Abstract
BackgroundThe triglyceride-glucose index (TyG index) has been proposed as a simple and reliable alternative insulin resistance (IR) marker, while the homeostasis model assessment for IR (HOMA-IR) is the most frequently used index. Few studies have evaluated the role of IR assessed by the TyG index and HOMA-IR on arterial stiffness in a type 2 diabetes (T2D) population with a high risk of increased arterial stiffness. We aimed to investigate the association of the TyG index and HOMA-IR with arterial stiffness in patients with T2D.MethodsWe recruited 3185 patients with T2D, who underwent brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, but without previous cardiovascular disease. Increased arterial stiffness was defined as a baPWV value greater than the 75th percentile (18.15 m/s) in the present study. The TyG index was determined as ln(fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2), and the HOMA-IR was calculated as (fasting insulin [μIU/mL] × fasting glucose [mmol/L])/22.5.ResultsThe mean age of the study participants was 54.6 ± 12.0 years, and 1954 (61.4%) were men. Seemingly unrelated regression estimation analysis demonstrated that the TyG index had stronger associations with baPWV than the HOMA-IR (all P < 0.001). In the multivariable logistic analyses, each one-unit increase in the TyG index was associated with a 1.40-fold (95% CI 1.16–1.70, P < 0.001) higher prevalence of increased arterial stiffness, but the prominent association of the HOMA-IR with the prevalence of increased arterial stiffness was not observed. Subgroup analyses showed that a more significant association between the TyG index and the prevalence of increased arterial stiffness was detected in older patients with a longer duration of diabetes and poor glycaemic control (all P < 0.05).ConclusionsCompared with the HOMA-IR, the TyG index is independently and more strongly associated with arterial stiffness in patients with T2D.
Highlights
The triglyceride-glucose index (TyG index) has been proposed as a simple and reliable alternative insulin resistance (IR) marker, while the homeostasis model assessment for IR (HOMA-IR) is the most frequently used index
Compared to those in the lowest tertile of the TyG index, participants in the higher tertile were younger with shorter duration of diabetes; were more frequently men, smokers, drinkers; less frequently used non-insulin hypoglycaemic agents; had lower levels of high-density lipoprotein cholesterol (HDL-C); and had higher blood pressures, Body mass index (BMI), waist circumferences, fasting and post load glucose levels, fasting insulin, HOMA-IR, HbA1c, TG, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), Urinary albumin/creatinine ratio (UACR), and white blood cell (WBC) counts
P v aluea was calculated by using seemingly unrelated regression estimation to compare the regression coefficient (β) between TyG index and HOMA-IR Model 1: adjusted for age and sex Model 2: model 1 + adjusted for BMI, waist circumference, systolic blood pressure, LDL-C, HDL-C and WBC counts Model 3: model 2 + adjusted for smoking status, drinking status, lipid lowering agents, antihypertensive agents, insulin therapy, non-insulin hypoglycemic agents TyG triglyceride glucose index, HOMA-IR homeostasis model assessment for insulin resistance, Brachial-ankle pulse wave velocity (baPWV) brachial to ankle pulse wave velocity increase in the TyG index was associated with a 1.40fold higher prevalence of increased arterial stiffness
Summary
The triglyceride-glucose index (TyG index) has been proposed as a simple and reliable alternative insulin resistance (IR) marker, while the homeostasis model assessment for IR (HOMA-IR) is the most frequently used index. Few studies have evaluated the role of IR assessed by the TyG index and HOMA-IR on arterial stiffness in a type 2 diabetes (T2D) population with a high risk of increased arterial stiffness. Insulin resistance (IR) is an important cause of several metabolic disease, including diabetes and CVD [18]. The homeostasis model assessment for IR (HOMAIR) is the most frequently used index to evaluate IR and uses insulin and glucose level derived from the fasting state. The TyG index is more available and less cost-effective, and some studies revealed that the TyG index shows better performance for assessing IR than the HOMA-IR in clinical practice regardless of diabetes status [20, 21]
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