Title: A study of triglyceride glucose index (TyG Index) as a predictor, in macro‑ and microvascular complications of diabetes mellitus

Authors: Dr Araveinth.G, Dr Badrinath A K, Dr Karthik J

 DOI: https://dx.doi.org/10.18535/jmscr/v10i3.02

Abstract

Introduction: Poor glycemic control is commonly assessed by HbA1c levels. In resource limited setting and as a cost effective approach, Triglyceride glucose (TyG) index can also be used as a marker for glycemic control and to predict the complication of diabetes mellitus. It is more cost effective and can be calculated manually with fasting blood glucose and triglyceride levels.

Aims: To find the association between Triglyceride Glucose index (TyG index) and HbA1c levels in assessing the micro and macro vascular complications of diabetes mellitus.

Methods: Total of 60 diabetic patients admitted in our hospital were included and they were grouped into 4 categories according to their HbA1c and TyG values. Presence of micro vascular complications including diabetic retinopathy, elevated protein creatinine ratio, decreased eGFR, abnormal monofilament test and macro vascular complication including reduced ankle brachial pressure index and ischemic changes in ECG and ECHO were noted. Presence of these diabetic complications were compared with the TyG and HbA1c level.

Results: Among 60 patients enrolled in the study, 46 patients (76.66%) had atleast one complication and only 14 patients (23.33%) are without any complication. As the TyG and HbA1c level progressed,  patients having  both microvascular and macrovascular complications increased [(TyG Group I - 20% vs TyG Group IV- 62.6%) and (HbA1c group I – 35% vs HbA1c Group IV- 50%)] and percentage of patients without any complications decreased [(TyG group I-40% vs TyG group IV-12.5%) and (HbA1c group I -35.71% vs HbA1c group IV -16.66%)].

Conclusion: Increased TyG index might be a cost effective predictor of complication of diabetes mellitus when compared to HbA1c levels and can be used in addition to HbA1C to offer additional benefit for predicting complications.

References

  1. Guerrero-Romero F, Simental-Mendia LE, Gonzalez-Ortiz M, Martinez-Abundis E, Ramos-Zavala MG, Hernandez-Gonzalez SO, et al. The productof triglycerides and glucose, a simple measure of insulin sensitivity.
  2. Irace C, Carallo C, Scavelli FB, De Franceschi MS, Esposito T, Tripolino C, et al. Markers of insulin resistance and carotid atherosclerosis. A comparisonof the homeostasis model assessment and triglyceride glucoseindex. Int J ClinPract. 2013;67(7):665–72
  3. Bressler P, Bailey SR, Matsuda M, DeFronzo RA. Insulin resistance and coronary artery disease. Diabetologia. 1996;39(11):1345–50.3. Bonora E, Tessari R, Micciolo R, Zenere M, Targher G, Padovani R, et al.Intimal-medial thickness of the carotid artery in non diabetic and NIDDM patients: relationship with insulin resistance. Diabetes Care.1997; 20(4):627–31.
  4. Anan, F.; Takayuki, M.; Takahashi, N.; Nakagawa, M.; Eshima, N.; Saikawa, T.; Yoshimatsu, H. Diabetic retinopathy is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Hypertens Res. 2009, 32, 299.
  5. Liang, S.; Cai, G.Y.; Chen, X.M. Clinical and pathological factors associated with progression of diabeticnephropathy. Nephrology. 2017, 22, 14–19
  6. Shang, J.; Yu, D.; Cai, Y.; Wang, Z.; Zhao, B.; Zhao, Z.; Simmons, D. The triglyceride glucose index canpredict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: A nested case controlstudy. Medicine. 2019, 98, e17995.
  7. Khan SH, Sobia F, Niazi NK, Manzoor SM, Fazal N, Ahmad F. Metabolic clusteringof risk factors: evaluation of Triglyceride-glucose index (TyG index)for evaluation of insulin resistance. Diabetol Metab Syndr. 2018;10:74.
  8. Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, Feldman EL. Elevated triglycerides correlate with progression of diabetic neuropathy. Diabetes 2009; 58: 1634-40.
  9. Zhao, S.; Yu, S.; Chi, C.; Fan, X.; Tang, J.; Ji, H.; Teliewubai, J.; Zhang, Y.; Xu, Y. Association between macro-and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: The Northern Shanghai Study. Cardiovasc Diabetol. 2019, 18, 95.
  10. Sanchez-Inigo L, Navarro-Gonzalez D, Fernandez-Montero A, Pastrana- Delgado J, Alfredo Martinez J. The TyG index may predict the development of cardiovascular events. Eur J Clin Invest. 2016;46(2):189–97.
  11. Jin JL, Cao YX, Wu LG, You XD, Guo YL, Wu NQ, et al. Triglyceride glucose index for predicting cardiovascular outcomes in patients with coronary artery disease. J Thorac Dis. 2018;10(11):6137–46.
  12. Zoungas S, Chalmers J, Ninomiya T, Li Q, Cooper ME, Colagiuri S, Fulcher G, de Galan BE, Harrap S, Hamet P, Heller S, MacMahon S, Marre M, Poulter N, Travert F, Patel A, Neal B, Woodward M; ADVANCE Collaborative Group. Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds. Diabetologia. 2012 Mar;55(3): 636-43. doi: 10.1007/s00125-011-2404-1. Epub 2011 Dec 21. PMID: 22186981.
  13. Sinha B, Ghosal S. A Target HbA1c Between 7 and 7.7% Reduces Microvascular and Macrovascular Events in T2D Regardless of Duration of Diabetes: a Meta-Analysis of Randomized Controlled Trials. Diabetes Ther. 2021 Jun;12(6):1661-1676. doi: 10.1007/s13300-021-01062-6. Epub 2021 Apr 24. PMID: 33895981; PMCID: PMC8179883.
  14. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonyl ureas or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 33). Lancet. 1998; 352:837–53. https://doi.org/10.2337/db18-1629-P.
  15. Radin MS. Pitfalls in hemoglobin A1c measurement: when results may be misleading. J Gen Intern Med. 2014 Feb;29(2):388-94. doi: 10.1007/s11606-013-2595-x. Epub 2013 Sep 4. PMID: 24002631; PMCID: PMC3912281.

Corresponding Author

Dr Araveinth.G

Post Graduate, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagadipet, Puducherry- 605 107, India