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Research Summary
Analyzed using Evidence Intelligence™

METS-IR improves cardiovascular risk prediction in type 2 diabetes.

Powered by the Dediabetes Evidence Intelligence™ framework

Last updated September 9, 2026

Key finding

Hazard ratios comparing the highest to the lowest METS-IR quartile were 1.25 [95% CI: 1.08-1.45] for MACEs.

The study investigated METS-IR as a predictive biomarker for cardiovascular risk in patients with type 2 diabetes, finding significant associations with various adverse outcomes.

Quick read

Study at a glance

The essential study design details in one scan.

EvidenceScore™

Moderate

Study type

RCTs

Follow-up

Extended (5–20+ y)

Risk of bias

Some Concerns

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Plain-language summary

What this paper says

A plain-language read of the study’s main message and where it applies.

Study focus

The study investigated METS-IR as a predictive biomarker for cardiovascular risk in patients with type 2 diabetes, finding significant associations with various adverse outcomes.

Clinical relevance

Understanding the relationship between METS-IR and cardiovascular risk is crucial for clinicians managing patients with type 2 diabetes. By identifying those at higher risk, healthcare providers can implement preventive measures and tailor treatment strategies, potentially reducing the incidence of serious cardiovascular events.

Keep in mind

The effectiveness of METS-IR monitoring remains unclear due to the nature of the evidence. The study may have limited generalizability to broader populations outside the trial. Potential confounding factors were not fully accounted for in the analysis.

Published in

Journal Reference

Publication details and source links for this paper.

Ying X, Na-Ling P, Cai-Yan X, et al. METS-IR as a Predictive Biomarker for Cardiovascular Risk in Patients with Type 2 Diabetes. World Journal of Diabetes. 2025;16(8):108671. doi:10.4239/wjd.v16.i8.108671

View DOIView on PubMedView on PMC

Main Effects

Higher METS-IR quartiles showed a 25% increased incidence of major adverse cardiovascular events (HR 1.25, p=0.0024).

There was a 55% increase in cardiovascular death risk for the highest METS-IR quartile (HR 1.55, p=0.0003).

All-cause mortality risk increased by 39% in higher METS-IR quartiles (HR 1.39, p=0.0001).

Congestive heart failure incidence was 122% higher in the highest METS-IR quartile (HR 2.22, p=0.0001).

Major coronary heart disease events were 35% more likely in those with higher METS-IR scores (HR 1.35, p=0.0001).

Evidence network

How this study fits

Understand where this research contributes within the broader evidence network.

Evidence Context

This study contributes evidence to METS-IR monitoring and All-cause mortality, Cardiovascular death, Incidence heart disease, and 2 more.

This study contributes evidence to

Intervention

METS-IR monitoring

Outcome

All-cause mortality

Evidence topic

Cardiovascular Risk

Primary intervention

METS-IR monitoring

Primary outcomes

  • All-cause mortality
  • Cardiovascular death
  • Incidence heart disease

Evidence topics

Cardiovascular Risk

Primary intervention

METS-IR monitoring

Primary outcomes

All-cause mortalityCardiovascular deathIncidence heart disease

Evidence relationships

Intervention and outcome relationships this study adds to the evidence network.

5
Evidence pairs
5
Relationships
1
Evidence topics
contributes_evidence

Editorial context

Why this study matters

See why this paper is useful beyond its individual results.

Evidence network role

This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.

Moderate contributionModerate confidenceNetwork score: 63

1

Related topics

5

Evidence pairs

54

Related studies

High relevance in at least one topic

Why it is useful

  • Contributes to 5 evidence relationships
  • Includes primary outcome data
  • Linked to 1 direct semantic evidence topic

Topic contributions

Evidence topic

Contributes evidence

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Primary evidence

Evidence topic

Cardiovascular Risk

matched_outcome

Core evidence

Study findings

The primary outcomes reported in this study.

All-cause mortality

METS-IR monitoring → All-cause mortality

METS-IR monitoring → All-cause mortality

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
25
Negative
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Cardiovascular death

METS-IR monitoring → Cardiovascular death

METS-IR monitoring → Cardiovascular death

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
100
Very Positive
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Incidence heart disease

METS-IR monitoring → Incidence heart disease

METS-IR monitoring → Incidence heart disease

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
25
Negative
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Incidence of heart failure

METS-IR monitoring → Incidence of heart failure

METS-IR monitoring → Incidence of heart failure

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
25
Negative
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Major adverse cardiovascular events, 5-point composite

METS-IR monitoring → Major adverse cardiovascular events, 5-point composite

METS-IR monitoring → Major adverse cardiovascular events, 5-point composite

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
100
Very Positive
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Evidence Library

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evidence suggest

Evidence Suggest

  • METS-IR monitoring is linked to a 25% higher risk of major cardiovascular events.
  • A 55% increased risk of cardiovascular death was observed in high METS-IR patients.
  • All-cause mortality risk rose by 39% with higher METS-IR levels.
who this applies

Who this applies to

  • Adults diagnosed with type 2 diabetes.
  • Patients at risk for cardiovascular diseases.
keep in mind

Keep in Mind

  • The study's findings are based on a specific population and may not apply universally.
  • Further research is needed to clarify the effectiveness of METS-IR monitoring.
  • Results may be influenced by unmeasured confounding variables.
between the lines

Between the Lines

  • The effectiveness of METS-IR monitoring remains unclear due to the nature of the evidence.
  • The study may have limited generalizability to broader populations outside the trial.
  • Potential confounding factors were not fully accounted for in the analysis.

Evidence Library

Build your evidence library

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Connected Evidence

Explore related studies, evidence collections, and research questions.

Relationships organized using the Dediabetes Evidence Intelligence™ framework.

Powered by the Dediabetes Evidence Intelligence™ framework

This study contributes to evidence on METS-IR monitoring and Cardiovascular Outcomes, METS-IR monitoring and Cardiovascular Outcomes.

Related evidence relationships

Explore in Evidence Explorer

This study contributes to the evidence on the following intervention-outcome relationships.

Questions answered by this study

Generated from the study's connected evidence using Evidence Intelligence™.

Does METS-IR monitoring improve cardiovascular death?

Emerging Evidence

METS-IR monitoring appears to improve cardiovascular death.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    Cardiovascular death

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence

Does METS-IR monitoring affect major adverse cardiovascular events, 5-point composite?

Emerging Evidence

METS-IR monitoring appears to affect major adverse cardiovascular events, 5-point composite.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    Major adverse cardiovascular events, 5-point composite

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence

Does METS-IR monitoring improve all-cause mortality?

Emerging Evidence

METS-IR monitoring may worsen all-cause mortality or be associated with harm.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    All-cause mortality

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | moderate negative | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence

Does METS-IR monitoring reduce incidence heart disease?

Emerging Evidence

METS-IR monitoring may increase incidence heart disease or be associated with harm.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    Incidence heart disease

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | moderate negative | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence
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Next steps

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Evidence topics

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Cardiovascular Risk Evidence Hub

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Open broader Evidence Explorer views for this relationship.

All studies on METS-IR monitoring and All-cause mortalityAll studies on METS-IR monitoring and Cardiovascular deathAll studies on METS-IR monitoring and Incidence heart diseaseAll studies on METS-IR monitoring and Incidence of heart failure

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