---
title: "Contrasting associations of insulin resistance with diabetes,…"
description: "In older adults, insulin resistance predicts diabetes but does not significantly predict cardiovascular disease or mortality."
url: "https://magellanlongevity.com/study/d25264116.md"
canonical: "https://magellanlongevity.com/study/d25264116.html"
html: "https://magellanlongevity.com/study/d25264116.html"
type: "study"
study_key: "d25264116"
journal: "Diabetologia"
year: 2014
pmid: "25264116"
doi: "10.1007/s00125-014-3383-9"
citations: 1
updated: 2026-09-02
author: "Gabriel Radu, DO"
author_credentials: "Physiatrist (PM&R). NY medical license 275110. NPI 1376861765."
publisher: "Magellan Longevity"
content_format: "markdown"
---

# Contrasting associations of insulin resistance with diabetes, cardiovascular disease and all-cause mortality in the elderly: PROSPER

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## Citation

| Field | Value |
| --- | --- |
| Journal | Diabetologia |
| Year | 2014 |
| PMID | [25264116](https://pubmed.ncbi.nlm.nih.gov/25264116/) |
| DOI | [10.1007/s00125-014-3383-9](https://doi.org/10.1007/s00125-014-3383-9) |
| Study key | d25264116 |

## Takeaway

In older adults, insulin resistance predicts diabetes but does not significantly predict cardiovascular disease or mortality.

## The question

Does insulin resistance, measured by fasting insulin and HOMA-IR, predict incident cardiovascular disease (CVD) and diabetes in older people, and do these associations differ in strength?

## Hypothesis

Insulin resistance is commonly proposed as a precursor to both type 2 diabetes and cardiovascular disease.

## Methods

The study used data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) cohort, specifically 4,742 older individuals (70-82 years) without diabetes at baseline who had HOMA-IR measurements. Participants were followed for 3.2 years for incident diabetes and 8.6 years for all-cause mortality, CHD deaths, and fatal/non-fatal CVD events. Cause-specific Cox proportional-hazards models were fitted using multivariable models to assess associations.

## Results

Higher HOMA-IR was associated with incident diabetes, with a hazard ratio (HR) of 4.80 (95% CI 3.14, 7.33) when comparing extreme thirds after adjustment. However, HOMA-IR in the top third was not associated with all-cause mortality (HR 1.02, 95% CI 0.90, 1.17), CHD mortality (HR 1.03, 95% CI 0.79, 1.36), or fatal/non-fatal CVD (HR 0.94, 95% CI 0.74, 1.20). Similar results were observed when fasting insulin was used as the exposure.

## Conclusion

The data support insulin resistance as a predictor of diabetes in later life. However, this pathway appears to be of negligible importance to cardiovascular disease outcomes in the elderly.

## Limitations

The abstract does not explicitly state limitations beyond the scope of the study, but it implies that the findings regarding CVD in the elderly might be surprising given common proposals.

## Verbatim from the abstract

> Higher HOMA-IR was associated with incident diabetes

## Hazard Ratios for Outcomes by High HOMA-IR

| Measure | Hazard Ratio |
| --- | --- |
| Incident Diabetes | 4.8 |
| All-cause Mortality | 1.02 |
| CHD Mortality | 1.03 |
| Fatal/Non-fatal CVD | 0.94 |

*Hazard ratios for incident diabetes, all-cause mortality, CHD mortality, and fatal/non-fatal CVD when comparing the top third of HOMA-IR to lower thirds, adjusted for confounders.*

## Where this study is used on Magellan

This paper is one of the citations behind the evidence grade on the pages below. Grades are assigned from the published research and are independent of affiliate commissions.

| Compound or device | Evidence grade | Graded pages |
| --- | --- | --- |
| Fasting Insulin / HOMA-IR Kit | Measurement tool | [Fasting Insulin / HOMA-IR Kit](https://magellanlongevity.com/p/145.md) |

## Reference

1. **Contrasting associations of insulin resistance with diabetes, cardiovascular disease and all-cause mortality in the elderly: PROSPER**
   Diabetologia 2014 · [PMID 25264116](https://pubmed.ncbi.nlm.nih.gov/25264116/) · [DOI 10.1007/s00125-014-3383-9](https://doi.org/10.1007/s00125-014-3383-9)

   > Higher HOMA-IR was associated with incident diabetes

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## Related on Magellan Longevity

- [Fasting Insulin / HOMA-IR Kit](https://magellanlongevity.com/p/145.md) — product graded on this and related evidence
- [Evidence: Fasting insulin and HOMA-IR](https://magellanlongevity.com/study/s145.md)
- [Longevity research map](https://magellanlongevity.com/longevity-research-map.html)
- [Evidence-based longevity supplements](https://magellanlongevity.com/longevity-supplements.md)

## Scope and disclosures

Educational information, not medical advice. Nothing here is intended to diagnose, treat, cure, or prevent any disease. Talk to your physician before starting any supplement or device, especially if you are pregnant, nursing, or taking medication.

Editorial firewall: evidence grades are assigned from the published research and are independent of any affiliate commission. As an Amazon Associate, Magellan Longevity earns from qualifying purchases.

Reviewed for accuracy by a board-certified physician (DO).