Predictive Value Of TyG?related Indices,obesity Indices,and Lipid Ratios On The Onset Of Diabetes In Middle-aged And Elderly Populations

Objective:On a global scale,diabetes and its complications have become a major public health problem worldwide,posing a serious threat to human health.Early and timely treatment of diabetes can effectively reduce the risk of adverse outcomes of diabetes.Therefore,effective screening strategies and early detection indicators are needed to predict the risk of diabetes.Insulin resistance(IR)plays a pivotal role in the pathogenesis of diabetes and other metabolic-related diseases and occurs before the diagnosis of diabetes.Indicators such as triglyceride-glucose(TyG)correlation index,adiposity index,and lipid ratio are associated with IR and may be helpful in identifying diabetes.The research results on the relationship between various indicators and the risk of diabetes were not consistent,and there was no systematic evaluation and comparison of the TyG-related parameters,obesity indices,and lipid ratios in the middle-aged and elderly Chinese population for the prediction value of new-onset diabetes.No study explored the relationship between the predictive value of the above indicators and the baseline blood glucose status of patients with new-onset diabetes.In this study,we evaluated the correlation between the TyG index and the risk of diabetes through the middle-aged and elderly people in China,and compared the predictive ability of the TyG-related indices,obesity indices,and lipid ratios on the risk of diabetes in different blood glucose states,so as to screen out the high-risk population of diabetes in time,and provide new data support for the early prevention and management of diabetes.Methods:The data used in this study was based on the 2011 baseline and 2013,2015,and 2018 follow-up data of the China Health and Retirement Longitudinal Study(CHARLS),and the middle-aged and elderly people over 45 years old were selected as the research objects.According to the baseline blood glucose status,they were divided into normal fasting glucose(NFG)group and impaired fasting glucose(IFG)group.The Kaplan-Meier method and log-rank test were used to observe and compare the differences in onset time between different groups.Cox proportional hazards model was used to evaluate the association between TyG index and the risk of diabetes.The dose-response relationship between the TyG index and the risk of new-onset diabetes after adjusting for potential confounding factors was explored by restricted cubic spline fitting.In order to compare the diagnostic value of different indicators for new-onset diabetes,TyG-body mass index(BMI),TyG-waist circumference(WC),TyG-waist height ratio(WHtR),visceral fat index(VAI),lipid accumulation product(LAP),triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C),and total cholesterol(TC)/HDL-C quartiles were used as independent variables,and the HR and 95%CI for new-onset diabetes were calculated.The area under the receiver operating characteristic curve(ROC)was used to detect the predictive ability of each index at baseline to the risk of new-onset diabetes at follow-up.In this study,R 4.1.1 software was used for statistical analysis,and bilateral P<0.05 was defined as a statistically significant difference.Results:1.A total of 6258 subjects were included in this study.According to the baseline blood glucose status,there were 2970 people in the NFG group and 3288 people in the IFG group.The average age of the people in the IFG group was older,and the proportion of people with high blood pressure history(23.8%)and heart disease history(11.3%)was higher(P<0.05).The HDL-C level of the NFG group was higher,and the levels of other physical examination and blood indicators were lower(P<0.05).In total population,the incidence of diabetes was 13.7%,among which the incidence of diabetes in NFG group was 9.4%,and the incidence of diabetes in IFG group was 17.6%.The cumulative incidence of diabetes was significantly different among different glycemic states at baseline(P<0.001).2.In the general population and populations with different blood glucose status,the risk of diabetes was positively correlated with the baseline TyG level(P<0.05).Restricted cubic spline results showed that there was a linear correlation between TyG index and the risk of new-onset diabetes.3.After adjusting covariates such as age,alcohol consumption,education level,history of hypertension,and history of heart disease,in the NFG group,the risk of newonset diabetes in the Q4 group of TyG-BMI,TyG-WHtR,and TyG-WC was 1.84,1.61,and 1.82 times that of the Q1 group,respectively.The risk of new-onset diabetes in Q4 group of VAI,LAP,TG/HDL-C and TC/HDL-C was 2.04,1.57,1.67 and 1.41 times that of Q1 group,respectively.In the IFG group,the risk of new-onset diabetes in the Q4 group of TyG-BMI,TyG-WHtR,and TyG-WC was 2.53,2.27,and 2.45 times that of the Q1 group,respectively.The risk of new-onset diabetes in Q4 group of VAI,LAP,TG/HDL-C and TC/HDL-C was 2.01,2.02,1.83 and 1.86 times that of Q1 group,respectively.4.ROC curve was drawn according to the relationship between the level of each index and the risk of diabetes.In the general population and the NFG group,TyG-WHtR had the highest predictive value for the risk of diabetes,with AUC values of 0.658 and 0.613,respectively.In the IFG group,the ability of TyG-BMI to predict the risk of diabetes was stronger than other indicators,with an AUC value of 0.643.5.The predictive value of each index to diabetes risk was analyzed by age stratification.The results showed that when the age was<65 years old,the predictive value of TyG-WHtR for the risk of diabetes was the highest among all indicators,and when the age was≥65 years old,the predictive value of all indicators for the risk of diabetes in the NFG group decreased.In the IFG group,TyG-BMI had the highest predictive value for new onset diabetes.Conclusion:1.In the middle-aged and elderly population in China,there was a positive correlation between TyG index and the risk of diabetes,and the correlation was linear.TyG-related parameters,obesity indices,and lipid ratios were associated with the incidence of diabetes in middle-aged and elderly Chinese population.2.TyG-related indices,obesity indices,and lipid ratios had different predictive abilities of diabetes onset in different populations.In the general population and NFG group,the ability of TyG-WHtR to predict the risk of diabetes was relatively better.In the IFG group,the ability of TyG-BMI to predict the risk of diabetes was relatively better.