Original Article| Volume 13, ISSUE 1, P129-137.e1, January 2019

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Lipoprotein insulin resistance index, a high-throughput measure of insulin resistance, is associated with incident type II diabetes mellitus in the Prevention of Renal and Vascular End-Stage Disease study

Published:December 01, 2018DOI:


      • Lipoprotein Insulin Resistance Index (LP-IR) is associated with insulin resistance.
      • Elevated LP-IR levels are associated with an increased type II diabetes mellitus risk.
      • LP-IR allowed to reclassify 27% of the patients from lower to higher type II diabetes mellitus risk.
      • LP-IR score ≥ 68 improved the Framingham Offspring prediction algorithm


      Early assessment of insulin resistance may be a way of identifying patients at risk as well as monitoring treatments that increase insulin sensitivity and reduce the risk of developing type II diabetes mellitus (T2DM).


      The objective of the study was to evaluate the ability of the Lipoprotein Insulin Resistance Index (LP-IR) to predict incident T2DM in a large cohort.


      LP-IR scores were calculated using 6 lipoprotein particle concentrations and sizes measured by nuclear magnetic resonance spectroscopy. In total, 5977 nondiabetic men and women were included. Cox proportional hazards regression was used to evaluate the association of LP-IR scores with incident T2DM.


      LP-IR scores were closely associated with insulin resistance, assessed by homeostatic model assessment of insulin resistance (r = 0.51; P < .0001). During a median follow-up for 7.5 years, 278 new T2DM cases were ascertained. The Kaplan–Meier plot with log-rank test (P < .001) demonstrated that elevated LP-IR levels are associated with an increased T2DM risk. In analyses adjusted for age and sex, LP-IR was associated with incident T2DM; hazard ratio (HR) for the highest versus lowest quartile was 10.18 (95% confidence interval: 6.24–16.61), P < .0001. After adjustment for clinical risk factors, the HR was attenuated but remained significant (HR 3.02 [1.73–5.25], P < .0001). LP-IR scores added significantly to the performance of the Framingham Offspring prediction algorithm; C-index (95% confidence interval) for the Framingham Offspring score without and with LP-IR (0.863 [0.863–0.864] and 0.868 [0.867–0.86], P < .0001). Similar results were observed when LP-IR was analyzed as a categorical variable with a clinical cut-point of 68.


      LP-IR may be a convenient way to assess insulin resistance and T2DM risk, as well as to monitor preventative treatments.


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