The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: A nested case control study

The impact of the triglyceride-glucose index on the deterioration of kidney function in patients with cardiovascular-kidney-metabolic syndrome: insight from a large cohort study in China

BACKGROUND

The triglyceride-glucose (TyG) index has emerged as a credible surrogate indicator of insulin resistance in recent years. This study aimed to investigate the relationship between the TyG index and the deterioration of kidney function in patients with cardiovascular-kidney-metabolic (CKM) syndrome.

METHODS

In this retrospective cohort study from China, 27,407 hospitalized patients with stage 1-4 CKM syndrome were consecutively included. The participants were categorized into four groups according to TyG index quartiles. The study outcome was the deterioration of kidney function, defined as a decrease in estimated glomerular filtration rate (eGFR) ≥ 40% from baseline. Restricted cubic spline (RCS) curves and multivariate Cox analysis were used for analysis.

RESULTS

3,248 outcome events were recorded during a mean follow-up period of 34 months. The RCS plot displayed a U-shaped curve between the baseline TyG index and the deterioration of kidney function (P for non-linear < 0.001). The baseline TyG index with the lowest hazard ratio (HR) of eGFR decline ranges from 8.65 to 9.15, with an inflection point at 8.88. After fully adjusting for covariates, HRs and 95% confidence intervals (CIs) from the lowest to highest TyG index quartile were 1.00 (reference), 0.82 (0.74, 0.91), 0.78 (0.70, 0.86), and 0.93 (0.83, 1.03), respectively. According to the Kaplan-Meier survival curve, the risk of deterioration of kidney function was elevated in the lowest and highest TyG index quartiles (log-rank test, p < 0.0001).

CONCLUSIONS

In individuals with CKM syndrome, a non-linear U-shaped relationship existed between the baseline TyG index and the deterioration of kidney function.

Triglyceride Glucose Index and the Risk of Diabetic Nephropathy in Patients with Type 2 Diabetes: A Meta-Analysis

Diabetic nephropathy (DN) is a leading cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). This meta-analysis aims to evaluate the association between the triglyceride glucose (TyG) index, a novel marker reflecting insulin resistance, and the risk of developing DN in patients with T2DM. We conducted a comprehensive literature search in PubMed, Embase, and Web of Science databases up to May 12, 2024. Studies assessing the TyG index in relation to DN risk among T2DM patients were included. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of eight longitudinal follow-up studies encompassing 15 889 patients with T2DM were included. The pooled analysis revealed a significant association between a higher TyG index and an increased risk of DN in patients with T2DM (RR=1.53, 95% CI: 1.37-1.71, p<0.001; I2=35%). The results of meta-regression analysis suggested that the cutoff of TyG index was positively associated with the RR for the association between TyG index and DN. Subgroup analyses demonstrated that the association was stronger in studies with cutoff of TyG index ≥9.5 as compared to those with the cutoff <9.5 (RR: 1.73 vs. 1.40, p for subgroup difference <0.05). The association was not significantly affected by study design, mean age of the patients, proportion of men, or follow-up durations. In conclusion, higher TyG index is significantly associated with an increased risk of DN in patients with T2DM.

Associations of the triglyceride-glucose index and remnant cholesterol levels with the prevalence of Carotid Plaque in patients with type 2 diabetes: a retrospective study

BACKGROUND

The triglyceride-glucose (TyG) index has been identified as an alternative biomarker for insulin resistance (IR), while residual cholesterol (RC) is a simple, cost-effective, and easily detectable lipid metabolite. However, the associations of these two markers with carotid plaque presence remain unclear. Thus, this study aimed to explore their associations with carotid plaque presence.

METHODS

Participants were chosen from patients with T2DM admitted to The Second Affiliated Hospital of Anhui Medical University from October 2023 to April 2024, and they were separated into two groups (patients without carotid plaque and patients with carotid plaque) based on their carotid ultrasound results. By comparing the general information and biochemical indicators of the two groups, we employed multivariate logistic regression models and RCS regression models to investigate the associations of the TyG index and RC levels with carotid plaque presence, and made adjustments based on multiple confounding factors to identify the differences between subgroups.

RESULTS

This study comprised 278 patients with T2DM in total, including 165 males and 113 females. A multivariate logistic regression study indicated that, after adjusting statistically significant variables screened in LASSO regression, TyG index [OR (95% CI): 1.810 (1.077, 3.113)] and RC [OR (95% CI): 1.988 (1.034, 3.950)] remained the risk factors for carotid plaque presence. According to restricted cubic splines (RCS), RC levels increased linearly with carotid plaque presence (P - nonlinear > 0.05). Conversely, the TyG index and carotid plaque presence did not associate linearly (P - nonlinear < 0.05). Results of subgroup analyses showed no grouping variables exhibited association with TyG index or RC (p for interaction > 0.05).

CONCLUSIONS

In patients with T2DM, both TyG index and RC levels were strongly linked to carotid plaque presence, and could serve as independent risk factors for this presence. Monitoring the TyG index and RC levels can help gain a better understanding and knowledge of carotid plaque presence in patients with T2DM, offering guidance for the clinical prevention and treatment of cardiovascular and cerebrovascular diseases (CCVDs) in patients with T2DM.

Association of the triglyceride glucose index with all cause and CVD mortality in the adults with diabetes aged < 65 years without cardiovascular disease

Although the triglyceride-glucose (TyG) index has been established as a valuable predictor for cardiovascular disease (CVD) and cardiovascular mortality, there is limited research exploring its association with all-cause or CVD mortality specifically in adults with diabetes aged < 65 years without cardiovascular disease. This study aimed to investigate the relationship between the TyG index and both all-cause and CVD mortality in this population within the United States. Our study recruited 1778 adults with diabetes aged < 65 years without cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31, 2019. Cox regression modeling was employed to examine the association between the TyG index and mortality in this population. The nonlinear relationship between the TyG index and mortality was assessed using restricted cubic splines (RCS). Additionally, subgroup analyses and interaction tests were conducted to explore potential effect modifiers. A total of 1788 participants were included in the final cohort, with an average age of 49.61 ± 0.32 years. During a median follow-up of 7.92 years, the occurrence of 150 all-cause deaths and 33 CVD-related deaths were recorded. To investigate the independent association between the TyG index and the risks of all-cause and CVD mortality, three Cox regression models were developed. In Model 1, a significant positive association was observed between the TyG index and the risk of all-cause mortality (HR 1.38, 95% CI 1.09-1.74). This association persisted in the minimally adjusted model (HR 1.44, 95% CI 1.13-1.83), which was adjusted for age, gender and race. Even after full adjustment, this positive association remained significant (HR 1.91, 95% CI 1.36-2.70). We also found that the relationship between the TyG index and all-cause mortality was linear. Subgroup analyses revealed no significant interactions between the TyG index and the stratification variables. However, we did not observe a significant association between the TyG index and CVD mortality in this population. Our results suggested that a significantly positive association between the TyG index and all-cause mortality. The positive association between the TyG index and all-cause mortality was linear. We did not observe a significant association between the TyG index and CVD mortality.

The Association Between Diabetic Nephropathy and Triglyceride/Glucose Index and Triglyceride/High-Density Lipoprotein Cholesterol Ratio in Patients with Type 2 Diabetes Mellitus

Background: In this study, we aimed to investigate the relationship between diabetic nephropathy (DN) and triglyceride/glucose (TyG) index and triglyceride/high-density lipoprotein cholesterol ratio (Tg/HDL-C) as surrogate markers of insulin resistance. Method: Medical records of 15,378 individuals between February 2019 and May 2024 were examined. Serum glucose, Tg, HDL-C, HbA1c, estimated glomerular filtration rate (eGFR), and urine albumin/creatinine ratio (UACR) were evaluated and the TyG index and TG/HDL-C ratios were calculated for each individual. DN was defined as a UACR ≥ 30 mg/g and/or eGFR <60 mL/min/1.73 m2. Results: Of 10,714 patients, DN was detected in 3763 (35.1%). Females had 10% higher odds of developing DN compared to males. A TyG index at or above the determined cutoff point (9.58) indicated a risk of DN and the sensitivity and specificity values were 44.01% and 71.28%, respectively. The risk of DN was 1.95 times higher in individuals with a TyG index value of ≥9.58 compared to those with a TyG index <9.58. While the Tg/HDL ratio was significant in detecting DN in the univariate analysis (odds ratio (OR) 1.59; 95% confidence interval 1.46-1.73), this significance was not found in the multivariate analysis (OR 1.15; 95% confidence interval 0.94-1.40). Conclusions: A high TyG index is associated with DN in patients with type 2 diabetes and it might be a potential marker in predicting DN.

Triglyceride-glucose index and risk of all-cause and cardiovascular mortality in patients with cardiovascular disease: Analysis from 1999 to 2018 NHANES data

This research seeks to examine the correlation between the triglyceride-glucose index and the hazard of all-cause and cardiovascular death in individuals with cardiovascular disease (CVD). By evaluating the index, we can better anticipate and assess the risk and prognosis of CVD patients, and provide precise and individualized guidance for clinical treatment and management. Demographic and clinical data of 2185 CVD patients from 10 cycles of the National Health and Nutrition Examination Survey database from 1999 to 2018 were extracted for analysis. Employed the 3-level quantile method to group data, and a multivariate Cox proportional hazard model along with subgroup analysis to study the correlation between index and both mortalities. Additionally, restricted cubic spline examination was employed to assess the correlation, aiming to enhance the comprehension of their interrelation. Over the course of an average post-observation duration of 89.5 months involving 2185 CVD individuals, 607 patients suffered from all-cause mortality and 313 patients suffered from CVD-related mortality. An inverted U-shaped correlation was identified through restricted cubic spline analysis. During the multivariate COX regression analysis, it was found that individuals in the T2 and T3 had a dramatically lower hazard of both mortalities as opposed to those in the T1. The results were overall consistent across subgroup analyses according to age, gender, race, body mass index, diabetes, and hypertension, the interaction between these characteristics and the index was not remarkable (P > .05). Studies conducted on CVD individuals in the US have revealed a U-shaped correlation between triglyceride-glucose index and hazard of both all-cause and CVD-related death. However, further investigations are required to examine the particular function of index in forecasting the prognosis of CVD individuals. This will be helpful in accurately evaluating the risk and prognosis of CVD patients, and ultimately in developing more precise and personalized treatment and management strategies.

Association between triglyceride-glucose index and chronic kidney disease: results from NHANES 1999-2020

AIMS

Examining the connection between the triglyceride-glucose (TyG) index and chronic kidney disease (CKD) was the aim of this investigation.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) covering the years 1999-2020 were analyzed in this study. The TyG index was calculated as Ln (triglycerides (mg/dl) * fasting glucose (mg/dl)/2). The two criteria used to diagnose CKD were low estimated glomerular filtration rate (eGFR) (eGFR < 60 mL/min/1.73m2) or albuminuria (urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g). To look into the independent associations between TyG index levels with CKD, albuminuria, and low-eGFR, weighted multivariable logistic regression and generalized additive models were employed. To assess and contrast the diagnostic ability, receiver operating characteristic (ROC) curves were employed.

RESULTS

Out of 18,078 total participants recruited, 48.54% were male. 8.48 + 0.68 was the mean value of the TyG index. CKD, albuminuria, and low-eGFR were common, with respective prevalences of 17.06%, 11.26%, and 8.03%, respectively. The TyG index and CKD were observed to positively correlate (OR = 4.03; 95% CI 1.81, 8.96). In US adults between the ages of 41 and 60, a J-shaped connection was found between the two. Furthermore, a higher TyG index is associated with a higher prevalence of albuminuria (OR = 6.11; 95% CI 2.64, 14.14). Subgroup analyses and interaction tests revealed that different stratifications did not significantly affect the relationship between TyG index and CKD, albuminuria, and low-eGFR. Comparing the TyG index to other indicators [lipid accumulation product (LAP), Visceral adiposity index (VAI), and the triglyceride glucose-body mass index (TyG-BMI)], it may be more accurate and discriminative in predicting CKD and albuminuria.

CONCLUSION

When predicting CKD and albuminuria, the TyG index may be a more useful marker when compared to other markers (LAP, VAI, and TyG-BMI index). In addition, in American adults aged 41-60, the TyG index shows a J-shaped relationship with CKD. As a result, when assessing the kidney health of US adults, we must pay close attention to the significance of the TyG index.

Role of Triglyceride-Glucose Index in Type 2 Diabetes Mellitus and Its Complications

Insulin resistance (IR) is the major mechanism in the pathogenesis of type 2 diabetes mellitus (T2DM). Early identification of IR is of great significance for preventing the onset of T2DM and delaying the progression of the disease. Previous studies have shown that triglyceride-glucose (TyG) index can be used as an effective surrogate marker for IR. There is a significant correlation between TyG index and T2DM and its common complications. In addition, the predictive efficacy of TyG index is better than that of other IR surrogate indicators. TyG index may not only become an important marker to identify people at high risk of T2DM and its complications, but is also expected to become a strong predictor of the prognosis of these diseases. However, there are still some challenges in the widespread application of TyG index in clinical practice. In the future, more high-quality studies are needed to clarify the assessment methods of TyG index for the prognosis of T2DM and its complications. Further investigations of the relationship between TyG index and T2DM and its complications will be expected to provide new ideas and methods for the prevention and treatment of T2DM and its complications.

Triglyceride Glucose Index for the Detection of Diabetic Kidney Disease and Diabetic Peripheral Neuropathy in Hospitalized Patients with Type 2 Diabetes

INTRODUCTION

The triglyceride-glucose index (TyG) has been identified as a dependable and simple indicator marker of insulin resistance (IR). Research has demonstrated a correlation between macrovascular complications and TyG. However, limited research exists regarding the relationship between TyG and diabetic microvascular complications. Consequently, the objective of this study is to investigate the association between TyG and diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN).

METHODS

This is a cross-sectional, observational study. A total of 2048 patients from Tongren Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. The primary outcomes are DKD and DPN. Quantile regression analysis was employed to investigate the implicit factors of TyG quartiles. Subsequently, based on implicit factors, logistic regression models were constructed to further examine the relationship between TyG and DKD and DPN.

RESULTS

In the baseline, TyG exhibited higher values across patients with DKD, DPN, and co-existence of DKD and DPN (DKD + DPN) in type 2 diabetes (T2D). Univariate logistic regressions demonstrated a significant association between an elevated TyG and an increased risk of DKD (OR = 1.842, [95% CI] 1.317-2.578, P for trend < 0.01), DPN (OR = 1.516, [95% CI] 1.114-2.288, P for trend < 0.05), DKD + DPN (OR = 2.088, [95% CI] 1.429-3.052, P for trend < 0.05). Multivariable logistic regression models suggested a statistically significant increase in the risk of DKD (OR = 1.581, [95% CI] 1.031-2.424, p < 0.05), DKD + DPN (OR = 1.779, [95% CI] 1.091-2.903, p < 0.05) after adjusting the implicit factors of TyG quartiles. However, no significant relationship was observed between TyG and DPN in the multivariable regression analysis.

CONCLUSIONS

Elevated TyG was significantly associated with an increased risk of DKD in T2D, but no significant relationship was shown with DPN. This finding provided further evidence for the clinical significance of integrating TyG into the initial assessment of diabetic microvascular complications.

Association between the triglyceride-glucose index and all-cause and CVD mortality in the young population with diabetes

BACKGROUND

Although studies have demonstrated the value of the triglyceride-glucose (TyG) index for cardiovascular disease (CVD) and cardiovascular mortality, however, few studies have shown that the TyG index is associated with all-cause or CVD mortality in young patients with diabetes. This study aimed to investigate the association between the TyG index and all-cause and CVD mortality in young patients with diabetes in the United States.

METHODS

Our study recruited 2440 young patients with diabetes from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31, 2019. Cox regression modeling was used to investigate the association between TyG index and mortality in young patients with diabetes. The nonlinear association between TyG index and mortality was analyzed using restricted cubic splines (RCS), and a two-segment Cox proportional risk model was constructed for both sides of the inflection point.

RESULTS

During a median follow-up period of 8.2 years, 332 deaths from all causes and 82 deaths from cardiovascular disease were observed. Based on the RCS, the TyG index was found to have a U-shaped association with all-cause and CVD mortality in young patients with diabetes, with threshold values of 9.18 and 9.16, respectively. When the TyG index was below the threshold value (TyG index < 9.18 in all-cause mortality and < 9.16 in CVD mortality), its association with all-cause and CVD mortality was not significant. When the TyG index was above the threshold (TyG index ≥ 9.18 in all-cause mortality and ≥ 9.16 in CVD mortality), it showed a significant positive association with all-cause mortality and CVD mortality (HR 1.77, 95% CI 1.05-2.96 for all-cause mortality and HR 2.38, 95% CI 1.05-5.38 for CVD mortality).

CONCLUSION

Our results suggest a U-shaped association between TyG index and all-cause and CVD mortality among young patients with diabetes in the United States, with threshold values of 9.18 and 9.16 for CVD and all-cause mortality, respectively.

Predictive value of triglyceride/glucose index for cardiac outcomes in non-diabetic renal transplant recipients

OBJECTIVES

Insulin resistance (IR) is associated with an increased risk of adverse cardiovascular outcomes. The triglyceride-glucose index (TyG index) is a reliable marker of IR. No study has examined the impact of the TyG index on major adverse cardiac and cerebrovascular events (MACCEs) in RTRs. Therefore, this study aimed to investigate the predictive value of the TyG index for MACCEs in RTRs.

MATERIALS AND METHODS

Non-diabetic patients undergoing renal transplantation were retrospectively enrolled. The patients were divided into two groups according to MACCE development. The cut-off value of the TyG index for MACCE was conducted.

RESULTS

The mean age of 522 patients was 41 (31-51) years, and 349 (66.9%) were male. During the 5.4-year follow-up, 84 (16%) MACCE were recorded. TyG index was significantly higher in the group that developed MACCE (p < 0,001). Cox regression analysis revealed that TyG index [HR: 3.297 (1.228-8.855), p = 0.018], left ventricle ejection fraction [HR: 0.934 (0.900-0.968), p < 0.001], cadaveric transplantation [HR: 8.886 (4.764-16.576), p < 0.001], graft survey [HR: 0.608 (0.542-0.682), p < 0.001)], and smoking [HR: 1.965 (1.117-3.456), p = 0.019] were independent predictors of MACCEs in nondiabetic RTRs.

CONCLUSION

TyG index is an independent predictor of MACCEs in non-diabetic RTRs. The widespread use of the TyG index may positively affect long-term treatment costs and survival.

The triglyceride-glucose index is a predictor for cardiovascular and all-cause mortality in CVD patients with diabetes or pre-diabetes: evidence from NHANES 2001-2018

BACKGROUND

The association between the triglyceride-glucose (TyG) index and mortality in cardiovascular disease (CVD) patients with diabetes or pre-diabetes remains unclear. This study aimed to investigate the relationship between baseline TyG index and all-cause and cardiovascular (CV) mortality in CVD patients with diabetes or pre-diabetes among American adults. .

METHODS

This study enrolled 1072 CVD patients with diabetes or pre-diabetes from the National Health and Nutrition Examination Survey (2001-2018). Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31, 2019. Multivariate Cox proportional hazards models were constructed to analyze explore the associations between baseline TyG index and mortality. Non-linear correlations were explored using restricted cubic splines, and a two-piecewise Cox proportional hazards model for both sides of the inflection point was constructed.

RESULTS

During 7541 person-years of follow-up, a total of 461 all-cause deaths and 154 CVD-related deaths were recorded. The restricted cubic splines revealed a U-shaped association between the baseline TyG index with all-cause and CVD mortality in CVD patients with diabetes or pre-diabetes. Specifically, baseline TyG index lower than the threshold values (TyG index < 9.05 in all-cause mortality and < 8.84 in CVD mortality) was negatively associated with mortality (HR 0.47, 95% CI = 0.27-0.81 for all-cause mortality and HR 0.25, 95% CI = 0.07-0.89 for CVD mortality). In contrast, baseline TyG index higher than the threshold values (TyG index > 9.05 in all-cause mortality and > 8.84 in CVD mortality) was positively associated with mortality (HR 1.42, 95% CI = 1.02-1.99 for all-cause mortality and HR 1.77, 95% CI = 1.08-2.91 for CVD mortality).

CONCLUSIONS

A U-shaped association was observed between the baseline TyG index with CVD and all-cause mortality in CVD patients with diabetes or pre-diabetes in a American population. The thresholds of 8.84 and 9.05 for CVD and all-cause mortality, respectively.

Assessment of Triglyceride-Glucose Index and Ratio in Patients with Type 2 Diabetes and Their Relation to Microvascular Complications

OBJECTIVE

Triglyceride-based indices have gained much attention over the past few years. Relation of triglyceride - glucose (TyG) index with insulin resistance and diabetic macrovascular complications was thoroughly studied; nevertheless its relation to microvascular complications is still unclear. This provoked us to carry out the present study.

METHODS

This cross-sectional study included 500 patients with type 2 diabetes (T2DM), who were enrolled from the outpatient clinic of the Diabetes and Metabolism Unit at Alexandria Main University Hospital. The equations utilized to calculate triglycerides-related indices were: TyG ratio = fasting triglycerides (mg/dL)/fasting glucose (mg/dL), and TyG index = logarithm of [fasting triglyceride (mg/dl) x fasting glucose (mg/dl)/2]. The diagnostic criteria set by the American Diabetes Association were followed to diagnose diabetic microvascular complications.

RESULTS

In patients with T2DM, TyG index was significantly higher in patients with diabetic retinopathy, diabetic kidney disease, and diabetic peripheral neuropathy compared to those without complications (p < 0.001). TyG index was significantly positively correlated to diabetes duration, as well as triglyceride/high density lipoprotein ratio in the total sample (p < 0.001).

CONCLUSION

TyG index is an easy, cheap, and available marker for detection of microvascular complications in patients with T2DM.

Association of S19W polymorphism in APOA5 gene and serum lipid levels in patients with type 2 diabetic nephropathy

OBJECTIVES

Type 2 diabetic Mellitus (T2DM) is the most common systemic and endocrine disease in humans, and diabetic nephropathy is one of the most serious complications of this disorder. The polymorphisms in the apolipoprotein A5 (ApoA5) gene are strongly related to hypertriglyceridemia and are considered a predisposing factor for diabetic nephropathy. The current study proposed to examine the association of APOA5-S19W polymorphism with serum lipids levels in patients with type 2 diabetic nephropathy in Mazandaran province.

METHODS

This case-control study was designed to determine the association of APOA5-S19W polymorphism with plasma lipid profile in 161 T2DM patients with nephropathy (DN+), without nephropathy (DN-), and in 58 healthy individuals. Lipid profile values were measured using Pars Azmoun commercial kits. S19W variant, one of the polymorphisms of the APOA5 gene, was determined by PCR-restriction fragment length polymorphism (PCR-RFLP) and Taq1 restriction enzyme.

RESULTS

In comparison between the three groups, DN+ had a higher mean TG than DN- and the control group (p<0.001). The incidence of the G allele in DN+ was not significant compared to groups of DN-. Comparing the relationship between the mean of biochemical variables with CC and CG genotypes showed that the mean level of TG in people with CC genotype was increased compared to people with CG genotype in diabetic patients. However, this increase was not significant (p=0.19).

CONCLUSIONS

There was no association between SNP APOA5 S19W and serum lipids in diabetic patients with and without nephropathy.

Non-insulin-based insulin resistance indices for predicting all-cause mortality and renal outcomes in patients with stage 1-4 chronic kidney disease: another paradox

Non-insulin-based insulin resistance (IR) indices serve as the indicators of metabolic syndrome (MetS) but have limited value for predicting clinical outcomes. Whether the obesity paradox affects the predictive value of these indicators in patients with chronic kidney disease (CKD) remains unknown. We investigated whether MetS and non-insulin-based IR indices can predict all-cause mortality and renal outcomes in a prospective observational study with stage 1-4 CKD Asians (N = 2,457). These IR indices were associated with MetS. A Cox regression model including body mass index (BMI) revealed an association between MetS and renal outcomes. Among the IR indices, only high triglyceride-glucose (TyG) index was associated with adverse renal outcomes: the hazard ratio of Q4 quartile of the TyG index was 1.38 (1.12-1.70). All-cause mortality was marginally associated with MetS but not high IR indices. Low TyG and TyG-BMI indices as well as low BMI and triglyceride were paradoxically associated with increased risks of clinical outcomes. The triglyceride-to-high-density lipoprotein cholesterol ratio and metabolic score for IR indices were not associated with clinical outcomes. In conclusion, MetS and TyG index predict renal outcome and obesity paradox affects the prediction of IR indices in patients with stage 1-4 CKD.

Triglyceride-Glucose Index May Predict Renal Survival in Patients with IgA Nephropathy

Background: The triglyceride−glucose (TyG) index is a simple, novel and reliable surrogate marker of insulin resistance. However, evidence for the prognostic impact of an elevated TyG index on IgA nephropathy (IgAN) is limited. Therefore, we evaluated the relationship between the TyG index and the risk of renal progression in IgAN. Method: This cohort study involved biopsy-proven IgAN between January 2009 and December 2018 in West China Hospital, in which patients were assigned to two groups based on the cut-off value of TyG using receiver operating characteristic (ROC) curves. A 1:1 matched-pair analysis was established to optimize the bias in IgAN by propensity score matching (PSM). The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The composite endpoint was defined by eGFR decreased ≥50% of the baseline level, end-stage kidney disease (ESKD), renal transplantation and/or death. Univariable and multivariable Cox proportional hazard models were applied to confirm the predictive value of the optimal marker. Results: Before PSM, a total of 1210 participants were ultimately included. During a median follow-up period of 55.8 months (range 37.20−79.09 months), 129 participants progressed to the composite endpoint (10.7%). After PSM, 366 patients were enrolled in the matched cohort, of whom 34 (9.3%) patients reached the endpoints. Based on the cut-off value of the TyG index, patients were divided into the low TyG index group (TyG ≤ 8.72, n = 690) and the high TyG index group (TyG > 8.72, n = 520). Further analysis demonstrated that a higher TyG index was significantly associated with a higher risk of reaching composite endpoints in IgAN patients in both the unmatched and matched cohorts (before PSM: HR 2.509, 95% CI 1.396−4.511, p = 0.002; after PSM: HR 2.654, 95% CI 1.299−5.423, p = 0.007). Conclusion: A high TyG index is associated with a higher risk of renal progression.

Triglyceride-glucose index is prospectively associated with chronic kidney disease progression in Type 2 diabetes - mediation by pigment epithelium-derived factor

BACKGROUND

Triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance. Its role in chronic kidney disease (CKD) progression in Type 2 Diabetes Mellitus (T2DM) is unclear. We investigated the association between TyG index and CKD progression, and possible mediation of the association by pigment epithelium-derived factor (PEDF).

METHODS

This was a prospective study on 1571 patients with T2DM. CKD progression was defined as worsening across KDIGO estimated glomerular filtration rate (eGFR) categories with ≥25% reduction from baseline. PEDF was quantitated using enzyme-linked immunosorbent assay method. Cox proportional hazards regression model was used to assess the relationship between TyG index and CKD progression.

RESULTS

Over a follow-up period of up to 8.6 years (median 4.6 years, IQR 3.0-3.6), 42.7% of subjects had CKD progression. Every unit increase in TyG was associated with hazards of 1.44 (95%CI 1.29-1.61; p < 0.001) in unadjusted analysis and 1.21 (1.06-1.37; p = 0.004) in fully adjusted model. Compared to tertile 1, tertiles 2 and 3 TyG index were positively associated with CKD progression with corresponding hazard ratios HRs 1.24 (1.01-1.52; p = 0.037) and 1.37 (1.11-1.68; p = 0.003) in fully adjusted models. PEDF accounted for 36.0% of relationship between TyG index and CKD progression.

CONCLUSIONS

Higher TyG index independently predicted CKD progression in T2DM. PEDF mediated the association between TyG index and CKD progression.

Time to develop chronic kidney disease in an Ecuadorian Type 2 Diabetes Mellitus cohort: Survival analysis in primary care

Chronic Kidney Disease (CKD) represents a high burden to health systems. However, the survival time for CKD in a Type 2 Diabetes Mellitus (T2DM) population is unknown.

AIMS

Determine the risk factors, survival time and the incidence rate of CKD in T2DM.

METHODS

Retrospective clinical cohort study (follow up 10 years). 513 patients with T2DM were included. Numerical variables were compared using the mean difference. Chi squared and odds ratios were calculated for categorical variables. Survival analysis was done through life tables and Kaplan-Meier.

RESULTS

The mean difference between the group that developed CKD and those who did not, was significant in: age, age at diagnosis of T2DM and years with T2DM. Risk factors for developing CKD were: the presence of hypertension, albuminuria, retinopathy, high triglycerides and high HbA1c. The incidence rate was 32.07 per 1000 person-years of follow-up and 207 (40.4%) of patients developed CKD during the study. The median for developing CKD was 20.52 years of disease with an increasing risk with time.

CONCLUSIONS

Half of the patients with T2DM will develop CKD by the second decade of disease. Time, arterial hypertension, retinopathy, albuminuria and triglycerides are factors associated with CKD in patients with T2DM.

[Triglyceride-glucose product is an independent risk factor for predicting chronic kidney disease in middle-aged and elderly population: a prospective cohort study]

OBJECTIVE

To explore the correlation of triglyceride-glucose product (TyG) index with chronic kidney disease (CKD) in elderly population in Lanzhou (Gansu Province, China).

METHODS

From May to September, 2011, a total of 3868 middleaged and elderly individuals without CKD from 3 communities in Lanzhou were selected as the cohort study population and were followed for an average of 3.1 years (from June, 2014 to August, 2015). After excluding those with missing follow-up data, a total of 3439 individuals were included for analysis, who were divided according to the quartile of TyG index into Q1 group (TyG≤8.47), Q2 group (TyG 8.48-8.84), Q3 group (TyG 8.85-9.20) and Q4 group (TyG>9.20). The estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio (UACR) were used to evaluate the renal function of the participants.

RESULTS

In this cohort, a high TyG index was found to correlate with a high risk of CKD (P < 0.05). Analysis of the follow-up data showed that the TyG index was significantly higher in patients who developed CKD during the follow-up than in those without CKD (P < 0.05). Logistic regression analysis showed that TyG index was an independent risk factor for abnormal eGFR and CKD (P < 0.05).

CONCLUSION

A high TyG index is an independent risk factor for CKD in middle-aged and elderly population.

Hypertriglyceridemia Is Associated with More Severe Histological Glomerulosclerosis in IgA Nephropathy

IgA nephropathy (IgAN) is a globally well-known primary glomerular nephropathy. Hypertriglyceridemia (HTG) is one factor contributing to atherosclerosis and is a common complication of renal failure. HTG is a significant risk factor for decreased renal function in patients with IgAN. We evaluated the association of HTG with the histopathological features of IgAN patients. A total of 480 patients diagnosed with IgAN via kidney biopsy from eight university hospitals affiliated with the College of Medicine of the Catholic University of Korea were included in the final cohort. Pathological features were evaluated by eight expert pathologists with hospital consensus. HTG was defined as a serum triglyceride (TG) level of ≥150 mg/dL. In the study population analysis, the HTG group was older, with more males; higher body mass index (BMI), low-density lipoprotein cholesterol (LDL-C) and spot urine protein ratio; and lower estimated glomerular filtration rate (eGFR). In the lipid profile analysis, eGFR was negatively correlated with TGs/ high-density lipoprotein cholesterol (HDL) and triglyceride-glucose index (TyG). Proteinuria positively correlated with TGs/HDL, non-HDL/HDL, LDL/HDL, TyG, TGs and LDL. The percentages of global sclerosis (GS), segmental sclerosis (SS) and capsular adhesion (CA), and the scores for mesangial matrix expansion (MME) and mesangial cell proliferation (MCP), were more elevated in the HTG group compared to the normal TG group. Multivariable linear regression analysis showed that the percentages of global sclerosis, segmental sclerosis and capsular adhesion, as well as the scores for mesangial matrix expansion and mesangial cell proliferation, were positively associated with TG level. In binary logistic regression, the HTG group showed a higher risk for global sclerosis and segmental sclerosis. In conclusion, HTG is a significant risk factor for glomerulosclerosis in IgAN.

The effects of chronic hypoxia on the endocrine-related parameters in elderly rats with type 2 diabetes mellitus

OBJECTIVE

This study aimed to investigate the effects of chronic hypoxia on the endocrine-related parameters in elderly rats with type 2 diabetes mellitus.

METHODS

Sixty, 55-week-old, female SD rats were studied, among which 20 were randomly divided into a blank control group (the BCG), and 40 were intraperitoneally injected with low-dose streptozotocin (STZ) for modeling and divided into a model control group (the MCG, n=20) and a hypoxic group (the HG, n=20). The BCG and the MCG were fed routinely under normoxia, while the HG was fed in the hypoxic environment of an OxyCycler Model A84XO hypoxic chamber. After 12 weeks of intervention, the body weights, the fasting blood glucose (FBG) levels, the fasting insulin (FINS) levels, the blood lipid metabolism levels, the bone densities, the fresh weights of the femurs, the biomechanical properties of the femurs, the inflammatory factor levels, the H&E staining of the liver tissue, and the oil red O staining were compared.

RESULTS

The increases in weight gain and the FBG and FINS levels in the HG were lower than the corresponding levels in the MCG and were higher than the levels in the BCG (P<0.05). The TC, TG, and LDL-C levels in the HG were lower than they were in the MCG and higher than they were in the BCG (P<0.05). The bone density and fresh weight of the femurs at 12 weeks after the intervention in the HG were higher than they were in the MCG and lower than they were in the BCG (P<0.05). The maximum stress, maximum load, fracture load, and elastic modulus in the HG were higher than they were in the MCG and lower than they were in the BCG (P<0.05). The TNF-α, IL-6, PAI-1, and CRP levels in the HG were lower than they were in the MCG and higher than they were in the BCG (P<0.05).

CONCLUSION

Chronic hypoxia can improve the endocrine parameters and insulin resistance, improve the insulin sensitivity and the femoral biomechanics, reduce the inflammatory factors levels, and improve the glucose and lipid metabolism levels and liver function in elderly rats with type 2 diabetes.

U-shaped association between the triglyceride-glucose index and the risk of incident diabetes in people with normal glycemic level: A population-base longitudinal cohort study

BACKGROUND

Previous studies have shown that a high baseline triglyceride-glucose (TyG) index is a potential risk factor for type 2 diabetes mellitus (T2DM). However, for a low TyG index, findings have been inconsistent. Moreover, the association between the baseline TyG index and incident T2DM in individuals with normal glycemic levels remains unclear. Therefore, this longitudinal study further examined and characterized the association between the baseline TyG index and incident T2DM in Japanese adults with normal glycemic levels. .

METHODS

The participants (7857 men and 6440 women) were selected from the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study that was conducted from 2004 to 2015. Cox proportional hazards models were used to evaluate the associations between baseline TyG index and T2DM incidence, and a two-piecewise linear regression model was used to examine the threshold effect of the baseline TyG index on incident T2DM using a smoothing function.

RESULTS

During a median follow-up period of 5.26 (women) and 5.88 (men) years, 47 women and 182 men developed T2DM. The risk of T2DM was strongly associated with the baseline TyG index in the fully adjusted model in men but not in women, and no dose-dependent positive relationship between incident T2DM and the TyG index was observed across the TyG tertiles. Interestingly, the two-piecewise linear regression analysis revealed a U-shaped association between the baseline TyG index and incident T2DM. Baseline TyG index lower than the threshold values (TyG index < 7.27 in women and <7.97 in men) were negatively associated with incident T2DM (hazard ratio [HR] = 0.09, 95% confidence interval [CI] = 0.01-0.93, P = 0.0435 for women and HR = 0.21, 95% CI = 0.08-0.57, P = 0.0021 for men). In contrast, baseline TyG index higher than the threshold values (TyG index > 7.27 in women and >7.97 in men) were positively associated with incident T2DM (HR = 2.76, 95% CI = 1.20-6.34, P = 0.0166 for women and HR = 2.42, 95% CI = 1.66-3.53, P < 0.0001 for men).

CONCLUSIONS

A U-shaped association was observed between the baseline TyG index and incident T2DM in a Japanese population.

Relationship Between the TyG Index and Diabetic Kidney Disease in Patients with Type-2 Diabetes Mellitus

BACKGROUND

Diabetic kidney disease (DKD) lacks a simple and relatively accurate predictor. The Triglyceride-Glucose (TyG) Index is a proxy of insulin resistance, but the association between the TyG Index and DKD is less certain. We investigated if the TyG Index can predict DKD onset effectively.

MATERIALS AND METHODS

Cross-sectional and longitudinal analyses were undertaken. In total, 1432 type-2 diabetes mellitus (T2DM) patients were included in the cross-sectional analysis. The TyG Index (calculated by ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]) was split into three tertiles. Associations of the TyG Index with microalbuminuria and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² were calculated. Longitudinally, 424 patients without DKD at baseline were followed up for 21 (range, 12-24) months. The main outcome was DKD prevalence as defined with eGFR <60 mL/min/1.73 m² or continuously increased urinary microalbuminuria: creatinine ratio (>30 mg/mL) over 3 months. Cox regression was used to analyze the association between the TyG Index at baseline and DKD. Receiver operating characteristics curve (ROC) analysis was used to assess the sensitivity and specificity of the TyG Index in predicting DKD.

RESULTS

In cross-sectional analysis, patients with a higher TyG Index had a higher risk of microalbuminuria (OR = 2.342, 95% CI = 1.744-3.144, p < 0.001), and eGFR <60 mL/min/1.73 m² (1.696, 95% CI =1.096-2.625, p = 0.018). Longitudinally, 94 of 424 participants developed DKD. After confounder adjustment, patients in the high tertile of the TyG Index at baseline had a greater risk to developing DKD than those in the low tertile (HR = 1.727, 95% CI = 1.042-2.863, p = 0.034). The area under the ROC curve was 0.69 (0.63-0.76).

CONCLUSION

The TyG Index is a potential predictor for DKD in T2DM patients.

CLINICAL TRIAL

Clinical Trials identification number = NCT03692884.

Triglyceride and glucose index and the risk of gestational diabetes mellitus: A nationwide population-based cohort study

AIMS

Pre-pregnancy insulin resistance is one of the main pathophysiologies of gestational diabetes mellitus (GDM). Triglyceride-glucose (TyG) index is a marker of insulin resistance. We aimed to evaluate the association between pre-pregnancy TyG index and GDM in primipara women.

METHODS

A total of 380,208 women who underwent a Korean national health screening exam within 2 years before their first delivery, between January 1, 2012 and December 31, 2015, were included. The TyG index was calculated as ln [triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2].

RESULTS

Among the 380,208 primipara women, 17,239 women were diagnosed with GDM (4.53%). Multivariate logistic regression analysis adjusted for risk factors showed a higher odds ratio of 1.73 for GDM (95% CI 1.65-1.81) in the highest quartile than that in the lowest quartile. A 1-SD increase in the TyG index increased the risk of GDM (31%) and GDM requiring insulin therapy (82%) in the fully adjusted model. A 1-unit increase in the TyG index significantly increased the risk of GDM and GDM requiring insulin treatment by 1.81 and 3.69 times, respectively.The impact of a high TyG index on the risk of GDM was more profound in the subjects aged ≥ 35 years, with obesity, with impaired fasting glucose, who are current smokers, and with a family history of diabetes mellitus.

CONCLUSIONS

Increased pre-pregnancy TyG index is associated with a risk of GDM. Elevation of the TyG index may be an early marker of GDM.

Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

BACKGROUND

The triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. Whether the TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of this study was to investigate the prognostic value of the TyG index in patients with diabetes and ACS.

METHODS

A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in this study. Patients were divided into tertiles according to their TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACEs), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as the ln (fasting triglyceride level [mg/dL] × fasting glucose level [mg/dL]/2).

RESULTS

The incidence of MACE increased with TyG index tertiles at a 3-year follow-up. The Kaplan-Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P = 0.005). Multivariate Cox hazards regression analysis revealed that the TyG index was an independent predictor of MACE (95% CI 1.201-1.746; P < 0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0%; specificity 63.6%; area under the curve 0.560; P = 0.001). Furthermore, adding the TyG index to the prognostic model for MACE improved the C-statistic value (P = 0.010), the integrated discrimination improvement value (P = 0.001) and the net reclassification improvement value (P = 0.019).

CONCLUSIONS

The TyG index predicts future MACE in patients with diabetes and ACS independently of known cardiovascular risk factors, suggesting that the TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.

Associations between Triglyceride-Glucose Index and Micro- and Macro-angiopathies in Type 2 Diabetes Mellitus

The aim of this study was to investigate the associations between the triglyceride-glucose (TyG) index, a marker of insulin resistance, and microangiopathies and macroangiopathies in patients with type 2 diabetes mellitus (DM). Our study enrolled 1990 type 2 diabetic patients from local hospitals in Taiwan during the period of 2002–2004. Multivariate logistic regression analysis was used to identify the factors related to microangiopathies, macroangiopathiess and TyG index. The patients were stratified by TyG index quartile (Q1–Q4). Adjusted odds ratios (aORs) of albuminuria for Q3 versus Q1 and Q4 versus Q1 were 1.424 (95% confidence interval [CI], 1.062–1.910, p = 0.018) and 1.948 (95% CI, 1.437–2.642, p < 0.001), respectively. The aOR of cerebrovascular disease (CVA) was 2.264 for Q4 versus Q1 (95% CI, 1.243–4.122, p = 0.008), but there were no significant associations with diabetic retinopathy (DR), coronary artery disease (CAD) or peripheral artery occlusive disease (PAOD). Significant stepwise increases were found in CVA (p = 0.0013) and albuminuria ≥30 mg/g (p < 0.001) corresponding to TyG index quartiles, but not DR (p = 0.573), CAD (p = 0.880) or PAOD (p = 0.223). There was a significant association between a high TyG index and a high risk of microalbuminuria and CVA in the study cohort. Further studies to investigate the use of medications in patients with DM to prevent micro- and macro-angiopathies are thus warranted.