In patients with early-onset type 2 diabetes, an elevated TyG index was independently associated with increased UACR levels and served as a potential indicator for early diabetic kidney injury.
Abstract
Background
Patients with early-onset type 2 diabetes mellitus (T2DM) face a significantly elevated risk of developing diabetic kidney disease (DKD) in the early stages, attributable to their prolonged disease duration. The urinary albumin-to-creatinine ratio (UACR) serves as a critical marker for screening incipient renal injury. While insulin resistance (IR) is a pivotal driver of this pathological progression, the triglyceride-glucose (TyG) index, a simple and effective surrogate marker for IR, has not been thoroughly investigated in this specific population. The association between TyG index and UACR, along with its potential discriminatory ability for early renal damage in patients with early-onset T2DM, remained unclear.
Objective
This study aimed to explore the correlation between the TyG index and UACR in patients with early-onset type 2 diabetes.
RESEARCH
Design
AND
Methods
A dual-center, retrospective cross-sectional study was conducted. Clinical data from a total of 596 adult patients (aged 18-40 years) with early-onset type 2 diabetes mellitus, admitted to the First Medical Center of the Chinese PLA General Hospital and Hainan Hospital of the Chinese PLA General Hospital between January 2012 and December 2022, were collected and retrospectively analyzed. Participants were stratified into three groups based on the tertiles of the TyG index: Q1 (< 7.67), Q2 (7.67-8.33), and Q3 (> 8.33). They were also categorized into two groups according to UACR levels: <30 mg/g and ≥ 30 mg/g. The association between TyG index, traditional glucose/lipid parameters, and elevated UACR (≥ 30 mg/g) was assessed using correlation analysis and binary logistic regression models. Receiver operating characteristic (ROC) curves were plotted to evaluate the discriminatory ability of these indicators for elevated UACR. Subgroup analyses were further performed based on gender, blood pressure status, and estimated glomerular filtration rate (eGFR).
Results
The mean age of the 596 participants was 31.78 ± 9.99 years. A significant positive correlation was observed between the TyG index and UACR (r = 0.250, P < 0.001). Binary logistic regression analysis revealed that after adjustment for multiple confounding factors, patients in the highest TyG tertile (Q3) had a 1.366-fold increased risk of elevated UACR (≥ 30 mg/g) compared to those in the lowest tertile (Q1) (OR: 1.366, 95% CI: 1.015-1.838, P = 0.039). The discriminatory ability of TyG index for elevated UACR was evaluated using the receiver operating characteristic curve, yielding an area under the curve of 0.649 (95% CI: 0.609-0.687). At the optimal cut-off value of 8.18, the sensitivity and specificity were 69.47% and 61.08%, respectively. Notably, the TyG index demonstrated superior discriminatory efficacy compared to traditional lipid parameters, including triglycerides, total cholesterol, LDL-C, and HDL-C.
Conclusion
In patients with early-onset type 2 diabetes, an elevated TyG index was independently associated with increased UACR levels and served as a potential indicator for early diabetic kidney injury. Specifically, for individuals aged 18-40 years, a TyG index exceeding 8.18 was associated with an elevated association of developing diabetic kidney disease.
CLINICAL TRIAL REGISTRATION
Not applicable.
In Chinese patients with early-onset T2DM, CGM-derived metrics are independently associated with early DKD, with TIR and GRI showing opposite associations and CV exhibiting a U-shaped relationship, and the observed association involving triglycerides suggests that lipid metabolism may be a correlate of glycemic control in relation to renal injury.
Yuan-Shuang Jiang, Jing Kang, Yan Chen· Frontiers in Endocrinology· 0 citations
Background An elevated triglyceride-glucose (TyG) index is strongly linked to an increased risk of cardiovascular events in patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM). However, the potential impact of increasing diabetes duration on the association between the TyG index and cardiovascular risk remains unclear. Methods Consecutive patients admitted for ACS with T2DM received PCI between March 2016 and March 2020 were enrolled in the analysis. A total of 7093 patients were categorized into tertiles according to the TyG index and T2DM duration. The primary outcome was ischemic events, composed of cardiac death, myocardial infarction, and/or stroke at 5 years. The main secondary outcomes were 5-year cardiac death and all-cause death. Interaction terms and non-linear associations of the TyG index with the clinical outcomes were examined across diabetes durations. Results Over 5 years, 753 (10.6%) experienced ischemic events, 375 (5.3%) cardiac death, and 636 (9.0%) all-cause death. Higher TyG index and longer diabetes duration independently associated with all outcomes. Compared with the lowest TyG tertile, the highest tertile had adjusted hazard ratios (HRs) of 1.55 (95% CI: 1.29–1.88) for ischemic events and 1.23 (1.10–1.38) for all-cause death. The association between TyG index and ischemic events was strongest in the shortest duration group (HR: 1.43), with significant interaction for ischemic and cardiac death (both p < 0.05). Conclusions A higher TyG index was independently associated with an increased risk of ischemic events and mortality among patients with ACS and T2DM. This association appeared to be attenuated with longer diabetes duration, suggesting that the prognostic relevance of the TyG index may vary according to the chronicity of diabetes.
Diabetic kidney disease (DKD) is a major microvascular complication of type 2 diabetes mellitus (T2DM) and a leading cause of progressive renal failure worldwide. Although urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate remain the cornerstone measures for DKD assessment, simple and readily available biomarkers may provide complementary clinical information. In this cross-sectional study, 300 patients with T2DM were categorized into three groups according to UACR. The study evaluated and compared the triglyceride–glucose (TyG) index, neutrophil-to-lymphocyte ratio (NLR), and high-sensitivity C-reactive protein (hs-CRP) across albuminuria categories. All three biomarkers differed significantly among the albuminuria categories, with the highest levels observed in patients with macroalbuminuria. Receiver operating characteristic analyses demonstrated good discriminatory performance for albuminuria, with both NLR and hs-CRP exhibiting significantly greater discriminatory ability than the TyG index in several comparisons. In adjusted multinomial logistic regression analysis, NLR was independently associated with both microalbuminuria and macroalbuminuria, whereas the TyG index and hs-CRP were independently associated only with macroalbuminuria. These findings support the complementary role of these readily available biomarkers in the assessment of albuminuria in T2DM and provide a basis for future longitudinal studies to clarify their clinical significance.
Marwa M. Seyam, H. Elhabiby, Z. Hamed et al.· Scientific Reports· 0 citations
Background Diabetic kidney disease (DKD) is a major complication of type 2 diabetes (T2D) and is closely linked to metabolic dysregulation. The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) integrates urate-related purine metabolism and high-density lipoprotein cholesterol (HDL-C)-related lipid metabolism, two metabolic signals potentially related to kidney injury. This study examined the cross-sectional association between UHR and prevalent DKD in patients with T2D. Methods This study included a primary clinical cohort of 912 patients with T2D and an external validation cohort from the National Health and Nutrition Examination Survey (NHANES; n = 2,738). Multivariable logistic regression was used to assess the association between UHR and prevalent DKD. Restricted cubic spline (RCS) analyses evaluated exposure-response patterns. Subgroup, interaction, and joint analyses were performed to examine the association across clinical strata. Results In the primary cohort, DKD prevalence increased from 20.52% in the lowest UHR quartile to 55.26% in the highest quartile (P < 0.001). After full adjustment, each 1-SD increase in UHR was associated with more than 2-fold higher odds of DKD (OR, 2.22; 95% CI, 1.80–2.77; P < 0.001). Compared with Q1, the adjusted ORs for Q2, Q3, and Q4 were 1.29, 2.32, and 6.73, respectively. The trend across quartiles was significant (P for trend < 0.001). RCS analyses showed positive overall associations between UHR and DKD. The positive association was generally observed across predefined subgroups, with nominal evidence of interaction by body mass index (BMI) and insulin use. In NHANES, 1,067 of 2,738 participants had DKD. External validation showed directionally consistent results. Higher odds of DKD were observed per 1-SD increase in UHR (OR, 1.44; 95% CI, 1.23–1.68; P < 0.001) and in Q4 vs. Q1 (OR, 2.61; 95% CI, 1.79–3.79; P < 0.001). Survey-weighted RCS showed a positive association without significant non-linearity. Conclusion Higher UHR was associated with greater odds of prevalent DKD in the hospital-based T2D cohort, with directionally consistent findings in the NHANES validation cohort.
Yong-Jun Ma, Xinyi Huang, Guangming Chen et al.· Frontiers in Nutrition· 0 citations
Background Diabetic kidney disease (DKD) is a prevalent microvascular complication of type 2 diabetes mellitus (T2DM) and contributes substantially to end-stage renal disease. The atherogenic index of plasma (AIP) has exhibited biomarker utility. However, its relationship with DKD remains uncertain. Methods This cross-sectional investigation included 10,112 T2DM subjects from the National Metabolic Management Center of Yuhuan Second People’s Hospital between September 2017 and February 2025 and 5,573 individuals in NHANES cohort (1999–2020). AIP values were calculated and categorized into quartiles. Multivariable logistic regression, restricted cubic spline, and stratified subgroup analyses were applied for assessing the link between AIP and DKD. The area under the curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI) was used to assess the discriminative ability of AIP. Results After adjustment for confounding factors, each one-unit AIP rise resulted in a 72% higher likelihood of DKD (OR: 1.72, 95% CI: 1.51–1.96, p < 0.001). Relative to the lowest AIP quartile, the highest quartile showed a 54% higher odds DKD (OR: 1.54, 95% CI: 1.36–1.75, p < 0.001), with a clear dose–response effect (P for trend <0.001). Spline modeling indicated a positive linear link between AIP and DKD, which was apparent in all examined subgroups (all P for interaction >0.05) and externally validated in NHANES. Incorporating AIP into the baseline model modestly improved discrimination, increasing the area under the curve from 68.42 to 68.76%, with a continuous NRI of 0.118 (95% CI: 0.079–0.157, p < 0.001) and an IDI of 0.006 (95% CI: 0.004–0.007, p < 0.001). Conclusion AIP shows an independent positive association with DKD in individuals with T2DM, demonstrating a linear dose–response relationship, but the incremental predictive value is limited. The association between AIP and DKD still needs to be further validated by larger-scale prospective studies.
Jinghan Zheng, J. Chi, K. Che et al.· Frontiers in Nutrition· 0 citations
Aims : Insulin resistance (IR) plays a pivotal role in the onset and progression of coronary artery disease (CAD). This study aims to assess the efficacy and clinical utility of four non-insulin-based IR indices—Triglyceride-Glucose (TyG) index, Metabolic Score for Insulin Resistance (METS-IR), Triglyceride-Glucose-Body Mass Index (TyG-BMI), and Triglyceride to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C)—in predicting prognosis in patients with newly diagnosed CAD. Methods This retrospective analysis included 890 patients with newly diagnosed CAD enrolled between January 2019 and June 2022. LASSO penalized regression was applied for covariate selection to mitigate overfitting (events-per-variable ratio ≈ 13.9), and Firth's penalized maximum likelihood estimation was performed as a sensitivity analysis. Multivariable Cox models and restricted cubic spline analyses examined associations between the four non-insulin-based IR indices and major adverse cardiovascular events (MACEs). The proportional hazards assumption was verified using Schoenfeld residual tests, and Bonferroni correction was applied for multiple comparisons (α = 0.0125). Receiver operating characteristic curves were plotted, and the incremental prognostic performance of each IR index for MACEs was assessed using the area under the ROC curve (AUC), C-statistics, net reclassification index (NRI), and integrated discrimination improvement (IDI). Kaplan–Meier analysis was used to evaluate the relationship between IR indices and clinical outcomes. Results Over a median follow-up of 26.5 months, the overall incidence of MACEs was 10.9%. TyG index (HR = 1.627, 95% CI: 1.228–2.145), TyG-BMI (HR = 1.019, 95% CI: 1.014–1.023), TG/HDL-C (HR = 1.127, 95% CI: 1.055–1.195), and METS-IR (HR = 1.104, 95% CI: 1.080–1.129) were all identified as independent risk factors for MACEs. METS-IR showed the highest incremental prognostic value (C-statistic = 0.779, IDI = 0.082, NRI = 0.356, P < 0.001). Log-rank tests indicated significantly higher MACEs rates in patients with higher IR indices (P < 0.01). Conclusions TyG index, TyG-BMI, TG/HDL-C ratio, and METS-IR are independently associated with MACEs in patients with newly diagnosed CAD, with METS-IR demonstrating the highest incremental predictive performance.
Meng Sun, Lulin Chen, Dandan Li et al.· Frontiers in Cardiovascular...· 0 citations
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