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已发表论文
METS-IR 在中国女性妊娠期糖尿病早期筛查中的作用：一项两中心前瞻性研究
Authors Gao J , Song S , Duo Y, Wang S , Qiao X, Zhang Y, Xu J, Zhang J, Nie X, Sun Q, Yang X, Wang A, Sun W, Fu Y, Zhang M, Dong Y, Lu Z, Yuan T, Zhao W
Received 25 May 2025
Accepted for publication 17 September 2025
Published 25 October 2025 Volume 2025:18 Pages 3967—3984
DOI https://doi.org/10.2147/DMSO.S538992
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Rebecca Baqiyyah Conway
Junxiang Gao,1 Shuoning Song,1 Yanbei Duo,1 Shihan Wang,1 Xiaolin Qiao,2 Yuemei Zhang,3 Jiyu Xu,4 Jing Zhang,5 Xiaorui Nie,2 Qiujin Sun,6 Xianchun Yang,6 Ailing Wang,7 Wei Sun,4 Yong Fu,1 Mengmeng Zhang,1 Yingyue Dong,1 Zechun Lu,7 Tao Yuan,1,* Weigang Zhao1,*
1Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 3Department of Obstetrics, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 4Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People’s Republic of China; 5Department of Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 6Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 7National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Tao Yuan, Email t75y@sina.com Weigang Zhao, Email xiehezhaoweigang@163.com
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.
Keywords: gestational diabetes mellitus, METS-IR, early pregnancy, insulin resistance, prospective cohort, predictors
1Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 3Department of Obstetrics, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 4Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People’s Republic of China; 5Department of Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 6Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 7National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Tao Yuan, Email t75y@sina.com Weigang Zhao, Email xiehezhaoweigang@163.com
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.
Keywords: gestational diabetes mellitus, METS-IR, early pregnancy, insulin resistance, prospective cohort, predictors