Correlation of triglyceride-glucose index combined with obesity indicators with diabetic retinopathy

doi:10.3969/j.issn.1004-583X.2024.07.005

Abstract

Abstract:

Objective To investigate the correlation of triglyceride-glucose index (TyG) and TyG combined with obesity indicators with diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM), and to analyze the predictive value of TyG and its combination with obesity indicators in DR. Methods This was a retrospective study. According to the inclusion and exclusion criteria, a total of 373 T2DM patients hospitalized in the Department of Endocrinology of Hebei General Hospital from September 2018 to May 2021 were recruited. They were assigned into T2DM group and DR group according to the presence of DR or not. The clinical data were collected. TyG, TyG-waist circumference index (TyG-WC), TyG-body mass index (TyG-BMI), TyG-waist-to-hip ratio (TyG-WHR), and TyG-waist-to-height ratio (TyG-WHtR) were calculated. Risk factors for DR were identified by binary logistic regression. The receiver operating characteristic (ROC) curves were plotted to determine the role of TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR in predicting DR. Results Patients in DR group had significantly higher age, course of T2DM, WC, WHR, WHtR, triglyceride (TG), serum creatinine (SCr), blood urea nitrogen (BUN), fasting blood glucose (FBG), glycosylated hemoglobin (HbA₁c), TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR, but lower glomerular filtration (GFR) than those of T2DM group (P<0.05). DR was positively correlated with age, course of T2DM, WC, WHR, WHtR, TG, SCr, BUN, FBG, HbA₁c, TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR, but negatively correlated with GFR. TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR were independent risk factors for DR. ROC curves showed the potential of TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR for predicting DR, with the largest area under the curve (AUC) of 0.623 in TyG-WHR. Conclusion TyG-WHR is closely related to DR in T2DM patients, and it may be a new clinical effective marker for early identification of the risk of DR in T2DM patients.

Key words: diabetes mellitus, type 2, diabetic retinopathy, triglyceride glucose product, waist-hip ratio, obesity index

CLC Number:

R587.26

Yan Tianmei, Wu Yanan, Liu Yueying, Wei Limin. Correlation of triglyceride-glucose index combined with obesity indicators with diabetic retinopathy[J]. Clinical Focus, 2024, 39(7): 612-619.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.07.005

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I7/612

Figures/Tables 12

Tab.1 General data between groups

组别		例数	性别(男) [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]		年龄 (岁)		糖尿病病程 (月)		身高 (cm)		体重 (kg)
非DR组		261	156(59.8)		68(26.1)		64(24.5)		56(46,66)		60(12,132)		168(160,174.25)		73±13.54
DR组		112	63(56.3)		32(28.6)		28(25.0)		61(50,67)		144(84,240)		168(159,172)		74(66,82)
χ²/ $Z$ / $t$ 值			0.401		1.256		0.443		-2.300		-7.065		-0.856		-0.990
P值			0.527		0.262		0.506		0.021		<0.001		0.392		0.322
组别	BMI (kg/m²)			WC (cm)		臀围 (cm)		WHR		WHtR		SBP (mmHg)		DBP (mmHg)
非DR组	25.95±3.54			92(86,100)		100.36±9.22		0.93(0.88,0.96)		0.55±0.06		132(121,146)		83.07±12.39
DR组	26.37(24.58,28.73)			95(88,101)		100(96,105)		0.94±0.07		0.56(0.53,0.61)		136(121,150)		81.39±11.66
$t$ / $Z$ 值	-1.683			-2.093		-0.335		-2.435		-2.405		-1.775		1.497
P值	0.092			0.036		0.738		0.015		0.016		0.076		0.135

Tab.1 General data between groups

组别		例数	性别(男) [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]		年龄 (岁)		糖尿病病程 (月)		身高 (cm)		体重 (kg)
非DR组		261	156(59.8)		68(26.1)		64(24.5)		56(46,66)		60(12,132)		168(160,174.25)		73±13.54
DR组		112	63(56.3)		32(28.6)		28(25.0)		61(50,67)		144(84,240)		168(159,172)		74(66,82)
χ²/ $Z$ / $t$ 值			0.401		1.256		0.443		-2.300		-7.065		-0.856		-0.990
P值			0.527		0.262		0.506		0.021		<0.001		0.392		0.322
组别	BMI (kg/m²)			WC (cm)		臀围 (cm)		WHR		WHtR		SBP (mmHg)		DBP (mmHg)
非DR组	25.95±3.54			92(86,100)		100.36±9.22		0.93(0.88,0.96)		0.55±0.06		132(121,146)		83.07±12.39
DR组	26.37(24.58,28.73)			95(88,101)		100(96,105)		0.94±0.07		0.56(0.53,0.61)		136(121,150)		81.39±11.66
$t$ / $Z$ 值	-1.683			-2.093		-0.335		-2.435		-2.405		-1.775		1.497
P值	0.092			0.036		0.738		0.015		0.016		0.076		0.135

Tab.2 Biochemical indicators between groups[ M(P25,P75)]

组别	例数	TC(mmol/L)		TG(mmol/L)		LDL-C(mmol/L)		HDL-C(mmol/L)		SCr(mmol/L)
非DR组	261	4.785(4.04, 5.53)		1.44(0.99, 2.02)		3.105(2.54, 3.68)		1.1(0.99, 1.28)		67.9(59.18, 74.1)
DR组	112	4.9(4.31, 5.86)		1.56(1.15, 2.44)		3.15(2.75, 3.86)		1.08(0.88, 1.24)		70.3(59.9, 85.7)
$Z$ 值		-1.363		-2.321		-1.269		-1.607		-3.024
P值		0.173		0.020		0.204		0.108		0.002
组别	BUN(mmol/L)		UA(mmol/L)		GFR (mL/min)		FBG(mmol/L)		HbA₁c(%)
非DR组	5.2(4.4, 6)		304.64(240.75, 356)		98.79(88.76, 107.3)		7.61(6.1, 9.485)		8.3(7.1, 9.9)
DR组	5.5(4.6, 7.3)		318.5(260.3, 371.3)		92.87(70.84, 103.07)		8.375(6.63, 11.585)		8.9(7.5, 10.7)
$Z$ 值	-3.197		-1.436		-3.924		-2.845		-2.810
P值	0.001		0.151		<0.001		0.004		0.005

Tab.2 Biochemical indicators between groups[ M(P25,P75)]

组别	例数	TC(mmol/L)		TG(mmol/L)		LDL-C(mmol/L)		HDL-C(mmol/L)		SCr(mmol/L)
非DR组	261	4.785(4.04, 5.53)		1.44(0.99, 2.02)		3.105(2.54, 3.68)		1.1(0.99, 1.28)		67.9(59.18, 74.1)
DR组	112	4.9(4.31, 5.86)		1.56(1.15, 2.44)		3.15(2.75, 3.86)		1.08(0.88, 1.24)		70.3(59.9, 85.7)
$Z$ 值		-1.363		-2.321		-1.269		-1.607		-3.024
P值		0.173		0.020		0.204		0.108		0.002
组别	BUN(mmol/L)		UA(mmol/L)		GFR (mL/min)		FBG(mmol/L)		HbA₁c(%)
非DR组	5.2(4.4, 6)		304.64(240.75, 356)		98.79(88.76, 107.3)		7.61(6.1, 9.485)		8.3(7.1, 9.9)
DR组	5.5(4.6, 7.3)		318.5(260.3, 371.3)		92.87(70.84, 103.07)		8.375(6.63, 11.585)		8.9(7.5, 10.7)
$Z$ 值	-3.197		-1.436		-3.924		-2.845		-2.810
P值	0.001		0.151		<0.001		0.004		0.005

Tab.3 TyG and TyG combined with obesity indicators between groups

组别	例数	TyG	TyG-WC	TyG-BMI	TyG-WHR	TyG-WHtR
非DR组	261	10.26±0.43	942.36(878.89, 1016.43)	266.32±38.74	9.48(8.98, 9.98)	5.63(5.24, 6.05)
DR组	112	10.43±0.44	975.19(906.71, 1055.61)	275.08(251.63, 303.48)	9.83±0.83	5.86(5.43, 6.48)
$t$ / $Z$ 值		-3.581	-3.151	-2.587	-3.762	-3.437
P值		<0.001	0.002	0.010	<0.001	0.001

Tab.3 TyG and TyG combined with obesity indicators between groups

组别	例数	TyG	TyG-WC	TyG-BMI	TyG-WHR	TyG-WHtR
非DR组	261	10.26±0.43	942.36(878.89, 1016.43)	266.32±38.74	9.48(8.98, 9.98)	5.63(5.24, 6.05)
DR组	112	10.43±0.44	975.19(906.71, 1055.61)	275.08(251.63, 303.48)	9.83±0.83	5.86(5.43, 6.48)
$t$ / $Z$ 值		-3.581	-3.151	-2.587	-3.762	-3.437
P值		<0.001	0.002	0.010	<0.001	0.001

Fig.1 Box plots of TyG and TyG combined with obesity indicators in the two groups a. TyG; b. TyG-WC; c. TyG-BMI; d. TyG-WHR; e. TyG-WHtR

Tab.4 Correlation analysis between DR and various indicators in T2DM patients

	T2DM合并DR
	$r$ 值	P值
年龄(岁)	0.119	0.021
性别	0.033	0.528
糖尿病病程(月)	0.366	<0.001
WC(cm)	0.109	0.036
WHR	0.126	0.015
WHtR	0.125	0.016
TC(mmol/L)	0.071	0.173
TG(mmol/L)	0.120	0.020
LDL-C(mmol/L)	0.066	0.205
HDL-C(mmol/L)	-0.083	0.108
SCr(mmol/L)	0.157	0.002
BUN(mmol/L)	0.166	0.001
UA(mmol/L)	0.074	0.151
GFR (mL/min)	-0.204	<0.001
FBG(mmol/L)	0.148	0.004
HbA₁c(%)	0.147	0.005
TyG	0.165	0.001
TyG-WC	0.163	0.002
TyG-BMI	0.134	0.010
TyG-WHR	0.195	<0.001
TyG-WHtR	0.178	0.001

Tab.4 Correlation analysis between DR and various indicators in T2DM patients

	T2DM合并DR
	$r$ 值	P值
年龄(岁)	0.119	0.021
性别	0.033	0.528
糖尿病病程(月)	0.366	<0.001
WC(cm)	0.109	0.036
WHR	0.126	0.015
WHtR	0.125	0.016
TC(mmol/L)	0.071	0.173
TG(mmol/L)	0.120	0.020
LDL-C(mmol/L)	0.066	0.205
HDL-C(mmol/L)	-0.083	0.108
SCr(mmol/L)	0.157	0.002
BUN(mmol/L)	0.166	0.001
UA(mmol/L)	0.074	0.151
GFR (mL/min)	-0.204	<0.001
FBG(mmol/L)	0.148	0.004
HbA₁c(%)	0.147	0.005
TyG	0.165	0.001
TyG-WC	0.163	0.002
TyG-BMI	0.134	0.010
TyG-WHR	0.195	<0.001
TyG-WHtR	0.178	0.001

Tab.5 Regression analysis of DR and TyG in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.940	0.271	12.032	0.001	2.561	1.505	4.356
model2	1.190	0.309	14.823	<0.001	3.288	1.794	6.025
model3	0.921	0.466	3.911	0.048	2.513	1.008	6.261

Tab.5 Regression analysis of DR and TyG in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.940	0.271	12.032	0.001	2.561	1.505	4.356
model2	1.190	0.309	14.823	<0.001	3.288	1.794	6.025
model3	0.921	0.466	3.911	0.048	2.513	1.008	6.261

Tab.6 Regression analysis of DR and TyG-WC in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.003	0.001	11.500	0.001	1.003	1.001	1.005
model2	0.013	0.003	15.313	<0.001	1.013	1.006	1.020
model3	0.011	0.005	4.634	0.031	1.011	1.001	1.021

Tab.6 Regression analysis of DR and TyG-WC in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.003	0.001	11.500	0.001	1.003	1.001	1.005
model2	0.013	0.003	15.313	<0.001	1.013	1.006	1.020
model3	0.011	0.005	4.634	0.031	1.011	1.001	1.021

Tab.7 Regression analysis of DR and TyG-BMI in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.009	0.003	10.578	0.001	1.009	1.004	1.014
model2	0.016	0.005	11.526	0.001	1.016	1.007	1.026
model3	0.020	0.006	11.506	0.031	1.020	1.009	1.032

Tab.7 Regression analysis of DR and TyG-BMI in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.009	0.003	10.578	0.001	1.009	1.004	1.014
model2	0.016	0.005	11.526	0.001	1.016	1.007	1.026
model3	0.020	0.006	11.506	0.031	1.020	1.009	1.032

Tab.8 Regression analysis of DR and TyG-WHR in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.572	0.144	15.650	<0.001	1.771	1.334	2.351
model2	1.297	0.330	15.437	<0.001	3.660	1.916	6.991
model3	1.044	0.496	4.436	0.035	2.840	1.075	7.503

Tab.8 Regression analysis of DR and TyG-WHR in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.572	0.144	15.650	<0.001	1.771	1.334	2.351
model2	1.297	0.330	15.437	<0.001	3.660	1.916	6.991
model3	1.044	0.496	4.436	0.035	2.840	1.075	7.503

Tab.9 Regression analysis of DR and TyG-WHtR in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.594	0.162	13.374	<0.001	1.811	1.317	2.490
model2	2.135	0.549	15.108	<0.001	8.455	2.882	24.810
model3	1.793	0.833	4.632	0.031	6.008	1.174	30.751

Tab.9 Regression analysis of DR and TyG-WHtR in T2DM patients

	回归系数	标准误	wald χ²值	P值	$O R$ 值	95% $C I$
	回归系数	标准误	wald χ²值	P值	$O R$ 值	下限	上限
model1	0.594	0.162	13.374	<0.001	1.811	1.317	2.490
model2	2.135	0.549	15.108	<0.001	8.455	2.882	24.810
model3	1.793	0.833	4.632	0.031	6.008	1.174	30.751

Fig.2 ROC curve of each index in predicting DR

Tab.10 Predictive value of each index for DR in T2DM patients

	AUC	95% $C I$		P值	敏感度	特异性	约登指数	界值
	AUC	下限	上限	P值	敏感度	特异性	约登指数	界值
TyG	0.604	0.541	0.667	0.001	0.670	0.525	0.195	10.2834
TyG-WC	0.603	0.540	0.666	0.002	0.473	0.713	0.186	999.6353
TyG-BMI	0.584	0.521	0.428	0.010	0.696	0.441	0.137	259.0222
TyG-WHR	0.623	0.560	0.686	<0.001	0.527	0.678	0.205	9.8027
TyG-WHtR	0.612	0.549	0.676	0.001	0.571	0.636	0.207	5.8247

Tab.10 Predictive value of each index for DR in T2DM patients

	AUC	95% $C I$		P值	敏感度	特异性	约登指数	界值
	AUC	下限	上限	P值	敏感度	特异性	约登指数	界值
TyG	0.604	0.541	0.667	0.001	0.670	0.525	0.195	10.2834
TyG-WC	0.603	0.540	0.666	0.002	0.473	0.713	0.186	999.6353
TyG-BMI	0.584	0.521	0.428	0.010	0.696	0.441	0.137	259.0222
TyG-WHR	0.623	0.560	0.686	<0.001	0.527	0.678	0.205	9.8027
TyG-WHtR	0.612	0.549	0.676	0.001	0.571	0.636	0.207	5.8247

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