Association Between Triglyceride Glucose Index And Type 2 Diabetic Peripheral Neuropathy

Objectives:Diabetic peripheral neuropathy is a common chronic complication of type 2 diabetes mellitus,but its pathogenesis is still unknown,which may be caused by hyperglycemia,hypertriglyceride and insulin resistance.The previous researches proved that the triglyceride glucose(TyG)index can be used to evaluate insulin resistance as well as reflecting the glucose and lipid metabolism.Thus,the main purpose of this study was to explore the correlation between TyG index and type 2 diabetic peripheral neuropathy,then to evaluate its predictive value for type 2 diabetic peripheral neuropathy.Methods:This was a retrospective study,we review the inpatients' medical records of 71 subjects with type 2 diabetes or type 2 diabetic peripheral neuropathy(October 1 st,2017 to August 31 st,2019),who were 60-80 aged and was hospitalized in department of endocrinology the Second Affiliated Hospital of Kunming Medical University.According to the inclusion,exclusion and related diagnostic criteria of the study.General data of patients were recorded as followed:age,gender,history of smoking and drinking,etiology of type 2 diabetes,history of hypertension;fasting blood glucose,fasting serum insulin level,glycosylated hemoglobin,triglyceride,low-density lipoprotein,high-density lipoprotein,total cholesterol,uric acid value in the laboratory investigation.Based on the clinical diagnosis standard of diabetic peripheral neuropathy,subjects were divided into three groups:simple type 2 diabetes group without peripheral neuropathy(NDPN group,n=25),type 2 diabetic peripheral neuropathy group with peripheral neuropathy,but without any self-symptoms of abnormal sensation(DPN 1 group,n=19),and clinically symptomatic type 2 diabetic peripheral neuropathy group(DPN 2 group,n=27).Data processing and statistical analysis used SPSS 22.00 statistical analysis package.The counting data is expressed by the number of cases and percentage.The measurement data conforming to normal distribution shall be described by mean ±standard deviation,otherwise,it shall be represented by median and quartile.The comparison of general data and laboratory data among the three groups showed that the measurement data with normal distribution and homogeneous variance were analyzed by one-way ANOVA,the multiple sample rank sum test was used for inconformity,and chi square test was used for count data.Pearson correlation analysis was used for normal distribution measurement data,meanwhile Spearman correlation analysis was used for skew distribution measurement data or counting data,the relationship between TyG index and HOMA-IR index was analyzed for all patients.In order to further explore the predictive significance of TyG index on DPN,according to the median,it was divided into low TyG value group(TyG?9.61)and high TyG value group(TyG>9.61).The significant difference between the two groups was compared by Chi square test,and independent sample t test was used for the count data consistent with normal distribution,rank sum test was used for the inconformity.The receiver operation characteristic curve(ROC curve)was used to identify the predict value of TyG index value to type 2 diabetic peripheral neuropathy and the sensitivity and specificity of diagnostic test were calculated by four grid table.P<0.05 was considered as statistically significant.Results:There were significant differences in TyG index distribution among the three groups,9.17±0.67,9.71±0.62 and 9.90±0.45 respectively.Further comparison showed that there was significantly higher value of TyG index value in the both DPN group than that in NDPN group(P<0.05).There was a correlation between TyG index and DPN in DPN 2 group,R=0.537(P<0.05).The proportion of type 2 diabetic peripheral neuropathy in high TyG group was significantly higher than that in low TyG group(P<0.05).The risk factors of type 2 diabetic peripheral neuropathy was correlated with fasting triglyceride,fasting insulin,TyG index and HOMA-IR index(P<0.001),as well as course of disease and glycosylated hemoglobin(P<0.05).Multivariate logistic analysis indicated that TyG index,course of disease and fasting insulin were the important risk factors for type 2 diabetic peripheral neuropathy(P<0.05).According to the ROC curve analysis,the area under the ROC curve of TyG index=0.773(P<0.001).According to the four grid table of diagnostic test,sensitivity=63.04%,specificity=76.00%,and Youden's index=0.39.Conclusions:TyG index can reflect insulin resistance;TyG index is closely related to type 2 diabetic peripheral neuropathy,which is an important risk factor.The higher the value,the greater the possibility of type 2 diabetic peripheral neuropathy;TyG index can be used as an effective predictor of type 2 diabetic peripheral neuropathy.