What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiometabolic multimorbidity (n=7197). Intervention: Estimated Glucose Disposal Rate (eGDR). Primary outcome: Incident cardiometabolic multimorbidity (OR 0.834, 95% CI 0.781-0.891).

What does this research mean for the field?

Each standard deviation increase in estimated Glucose Disposal Rate (eGDR) is associated with a reduced risk of incident cardiometabolic multimorbidity (HR 0.834) and demonstrates superior predictive capacity compared to other insulin resistance surrogate indexes in Chinese middle-aged and older adults. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the predictive ability of seven insulin resistance indexes for cardiometabolic multimorbidity in Chinese adults aged 45 and above.

April 7, 2026Open Access

Assessment of seven insulin resistance surrogate indexes for predicting cardiometabolic multimorbidity among Chinese middle-aged and older adults: a national prospective cohort study

Key Result

Each standard deviation increase in estimated Glucose Disposal Rate (eGDR) was associated with a reduced risk of incident cardiometabolic multimorbidity (OR 0.834).

Key Points

To evaluate the predictive ability of seven insulin resistance indexes for cardiometabolic multimorbidity in Chinese adults aged 45 and above.
Conducted a prospective cohort study using CHARLS datasets from 2011 to 2020.
Assessed associations between seven insulin resistance indexes and cardiometabolic multimorbidity risk.
Utilized Kaplan–Meier curves and multivariable Cox proportional hazards models for statistical analyses.
Evaluated predictive accuracy with time-dependent receiver operating characteristic curves and net reclassification improvement.
1043 out of 7197 participants developed cardiometabolic multimorbidity during a median follow-up of 9 years.
Each standard deviation increase in estimated glucose disposal rate (eGDR) was linked to a reduced risk of cardiometabolic multimorbidity (HR 0.834).
Higher values of TyG and other indexes were associated with increased cardiometabolic multimorbidity risk.
eGDR exhibited superior predictive capacity with an AUC ranging from 0.68 to 0.76.
Optimal eGDR cut-off for identifying high-risk individuals was determined to be 7.64.

Study Design

Type

Cohort (n=7,197)

Multicenter

Yes

Structured PICO

Do surrogate indexes of insulin resistance predict the incidence of cardiometabolic multimorbidity in Chinese middle-aged and older adults?

Population

7,197 Chinese middle-aged and older adults (aged ≥ 45 years) without baseline cardiometabolic multimorbidity, mean age 58.2 ± 8.5 years, 44.80% male, from the nationally representative China Health and Retirement Longitudinal Study (CHARLS) 2011–2020.

Intervention

Seven surrogate indexes of insulin resistance (IR): triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), Chinese visceral adiposity Index (CVAI), Metabolic score for IR (METS-IR), Atherogenic index of plasma (AIP), and estimated glucose disposal rate (eGDR).

Outcome

Incidence of cardiometabolic multimorbidity (CMM) events, characterized by the coexistence of two or more cardiometabolic diseases (diabetes, heart disease, and stroke) during a median follow-up of 9 years.composite

Among middle-aged and older Chinese adults, eGDR demonstrated superior predictive capacity for incident cardiometabolic multimorbidity compared to other insulin resistance surrogate indexes, with an optimal cut-off of 7.64 for identifying high-risk individuals.

Main Result

Effect estimate: OR 0.834 (95% CI 0.781-0.891)

Abstract

Cardiometabolic multimorbidity (CMM) poses a mounting health challenge worldwide. Seven surrogate indexes of insulin resistance (IR)—the triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), Chinese visceral adiposity Index (CVAI), Metabolic score for IR (METS-IR), Atherogenic index of plasma (AIP), and estimated glucose disposal rate (eGDR)—are well-established. However, comparative studies evaluating their predictive capacity for CMM incidence in Chinese middle-aged and older adults remain scarce. This study aimed to assess the associations between these seven IR indexes and CMM risk within this population and determine their relative predictive abilities. Utilizing the China Health and Retirement Longitudinal Study (CHARLS) 2011–2020 datasets, this prospective cohort investigation assessed Chinese participants aged ≥ 45 years. We applied Kaplan–Meier curve plotting, multivariable Cox proportional hazards models, and restricted cubic splines (RCS) to quantify associations of insulin resistance surrogate indexes with CMM risk. Predictive accuracy was appraised via time-dependent receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Subgroup evaluations further verified findings robustness. During a median follow-up of 9 years, 1043 (14.49%) of the 7197 participants developed CMM. After adjusting for potential confounders, we observed that each standard deviation (SD) increase in eGDR was associated with a reduced risk of CMM, with an adjusted hazard ratio (HR) of 0.834 95% confidence interval (CI): 0.781–0.891. In contrast, each SD increase in TyG, TyG-BMI, TyG-WC, METS-IR, AIP and CVAI were associated with an increased risk of CMM. Restricted cubic spline analyses showed that TyG-BMI, TyG-WC, METS-IR, and eGDR were nonlinear associated with incident new-onset CMM (P-nonlinearity < 0.05). eGDR showed a L-shaped association (P-nonlinearity < 0.05), with CMM risk decreasing until the inflection point at 11.82 (HR = 0.758; 95% CI: 0.702–0.818). Conversely, TyG-WC displayed a U-shaped relationship (inflection point: 572.14). Moreover, the time-dependent AUC analysis revealed that eGDR exhibited superior predictive discrimination (AUC 0.68–0.76) during early follow-up and across all intervals. The optimal cut-off value for eGDR was determined to be 7.64. All seven insulin resistance surrogate indexes independently demonstrated elevated CMM risk. In the context of Chinese middle-aged and elderly cohorts, eGDR demonstrated a notable predictive capacity for CMM. ROC-derived cut-offs (eGDR < 7.64) are utilised for identifying high-risk individuals requiring intervention. Spline-derived thresholds (eGDR = 11.82) serve as therapeutic targets for risk reduction.

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