Hyperinsulinemia Rates in US Adults Significantly Increased Over 20 Year Period

James R. Churilla, PhD

The association of hyperinsulinemia with both a multitude of chronic diseases and cardiovascular disease risk factors highlights the importance of investigating changes in hyperinsulinemia over time, due to these prevalent clinical outcomes

Led by James R. Churilla, PhD, University of North Florida, investigators estimated the prevalence of and trends in hyperinsulinemia among adults in the US without diabetes, between the years 1999 - 2018. Data in these findings show hyperinsulinemia rates have significantly increased among US adults during that time period of 20 years, with a slight downward trend between 2010 - 2018.

The study was presented at the 19th Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease Meeting.

Study Methods

Churilla and colleagues utilized the 20 years’ data set from the NHANES survey, conducted by the National Center for Health Statistics. They included weighted data from adults ≥20 years of age without diabetes in the analysis, for a total fasting subsample of 23,447 patients.

These patients had completed an in-home interview questionnaire and visited a mobile examination center in order to provide anthropometric measurements (WC and BMI) and serum blood samples necessary for the measurement of fasting insulin and other clinical biomarkers.

They noted exclusion criteria included pregnancy, history of diabetes or blood glucose ≥126 mg/dL and taking diabetes medications (n = 23,447).

Then, hyperinsulinemia was calculated using the weighted 75th percentile of log-fasted insulin who did not have fasting blood glucose values <126 mg/dL, answered no to a diabetes question, and reported taking no diabetes medications.

The study considered the 20-year trend for hyperinsulinemia to be nonlinear, with the two segments including 1999 - 2000 to 2009 - 2010 and 2009 - 2010 to 2017 - 2018. They considered the 2009 - 2010 cycle to be a joinpoint for both segments.

Findings

Findings from the study show a significant upward trend in the prevalence of hyperinsulinemia between 1999 - 2010, similar to previous analyses on data from NHANES. However, the data show the trend is met by a slight downward trend (P = .010) between 2010 - 2018.

Additionally, the age-adjusted prevalence of hyperinsulinemia increased by 18% in the study population between 1999 - 2000 and 2017 - 2018 (21.5% - 25.3%, P = .0034).

In the first joinpoint segment of 2009 - 2010, the age adjusted prevalence of hyperinsulinemia increased by 65% (21.5% - 35.4%, P = .0001). Then, the second joinpoint segment showed the prevalence of hyperinsulinemia decreased by 29%, but this was not considered significant (35.4% to 25.3%, P = .10).

Additionally, male patients have a higher prevalence of hyperinsulinemia compared to female patients (30.8% versus 22.3%, respectively). Patients with an augmented weight circumference show a five-fold difference in hyperinsulinemia rates compared to those with a healthy waist circumference (40.1% versus 8.3%, respectively).

Moreover, investigators illustrated a consistent, significant positive dose-response relationship between BMI and hyperinsulinemia. Data show 0.9% of patients with a BMI of <18.5 kg/m2 had hyperinsulinemia, while 77.3% of patients with a BMI of >=40 kg/m2 had hyperinsulinemia (P for trend <.0001).

Takeaways

“Hyperinsulinemia rates in U.S. adults without diabetes significantly increased at the turn of the century, however, the more recent decline and steadying of rates may be due to improved medication regimens and lifestyle modifications,” investigators wrote.

“Hyperinsulinemia Trends in U.S. Adults without Diabetes: A Joinpoint Analysis,” was published online by WCIRDC.