{
  "abstract": "Background\n\nRoutine assessment of insulin resistance (IR) remains challenging because fasting insulin measurements are not routinely available in many clinical settings. Several readily available metabolic indices, including the HbA1c/HDL-C ratio, stress hyperglycemia ratio (SHR), and Zhejiang University (ZJU) index, have been associated with IR or related metabolic disturbances. However, their relative discriminative performance for HOMA-IR-defined IR in patients with established Type 2 diabetes has not been systematically compared. We aimed to compare their discriminative performance for HOMA-IR-defined IR and to assess whether ZJU provides incremental discrimination beyond conventional clinical and metabolic characteristics.Methods\n\nThis was a single-center retrospective cross-sectional study. We included 1000 hospitalized adults with established T2DM. HOMA-IR was calculated from fasting plasma glucose and fasting insulin, and IR was operationally defined as HOMA-IR ≥ 2.69. Multivariable logistic regression and restricted cubic spline analyses evaluated associations and nonlinear associations. Receiver operating characteristic analyses with paired DeLong tests compared discriminative performance. Additional analyses included TyG and TyG-BMI, comparisons with individual ZJU components, nested-model analysis, decision-curve analysis, bootstrap internal validation, and medication-adjusted sensitivity analyses.Results\n\nAll three indices were significantly associated with HOMA-IR-defined IR after multivariable adjustment. Compared with the lowest quartile, the adjusted odds ratios in the highest quartile were 3.16 (95% CI 1.95-5.18) for the HbA1c/HDL-C ratio, 6.86 (4.11-11.84) for SHR, and 18.36 (10.21-34.79) for ZJU. Significant nonlinear associations were observed for all three indices. Among the evaluated composite indices, ZJU had the highest AUC (0.777, 95% CI 0.742-0.812), followed by TyG (0.749, 0.712-0.785), TyG-BMI (0.733, 0.695-0.770), SHR (0.698, 0.659-0.738), and HbA1c/HDL-C (0.615, 0.573-0.657). ZJU did not significantly outperform FPG alone (AUC 0.766; p = 0.509). Adding ZJU to the basic clinical model increased the AUC from 0.658 to 0.780 (ΔAUC = 0.123; p < 0.001), whereas adding ZJU to a more comprehensive model including its major metabolic components did not improve discrimination (0.806 vs. 0.807; p = 0.983).Conclusions\n\nIn hospitalized patients with established T2DM, ZJU demonstrated moderate discrimination for HOMA-IR-defined IR and provided incremental discrimination beyond basic clinical characteristics.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Endocrinology The First Affiliated Hospital of Harbin Medical University Harbin China hrbmu.edu.cn."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zhangna Zheng",
      "orcid": "0009-0003-1928-9545"
    },
    {
      "affs": [
        0
      ],
      "name": "Qianyi Li",
      "orcid": "0009-0009-4050-0361"
    },
    {
      "affs": [
        0
      ],
      "name": "Huijuan Zhang",
      "orcid": "0000-0002-2058-0175"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ab5wmxv5p5raj.bib",
  "cited_by": 0,
  "doi": "10.1155/ije/2925122",
  "fulltext_url": "https://europepmc.org/articles/PMC13686360",
  "id": "ab5wmxv5p5raj",
  "issns": [
    "1687-8337",
    "1687-8345"
  ],
  "landing_url": "https://europepmc.org/article/MED/42910358",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetes, Cardiovascular Risks, and Lipoproteins"
    ]
  ],
  "openalex": "W7223141339",
  "pdf_url": "https://europepmc.org/articles/PMC13686360?pdf=render",
  "pmcid": "PMC13686360",
  "pmid": "42910358",
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ab5wmxv5p5raj.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "MED:42910358",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42910358"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes, Cardiovascular Risks, and Lipoproteins",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Comparative Discriminative Performance of the HbA1c/HDL-C Ratio, Stress Hyperglycemia Ratio, and ZJU Index for HOMA-IR-Defined Insulin Resistance in Patients With Type 2 Diabetes.",
  "title_text": "Comparative Discriminative Performance of the HbA1c/HDL-C Ratio, Stress Hyperglycemia Ratio, and ZJU Index for HOMA-IR-Defined Insulin Resistance in Patients With Type 2 Diabetes.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/ab5wmxv5p5raj",
  "venue": "International journal of endocrinology",
  "versions": []
}