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Background and Objectives: Metabolic disease has become a global health concern, and insulin resistance (IR) is a crucial underlying mechanism in various metabolic diseases. This study aims to compare the ability of seven anthropometric indicators in predicting IR in the Chinese population, and to find more sensitive and simple anthropometric indicator for early identification of IR., Methods: This prospective cross-sectional study obtained participants' medical history, anthropometric indicators, and serum samples from three hospitals in China. Various anthropometric indicators were calculated, including body mass index (BMI), Waist-to-hip ratio (WHR), waist-to-height ratio (WtHR), conicity index (CI), A Body Shape Index (ABSI), body roundness index (BRI), abdominal volume index (AVI). The evaluation of IR is performed using the homeostasis model assessment-insulin resistance (HOMA-IR). Logistic regression analysis examined the relationship between indicators and HOMA-IR. The ability of the anthropometric indicators to predict IR was analyzed using the receiver operating characteristic (ROC) curve. Additionally, a stratified analysis was performed to evaluate the ability of the indicators in different age and gender groups., Results: The study included 1,592 adult subjects, with 531 in the non-IR group and 1,061 in the IR group. After adjusting for confounding factors, the anthropometric indicators showed a positive correlation with IR in the general population and across different genders and age groups (OR > 1, p  < 0.05), except for ABSI. In the ROC curve analysis, WtHR and BRI had the highest AUC values of 0.711 for detecting IR. The optimal cut-off value for WtHR to diagnose IR was 0.53, while for BRI, it was 4.00. In the gender-stratified and age-stratified analysis, BMI, WtHR, BRI, and AVI all had AUC values >0.700 in females and individuals below 60., Conclusion: WtHR and BRI demonstrated a better ability to predict IR in the overall study population, making them preferred indicators for screening IR, and gender and age are important considerations. In the stratified analysis of different genders or age, BMI, WtHR, BRI, and AVI are also suitable for detecting IR in women or individuals under 60 years old in this study., Clinical Trial Registration: www.chictr.org.cn, ChiCTR2100054654., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Liu, Liu, Peng, Liang, Tao, Liu, Cui, Ren, Zhou, Long, Fan, Lu and Liu.)

Objective: To evaluate whether the intense simplified strategy, which comprises short term intensive insulin therapy (SIIT) followed by subsequent oral antihyperglycaemic regimens, could improve long term glycaemic outcomes in patients with newly diagnosed type 2 diabetes mellitus and severe hyperglycaemia., Design: Multicentre, open label, randomised trial., Setting: 15 hospitals in China between December 2017 and December 2020., Participants: 412 patients with newly diagnosed type 2 diabetes and significant hyperglycaemia (HbA 1c ≥8.5%)., Interventions: All randomised participants initially received SIIT for 2-3 weeks, followed by linagliptin 5 mg/day, metformin 1000 mg/day, combination linagliptin plus metformin, or lifestyle modification alone (control) for 48 weeks., Main Outcome Measures: The primary outcome was the percentage of participants achieving HbA 1c <7.0% at week 48 after SIIT. Secondary outcomes included glycaemic control, β cell function, and variations in insulin sensitivity., Results: 412 participants were randomised. At baseline, the mean age was 46.8 (standard deviation 11.2) years, mean body mass index was 25.8 (2.9), and mean HbA 1c was 11.0% (1.9%). At week 48, 80% (78/97), 72% (63/88), and 73% (69/95) of patients in the linagliptin plus metformin, linagliptin, and metformin groups, respectively, achieved HbA 1c <7.0%, compared with 60% (56/93) in the control group (P=0.02 overall; P=0.003 for linagliptin plus metformin versus control; P=0.12 for linagliptin versus control; P=0.09 for metformin versus control). Additionally, 70% (68/97), 68% (60/88), and 68% (65/95) of patients in the linagliptin plus metformin, linagliptin, and metformin group, respectively, achieved HbA 1c <6.5% compared with 48% (45/93) in the control group (P=0.005 overall; P=0.005 for linagliptin plus metformin versus control; P=0.01 for linagliptin versus control; P=0.008 for metformin versus control; all were significant after adjustment for multiple comparisons). Thus, compared with the control group, participants in the linagliptin plus metformin group were more likely to achieve HbA 1c <7.0% at week 48 (odds ratio 2.78, 95% confidence interval 1.37 to 5.65; P=0.005). Moreover, the linagliptin plus metformin group showed the most significant improvement in fasting plasma glucose and β cell function indices. All treatments were well tolerated., Conclusions: The intense simplified strategy using subsequent oral therapies post-SIIT, especially the linagliptin plus metformin combination, sustainably improved glycaemic control and β cell function in patients with newly diagnosed type 2 diabetes mellitus and severe hyperglycaemia. This approach offers a promising direction for decision making in the clinical management of type 2 diabetes mellitus., Trial Registration: ClinicalTrials.gov NCT03194945., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Ministry of Science and Technology of China, Science and Technology Department of Guangdong Province, Guangzhou Science and Technology Bureau, and Boehringer-Ingelheim for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.)