted models, METS-IR quartile 4 (Q4) was strongly associated with GDM (OR=3.33, 95% CI:2.38-4.70), but this association attenuated after adjusting for age, weight gain, lipids, and insulin (adjusted OR=1.56, 95% CI:1.04-2.35). Comparatively, the TyG index (adjusted OR=3.06, 95% CI:2.03-4.66) and TG/HDL-C ratio (adjusted OR=2.02, 95% CI:1.38-2.99) retained robust predictive power. ROC analysis revealed a moderate discriminative capacity for METS-IR (AUC=0.629 unadjusted; 0.676 fully adjusted), outperformed by HOMA-IR (AUC=0.699) and TyG (AUC=0.699). METS-IR demonstrated high specificity (76.2%) in unadjusted screening but showed dependency on metabolic confounders in adjusted models.
CONCLUSION: METS-IR shows promise for early GDM screening and is outperformed by TyG and HOMA-IR in predictive value. METS-IR in early pregnancy reflects metabolic dysregulation linked to GDM risk, yet its predictive utility is partially mediated by lipid and insulin abnormalities. While METS-IR offers clinical feasibility through routine measurements, TyG and HOMA-IR exhibit superior independent predictive value. These findings highlight the importance of context-specific IR indices for early GDM risk stratification and underscore METS-IR's role as a composite marker of metabolically unhealthy obesity in pregnancy.