Association of TyG index and its derivatives with the risk of diabetic kidney disease in patients with type 2 diabetes mellitus

doi:10.3969/j.issn.1004-583X.2024.10.006

Abstract

Abstract:

Objective To study the correlation of triglyceride-glucose (TyG) and its derivative index with the risk of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), and to explore its clinical application value. Methods This was a cross-sectional study including 895 T2DM patients hospitalized in the Endocrinology Department of Tianjin People's Hospital from 2018 to 2022. Patients were divided into DKD group (n=326) and non-DKD group (n=569) according to whether they had DKD or not. The clinical data of the two groups were compared. The correlation of TyG, triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-body mass index (TyG-BMI), and homeostatic model assessment for insulin resistance (HOMA-IR) with DKD was identified. The interaction of TyG and its derivatives with stratification factors was explored. Results There were significant differences in TyG, TyG-WC, TyG-BMI and HOMA-IR between the two groups (P<0.05). TyG and TyG-WC were independent influencing factors of the risk of DKD before and after adjusting for influencing factors (P<0.05). The prevalence of DKD in T2DM patients increased gradually with the increased TyG, TyG-WC and HOMA-IR (trend test P<0.05). In the T3 subgroup of TyG and TyG-WC, the prevalence of DKD was significantly higher than that of T1 subgroup (P<0.05). At varied levels of TyG, it was an independent risk factor for the risk of DKD before and after adjusting for the influencing factors (P<0.05). Conclusion As an independent risk factor for the risk of DKD, continuous and categorical variables of TyG and its derivatives as well as HOMA-IR stably predict DKD in T2DM patients.

Key words: diabetes mellitus, type 2, diabetic nephropathies, insulin resistance, TyG index

CLC Number:

Li Jiawen, Liu Yanlan, Li Yaoshuang, Qiu Huina, Li Fang, Wu Fan, Lin Chenying, Lin Jingna. Association of TyG index and its derivatives with the risk of diabetic kidney disease in patients with type 2 diabetes mellitus[J]. Clinical Focus, 2024, 39(10): 901-908.

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https://huicui.hebmu.edu.cn/EN/Y2024/V39/I10/901

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References 35

[1]	Rabkin R. Diabetic nephropathy[J]. Clin Cornerstone, 2003, 5(2):1-11. doi: 10.1016/s1098-3597(03)90014-7 pmid: 12800476
[2]	Hsu CC, Chang HY, Huang MC, et al. Association between insulin resistance and development of microalbuminuria in type 2 diabetes: A prospective cohort study[J]. Diabetes Care, 2011, 34(4):982-987.
[3]	Rizvi A, Varasteh B, Chen YD, et al. Lack of a relationship between urinary albumin excretion rate and insulin resistance in patients with non-insulin-dependent diabetes mellitus[J]. Metabolism, 1996, 45(9):1062-1064.
[4]	Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J]. Diabetologia, 1985, 28(7):412-419. doi: 10.1007/BF00280883 pmid: 3899825
[5]	Hong S, Han K, Park CY. The insulin resistance by triglyceride glucose index and risk for dementia: Population-based study[J]. Alzheimers Res Ther, 2021, 13(1):9. doi: 10.1186/s13195-020-00758-4 pmid: 33402193
[6]	Brahimaj A, Rivadeneira F, Muka T, et al. Novel metabolic indices and incident type 2 diabetes among women and men: The Rotterdam Study[J]. Diabetologia, 2019, 62(9):1581-1590. doi: 10.1007/s00125-019-4921-2 pmid: 31183505
[7]	Park B, Lee HS, Lee YJ. Triglyceride glucose (TyG) index as a predictor of incident type 2 diabetes among nonobese adults: A 12-year longitudinal study of the Korean Genome and Epidemiology Study cohort[J]. Transl Res, 2021, 228:42-51. doi: 10.1016/j.trsl.2020.08.003 pmid: 32827706
[8]	Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects[J]. Metab Syndr Relat Disord, 2008, 6(4):299-304. doi: 10.1089/met.2008.0034 pmid: 19067533
[9]	Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp[J]. J Clin Endocrinol Metab, 2010, 95(7):3347-3351. doi: 10.1210/jc.2010-0288 pmid: 20484475
[10]	Vasques AC, Novaes FS, de Oliveira Mda S, et al. TyG index performs better than HOMA in a Brazilian population: A hyperglycemic clamp validated study[J]. Diabetes Res Clin Pract, 2011, 93(3):e98-e100.
[11]	Er LK, Wu S, Chou HH, et al. Triglyceride glucose-body mass index is a simple and clinically useful surrogate marker for insulin resistance in nondiabetic individuals[J]. PLoS One, 2016, 11(3):e0149731.
[12]	Yang S, Shi X, Liu W, et al. Association between triglyceride glucose-body mass index and heart failure in subjects with diabetes mellitus or prediabetes mellitus: A cross-sectional study[J]. Front Endocrinol (Lausanne), 2023, 14:1294909.
[13]	Peng N, Kuang M, Peng Y, et al. Associations between TyG-BMI and normal-high blood pressure values and hypertension: Cross-sectional evidence from a non-diabetic population[J]. Front Cardiovasc Med, 2023, 10:1129112.
[14]	Dang K, Wang X, Hu J, et al. The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003-2018[J]. Cardiovasc Diabetol, 2024, 23(1):8. doi: 10.1186/s12933-023-02115-9 pmid: 38184598
[15]	Srinivasan S, Singh P, Kulothungan V, et al. Relationship between triglyceride glucose index, retinopathy and nephropathy in type 2 diabetes[J]. Endocrinol Diabetes Metab, 2020, 4(1):e00151.
[16]	Gowda S, Desai PB, Kulkarni SS, et al. Markers of renal function tests[J]. N Am J Med Sci, 2010, 2(4):170-173.
[17]	Ji W, Gao L, Sun P, et al. Association of the triglyceride-glucose index and vascular target organ damage in a Beijing community-based population[J]. Front Cardiovasc Med, 2022, 9:948402.
[18]	Liu L, Xia R, Song X, et al. Association between the triglyceride-glucose index and diabetic nephropathy in patients with type 2 diabetes: A cross-sectional study[J]. J Diabetes Investig, 2021, 12(4):557-565.
[19]	Xu X, Tang X, Che H, et al. Triglyceride-glucose product is an independent risk factor for predicting chronic kidney disease in middle-aged and elderly population: A prospective cohort study[J]. Nan Fang Yi Ke Da Xue Xue Bao, 2021, 41(11):1600-1608.
[20]	Shang J, Yu D, Cai Y, et al. The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: A nested case control study[J]. Medicine (Baltimore), 2019, 98(46):e17995.
[21]	Lim J, Kim J, Koo SH, et al. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: An analysis of the 2007-2010 Korean National Health and Nutrition Examination Survey[J]. PLoS One, 2019, 14(3):e0212963.
[22]	Malek M, Khamseh ME, Chehrehgosha H, et al. Triglyceride glucose-waist to height ratio: A novel and effective marker for identifying hepatic steatosis in individuals with type 2 diabetes mellitus[J]. Endocrine, 2021, 74(3):538-545. doi: 10.1007/s12020-021-02815-w pmid: 34355342
[23]	Cho YK, Lee J, Kim HS, et al. Triglyceride glucose-waist circumference better predicts coronary calcium progression compared with other indices of insulin resistance: A longitudinal observational study[J]. J Clin Med, 2020, 10(1):92.
[24]	Kuang M, Yang R, Huang X, et al. Assessing temporal differences in the predictive power of baseline TyG-related parameters for future diabetes: An analysis using time-dependent receiver operating characteristics[J]. J Transl Med, 2023, 21(1):299. doi: 10.1186/s12967-023-04159-7 pmid: 37138277
[25]	Li X, Sun M, Yang Y, et al. Predictive Effect of triglyceride glucose-related parameters, obesity indices, and lipid ratios for diabetes in a Chinese population: A prospective cohort study[J]. Front Endocrinol (Lausanne), 2022, 13:862919.
[26]	Jiang Y, Lai X. Association between the triglyceride glucose index, triglyceride-glucose body mass index and diabetic kidney disease in adults with newly diagnosed type 2 diabetes[J]. Front Med (Lausanne), 2024, 11:1328601.
[27]	Da Silva AA, Do Carmo JM, Li X, et al. Role of hyperinsulinemia and insulin resistance in hypertension: Metabolic syndrome revisited[J]. Can J Cardiol 2020, 36(5): 671-682. doi: S0828-282X(20)30169-0 pmid: 32389340
[28]	Hill MA, Yang Y, Zhang L, et al. Insulin resistance, cardiovascular stiffening and cardiovascular disease[J]. Metabolism, 2021, 119:154766.
[29]	陈映群, 张卫星, 李智, 等. 高尿酸通过氧化应激诱导心肌细胞胰岛素抵抗[J]. 安徽医科大学学报, 2022, 57(3): 418-424.
[30]	Zhang Y, Wang R, Fu X, et al. Non-insulin-based insulin resistance indexes in predicting severity for coronary artery disease[J]. Diabetol Metab Syndr, 2022, 14(1):191. doi: 10.1186/s13098-022-00967-x pmid: 36528713
[31]	Carreau AM, Xie D, Garcia-Reyes Y, et al. Good agreement between hyperinsulinemic-euglycemic clamp and 2 hours oral minimal model assessed insulin sensitivity in adolescents[J]. Pediatr Diabetes, 2020, 21(7):1159-1168.
[32]	Fritz J, Brozek W, Concin H, et al. The triglyceride-glucose index and obesity-related risk of end-stage kidney disease in Austrian adults[J]. JAMA Netw Open, 2021, 4(3):e212612.
[33]	Sasson AN, Cherney DZ. Renal hyperfiltration related to diabetes mellitus and obesity in human disease[J]. World J Diabetes, 2012, 3(1):1-6. doi: 10.4239/wjd.v3.i1.1 pmid: 22253940
[34]	Gupta J, Mitra N, Kanetsky PA, et al. Association between albuminuria, kidney function, and inflammatory biomarker profile in CKD in CRIC[J]. Clin J Am Soc Nephrol. 2012; 7(12):1938-1946.
[35]	Marunaka Y. Roles of interstitial fluid pH in diabetes mellitus: Glycolysis and mitochondrial function[J]. World J Diabetes, 2015, 6(1):125-135. doi: 10.4239/wjd.v6.i1.125 pmid: 25685283

项目	非DKD组(n=569)	DKD组(n=326)	t/Z/χ²值	P值
年龄	61(56, 66)	62(55, 67)	-0.172	0.864
性别[例(%)]
男女	266(46.8) 303(53.2)	178(54.6) 148(45.4)	5.122	0.024
糖尿病病程(年)	5(1, 10)	8(1, 13)	-3.359	0.001
规律运动[例(%)]	420(73.81)	240(73.62)	0.004	0.949
糖尿病饮食管理[例(%)]	344(60.46)	195(59.82)	0.036	0.850
收缩压(mmHg)	130(120, 140)	132(127, 140)	-3.147	0.002
舒张压(mmHg)	80(74, 8)	80(73, 8)	-0.289	0.773
目前吸烟[例(%)]	214(37.6)	152(46.6)	6.970	0.008
目前饮酒[例(%)]	174(30.6)	107(32.8)	0.484	0.487
合并高血压病[例(%)]	352(61.9)	227(69.6)	5.477	0.019
使用降压药[例(%)]	193(60.1)	468(52.9)	10.439	0.001
使用降脂药[例(%)]	53(9.3)	51(15.6)	8.085	0.004
糖尿病药物使用[例(%)]
未使用药物	195(34.3)	73(22.4)
只用口服降糖药	252(44.3)	135(41.4)	28.880	0.000
只用胰岛素	13(2.3)	7(2.2)
口服药胰岛素联合	109(19.1)	111(34.0)
FPG(mmol/L)	8.350(6.800, 10.200)	8.700(7.200, 10.800)	-1.967	0.049
HbA₁c(%)	8.800(7.400, 10.700)	9.100(7.800, 10.900)	-1.831	0.067
FINS(mU/L)	10.710(6.900, 15.900)	11.900(7.500, 16.300)	-1.834	0.067
SCr(μmol/L)	57.000(48.000, 65.200)	59.000(49.200, 72.000)	-2.675	0.007
UA(μmol/L)	278.980(231.000, 330.000)	298.255(247.800, 361.900)	-3.853	0.000
ALT(U/L)	20.520(14.600, 30.300)	18.645(13.400, 29.700)	-1.624	0.104
TC(mmol/L)	4.880(4.300, 5.600)	4.885(4.200, 5.600)	-0.141	0.888
TG(mmol/L)	1.490(1.100, 2.200)	1.775(1.200, 2.500)	-3.565	0.000
HDL-C(mmol/L)	1.190(1.000, 1.300)	1.145(1.000, 1.300)	-1.686	0.092
LDL-C(mmol/L)	3.050(2.500, 3.600)	3.000(2.500, 3.600)	-0.971	0.331
eGFR[ml/(min×1.73 m²)]	121.320(104.900, 140.400)	116.520(97.100, 138.300)	-2.863	0.004
UACR(mg/mmol)	1.015(0.500, 1.900)	3.985(1.300, 8.100)	-12.325	0.000
BMI(kg/m²)	25.447(23.700, 28.300)	25.837(23.600, 28.300)	-1.030	0.303
WC(cm)	90.000(84.100, 97.000)	91.000(85.000, 99.000)	-2.163	0.031
TyG指数	7.618(7.300, 8.100)	7.837(7.400, 8.300)	-4.122	0.000
TyG-WC	688.945(629.800, 754.600)	721.013(643.700, 788.600)	-3.723	0.000
TyG-BMI	197.301(178.200, 219.700)	204.966(182.100, 229.200)	-2.368	0.018
HOMA-IR	3.919(2.500, 6.200)	4.697(2.700, 6.900)	-2.424	0.015

项目	非DKD组(n=569)	DKD组(n=326)	t/Z/χ²值	P值
年龄	61(56, 66)	62(55, 67)	-0.172	0.864
性别[例(%)]
男女	266(46.8) 303(53.2)	178(54.6) 148(45.4)	5.122	0.024
糖尿病病程(年)	5(1, 10)	8(1, 13)	-3.359	0.001
规律运动[例(%)]	420(73.81)	240(73.62)	0.004	0.949
糖尿病饮食管理[例(%)]	344(60.46)	195(59.82)	0.036	0.850
收缩压(mmHg)	130(120, 140)	132(127, 140)	-3.147	0.002
舒张压(mmHg)	80(74, 8)	80(73, 8)	-0.289	0.773
目前吸烟[例(%)]	214(37.6)	152(46.6)	6.970	0.008
目前饮酒[例(%)]	174(30.6)	107(32.8)	0.484	0.487
合并高血压病[例(%)]	352(61.9)	227(69.6)	5.477	0.019
使用降压药[例(%)]	193(60.1)	468(52.9)	10.439	0.001
使用降脂药[例(%)]	53(9.3)	51(15.6)	8.085	0.004
糖尿病药物使用[例(%)]
未使用药物	195(34.3)	73(22.4)
只用口服降糖药	252(44.3)	135(41.4)	28.880	0.000
只用胰岛素	13(2.3)	7(2.2)
口服药胰岛素联合	109(19.1)	111(34.0)
FPG(mmol/L)	8.350(6.800, 10.200)	8.700(7.200, 10.800)	-1.967	0.049
HbA₁c(%)	8.800(7.400, 10.700)	9.100(7.800, 10.900)	-1.831	0.067
FINS(mU/L)	10.710(6.900, 15.900)	11.900(7.500, 16.300)	-1.834	0.067
SCr(μmol/L)	57.000(48.000, 65.200)	59.000(49.200, 72.000)	-2.675	0.007
UA(μmol/L)	278.980(231.000, 330.000)	298.255(247.800, 361.900)	-3.853	0.000
ALT(U/L)	20.520(14.600, 30.300)	18.645(13.400, 29.700)	-1.624	0.104
TC(mmol/L)	4.880(4.300, 5.600)	4.885(4.200, 5.600)	-0.141	0.888
TG(mmol/L)	1.490(1.100, 2.200)	1.775(1.200, 2.500)	-3.565	0.000
HDL-C(mmol/L)	1.190(1.000, 1.300)	1.145(1.000, 1.300)	-1.686	0.092
LDL-C(mmol/L)	3.050(2.500, 3.600)	3.000(2.500, 3.600)	-0.971	0.331
eGFR[ml/(min×1.73 m²)]	121.320(104.900, 140.400)	116.520(97.100, 138.300)	-2.863	0.004
UACR(mg/mmol)	1.015(0.500, 1.900)	3.985(1.300, 8.100)	-12.325	0.000
BMI(kg/m²)	25.447(23.700, 28.300)	25.837(23.600, 28.300)	-1.030	0.303
WC(cm)	90.000(84.100, 97.000)	91.000(85.000, 99.000)	-2.163	0.031
TyG指数	7.618(7.300, 8.100)	7.837(7.400, 8.300)	-4.122	0.000
TyG-WC	688.945(629.800, 754.600)	721.013(643.700, 788.600)	-3.723	0.000
TyG-BMI	197.301(178.200, 219.700)	204.966(182.100, 229.200)	-2.368	0.018
HOMA-IR	3.919(2.500, 6.200)	4.697(2.700, 6.900)	-2.424	0.015

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
性别	0.315	0.139	5.099	0.024	1.370	1.042~1.800
年龄	0.004	0.009	0.197	0.657	1.004	0.986~1.022
规律运动	-0.010	0.158	0.004	0.949	0.990	0.727~1.349
糖尿病饮食管理	0.027	0.142	0.036	0.850	1.027	0.778~1.356
糖尿病病程	0.033	0.009	12.464	0.000	1.034	1.015~1.053
收缩压	0.015	0.005	8.128	0.004	1.015	1.005~1.026
舒张压	0.005	0.008	0.358	0.549	1.005	0.989~1.021
目前吸烟	0.371	0.141	6.945	0.008	1.449	1.100~1.910
目前饮酒	0.104	0.149	0.484	0.487	1.109	0.828~1.485
合并高血压病	0.346	0.148	5.456	0.020	1.414	1.057~1.890
使用降压药	0.457	0.142	10.382	0.001	1.579	1.196~2.085
使用降脂药	0.591	0.210	7.926	0.005	1.806	1.197~2.724
糖尿病药物使用	0.327	0.062	27.770	0.000	1.387	1.228~1.566
FPG	0.002	0.001	2.958	0.085	1.002	1.000~1.005
HbA₁c	0.056	0.033	2.981	0.084	1.058	0.992~1.128
FINS	0.004	0.003	1.521	0.217	1.004	0.998~1.010
UA	0.004	0.001	17.302	0.000	1.004	1.002~1.005
ALT	-0.005	0.004	1.491	0.222	0.995	0.987~1.003
TC	0.045	0.056	0.664	0.415	1.046	0.938~1.167
TG	0.006	0.002	7.697	0.006	1.006	1.002~1.010
HDL-C	-0.495	0.247	4.001	0.045	0.610	0.375~0.990
LDL-C	-0.050	0.080	0.391	0.532	0.951	0.813~1.113
BMI	0.028	0.02	1.891	0.169	1.028	0.988~1.069
WC	0.019	0.007	6.392	0.011	1.019	1.004~1.033
TyG指数	0.394	0.100	15.620	0.000	1.482	1.219~1.802
TyG-WC	0.027	0.007	16.052	0.000	1.027	1.014~1.041
TyG-BMI	0.054	0.020	7.336	0.007	1.056	1.015~1.098
HOMA-IR	0.015	0.008	2.996	0.083	1.015	0.998~1.031

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
性别	0.315	0.139	5.099	0.024	1.370	1.042~1.800
年龄	0.004	0.009	0.197	0.657	1.004	0.986~1.022
规律运动	-0.010	0.158	0.004	0.949	0.990	0.727~1.349
糖尿病饮食管理	0.027	0.142	0.036	0.850	1.027	0.778~1.356
糖尿病病程	0.033	0.009	12.464	0.000	1.034	1.015~1.053
收缩压	0.015	0.005	8.128	0.004	1.015	1.005~1.026
舒张压	0.005	0.008	0.358	0.549	1.005	0.989~1.021
目前吸烟	0.371	0.141	6.945	0.008	1.449	1.100~1.910
目前饮酒	0.104	0.149	0.484	0.487	1.109	0.828~1.485
合并高血压病	0.346	0.148	5.456	0.020	1.414	1.057~1.890
使用降压药	0.457	0.142	10.382	0.001	1.579	1.196~2.085
使用降脂药	0.591	0.210	7.926	0.005	1.806	1.197~2.724
糖尿病药物使用	0.327	0.062	27.770	0.000	1.387	1.228~1.566
FPG	0.002	0.001	2.958	0.085	1.002	1.000~1.005
HbA₁c	0.056	0.033	2.981	0.084	1.058	0.992~1.128
FINS	0.004	0.003	1.521	0.217	1.004	0.998~1.010
UA	0.004	0.001	17.302	0.000	1.004	1.002~1.005
ALT	-0.005	0.004	1.491	0.222	0.995	0.987~1.003
TC	0.045	0.056	0.664	0.415	1.046	0.938~1.167
TG	0.006	0.002	7.697	0.006	1.006	1.002~1.010
HDL-C	-0.495	0.247	4.001	0.045	0.610	0.375~0.990
LDL-C	-0.050	0.080	0.391	0.532	0.951	0.813~1.113
BMI	0.028	0.02	1.891	0.169	1.028	0.988~1.069
WC	0.019	0.007	6.392	0.011	1.019	1.004~1.033
TyG指数	0.394	0.100	15.620	0.000	1.482	1.219~1.802
TyG-WC	0.027	0.007	16.052	0.000	1.027	1.014~1.041
TyG-BMI	0.054	0.020	7.336	0.007	1.056	1.015~1.098
HOMA-IR	0.015	0.008	2.996	0.083	1.015	0.998~1.031

变量	模型1		模型2		模型3
变量	OR(95%CI)	P值	OR(95%CI)	P值	OR(95%CI)	P值
TyG指数	1.516(1.240~1.854)	0.000	1.534(1.240~1.897)	0.000	1.373(1.090~1.728)	0.007
TyG-WC	1.027(1.013~1.040)	0.000	1.025(1.010~1.040)	0.001	1.017(1.001~1.032)	0.036
TyG-BMI	1.064(1.021~1.107)	0.003	1.056(1.011~1.104)	0.015	1.029(0.982~1.078)	0.238
HOMA-IR	1.016(0.999~1.033)	0.074	1.005(0.989~1.022)	0.524	1.003(0.987~1.020)	0.696