Association between triglyceride-glucose index and risk of incident diabetes: a secondary analysis based on a Chinese cohort study

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Abstract

Background

Recent studies have suggested the triglyceride-glucose index (TyG index) may serve as a suitable substitute for insulin resistance. However, evidence for the relationship between TyG index and risk of diabetes remains limited. This study sought to explore the association of baseline TyG index with risk of developing diabetes in Chinese adults.

Methods

This retrospective cohort study was conducted using data from the health screening program in China. A total of 201,298 non-diabetic individuals were included. TyG index was calculated as Ln [fasting plasma glucose (mg/dL) × fasting triglyceride level (mg/dL) / 2]. Diabetes was defined as fasting plasma glucose ≥126 mg/dL and/or self-reported diabetes. Cox proportion-hazard model was employed to evaluate the independent impact of baseline TyG index on future diabetes risk. Sensitivity and subgroup analyses were implemented to verify the reliability of results. Notably, data were downloaded from the DATADRYAD website, and used only for secondary analyses.

Results

During an average follow-up of 3.12 years, among 201,298 individuals aged ≥20 years, 3389 subjects developed diabetes. After adjusting for potential confounders, elevated TyG index were independently correlated with greater risk of incident diabetes (hazard ratio (HR), 3.34; 95% confidence interval (CI), 3.11–3.60). Compared with the lowest quartile (Q1), increasing TyG index (Q2, Q3, and Q4) was related to increased HR estimates of incident diabetes [HR (95% CI), 1.83 (1.49–2.26); 3.29 (2.70–4.01), and 6.26 (5.15–7.60), respectively]. Moreover, a nonlinear relationship was observed between TyG index and risk of diabetes and the slope of the curve increased accompanying the rise of TyG index. Subgroup analysis revealed the positive association was stronger among subjects with age < 40 years, body mass index ≥18.5 kg/m ² and < 24 kg/m ², or systolic blood pressure < 140 mmHg, or in females.

Conclusions

Elevated TyG index is independently correlated with increased risk of incident diabetes in Chinese adults, indicating it may represent a reliable predictor of diabetes in high-risk populations.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12944-020-01403-7.

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Most cited references 51

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Global estimates of the prevalence of diabetes for 2010 and 2030.

J E Shaw, R. A. Sicree, P Zimmet (2010)

We estimated the number of people worldwide with diabetes for the years 2010 and 2030. Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

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Epidemic obesity and type 2 diabetes in Asia.

Kun-Ho Yoon, Jin-Hee Lee, Ji-Won Kim … (2006)

The proportions of people with type 2 diabetes and obesity have increased throughout Asia, and the rate of increase shows no sign of slowing. People in Asia tend to develop diabetes with a lesser degree of obesity at younger ages, suffer longer with complications of diabetes, and die sooner than people in other regions. Childhood obesity has increased substantially and the prevalence of type 2 diabetes has now reached epidemic levels in Asia. The health consequences of this epidemic threaten to overwhelm health-care systems in the region. Urgent action is needed, and advocacy for lifestyle changes is the first step. Countries should review and implement interventions, and take a comprehensive and integrated public-health approach. At the level of primary prevention, such programmes can be linked to other non-communicable disease prevention programmes that target lifestyle-related issues. The cost of inaction is clear and unacceptable.

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The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp.

Fernando Guerrero-Romero, Luis E Simental-Mendía, Manuel González-Ortiz … (2010)

To meet the worldwide challenge of emerging diabetes, accessible and inexpensive tests to identify insulin resistance are needed. To evaluate the sensitivity and specificity of the product of fasting, we compared the triglycerides and glucose (TyG) index, a simple measure of insulin resistance, with the euglycemic-hyperinsulinemic clamp test. We conducted a cross-sectional study of the general population and outpatients of the Internal Medicine Department at the Medical Unit of High Specialty of the Specialty Hospital at the West National Medical Center in Guadalajara, Mexico. Eleven nonobese healthy subjects, 34 obese normal glucose tolerance individuals, 22 subjects with prediabetes, and 32 diabetic patients participated in the study. We performed a euglycemic-hyperinsulinemic clamp test. Sensitivity and specificity of the TyG index [Ln(fasting triglycerides) (mg/dl) x fasting glucose (mg/dl)/2] were measured, as well as the area under the curve of the receiver operating characteristic scatter plot and the correlation between the TyG index and the total glucose metabolism (M) rates. Pearson's correlation coefficient between the TyG index and M rates was -0.681 (P < 0.005). Correlation between the TyG index and M rates was similar between men (-0.740) and women (-0.730), nonobese (-0.705) and obese (-0.710), and nondiabetic (-0.670) and diabetic (-0.690) individuals. The best value of the TyG index for diagnosis of insulin resistance was 4.68, which showed the highest sensitivity (96.5%) and specificity (85.0%; area under the curve + 0.858). The TyG index has high sensitivity and specificity, suggesting that it could be useful for identification of subjects with decreased insulin sensitivity.

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Author and article information

Contributors

Huijuan Ma:

ORCID: http://orcid.org/0000-0002-4176-5013

huijuanma76@163.com

Journal

Journal ID (nlm-ta): Lipids Health Dis

Journal ID (iso-abbrev): Lipids Health Dis

Title: Lipids in Health and Disease

Publisher: BioMed Central (London )

ISSN (Electronic): 1476-511X

Publication date (Electronic): 8 November 2020

Publication date PMC-release: 8 November 2020

Publication date Collection: 2020

Volume: 19

Electronic Location Identifier: 236

Affiliations

[1 ]GRID grid.256883.2, ISNI 0000 0004 1760 8442, Department of Internal Medicine, , Hebei Medical University, ; Shijiazhuang, 050017 Hebei China

[2 ]GRID grid.440208.a, Department of Endocrinology and Metabolic Diseases, , Hebei General Hospital, ; Shijiazhuang, 050051 Hebei China

[3 ]Department of Cardiology, Xingtai Third Hospital, Xingtai, 054000 Hebei China

[4 ]GRID grid.440734.0, ISNI 0000 0001 0707 0296, Clinical Medical College, , North China University of Science and Technology, ; Tangshan, 063210 Hebei China

[5 ]GRID grid.440208.a, Hebei Key Laboratory of Metabolic Diseases, , Hebei General Hospital, ; Shijiazhuang, 050051 Hebei China

Author information

Huijuan Ma http://orcid.org/0000-0002-4176-5013

Article

Publisher ID: 1403

DOI: 10.1186/s12944-020-01403-7

PMC ID: 7649000

PubMed ID: 33161902

SO-VID: 28c708e3-4eff-4b17-a75f-b3903b501b90

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 1 September 2020

Date accepted : 14 October 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003787, Natural Science Foundation of Hebei Province;

Award ID: H2019307108

Award Recipient : Huijuan Ma

Funded by: Project of Youth Science and Technology of Medical Science Research in Hebei Province

Award ID: No. 20191706

Award Recipient : Xiaoli Li

Custom metadata

ScienceOpen disciplines: Biochemistry

Keywords: triglyceride-glucose index,incident diabetes,association,nonlinearity,insulin resistance,cohort study,chinese adults

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ScienceOpen disciplines: Biochemistry

Keywords: triglyceride-glucose index, incident diabetes, association, nonlinearity, insulin resistance, cohort study, chinese adults

Association between triglyceride-glucose index and risk of incident diabetes: a secondary analysis based on a Chinese cohort study : TyG index and incident diabetes

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Most cited references 51

Global estimates of the prevalence of diabetes for 2010 and 2030.

Epidemic obesity and type 2 diabetes in Asia.

The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp.

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