Diabetic retinopathy (DR) is a leading cause of vision impairment in type 2 diabetes. This study aims to clarify the association between baseline triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and DR risk in type 2 diabetes patients to aid in prevention and treatment strategies. This retrospective cohort study included 1049 patients with type 2 diabetes who met the inclusion criteria and underwent health examinations at our hospital from January 2017 to December 2023. All patients completed seven follow-up visits within seven years. Baseline data from 2017 were utilized for the analysis. The Kaplan-Meier method and the Cox proportional hazards regression model and restricted cubic spline (RCS) method were employed to analyze the association between baseline serum TG/HDL-C ratio and the risk of DR. A total of 1049 patients were included in the cohort, with a median follow-up period of seven years. During the follow-up period, 124 new cases of DR were identified, with an incidence rate of 11.8 %. The incidence of DR showed an upward trend with increasing baseline TG/HDL-C ratio. After adjusting for various potential confounding factors in the Cox proportional hazards regression model, high TG/HDL-C ratio levels were identified as a risk factor for DR (HR=3.04, 95 % CI 1.55-5.98, P = 0.0029).In the dose-response relationship analysis, a significant nonlinear relationship was observed between the TG/HDL-C ratio and the risk of diabetic retinopathy (DR) (nonlinear P value = 0.029). The risk of DR significantly increased when the TG/HDL-C ratio reached 3.3 (HR = 1.56, 95 % CI: 1.17-2.10, P = 0.003) and then leveled off. High TG/HDL-C ratio is closely associated with the occurrence of DR and has a certain predictive value for the onset of DR. The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to confidentiality agreements with the funding organization.
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