Association Between Triglyceride-Glucose Index And Albuminuria In Patients With Type 2 Diabetes Mellitus

ObjectiveTriglyceride-glucose(TyG)index is a simple indicator to evaluate insulin resistance.Previous studies have shown that higher TyG index is significantly associated with increased risk of diabetes mellitus,metabolic syndrome and cardiovascular disease,but the association between TyG index with albuminuria in patients with type 2 diabetes mellitus(T2DM)is not clear.The aim of this study was to explore the relationship between TyG index and albuminuria in T2 DM,so as to provide reference for the early prediction of diabetic kidney disease(DKD).MethodsA total of 524 patients with T2 DM who treated in our hospital were recruited in this study,aged 24-70 years.Anthropometric characteristics were measured.Fasting blood glucose(FPG),blood lipid,urinary albumin/creatinine ratio(UACR)and renal function indicators were detected.TyG index was calculated.TyG was grouped by tertiles: low TyG(L-TyG,n=175)group,medium TyG(M-TyG,n=175)group and high TyG(H-TyG,n=174)group.Meanwhile,according to the UACR value,all subjects were divided into normal albuminuria group(UACR<30mg/g,n=267),microalbuminuria group(30mg/g?UACR<300mg/g,n=207)and macroalbuminuria group(UACR?300mg/g,n=50).Microalbuminuria and macroalbuminuria are abnormal albuminuria group(UACR?30mg/g,n=257).The differences of relevant indicators among three groups of TyG index and UACR were compared;The correlation between TyG index and UACR was analyzed;The association between TyG index and the risk of albuminuria in T2 DM patients was evaluated by Logistic regression analysis;Receiver operating characteristic(ROC)curve was used to analyze the predictive value of TyG index on the occurrence of abnormal albuminuria in T2 DM patients.Results(1)Compared with the L-TyG group,UACR,body mass index(BMI),hemoglobinA1c(HbA1c),total cholesterol(TC)and low density lipoprotein cholesterol(LDL-C)in the M-TyG group and H-TyG group were significantly increased(P<0.05 or P<0.01),while the value of high density lipoprotein cholesterol(HDL-C)was significantly decreased(P<0.01).Compared with the M-TyG group,UACR,homeostasis model of insulin resistance(HOMA-IR),HbA1 c,TC and serum uric acid(SUA)in the H-TyG group were significantly increased(P<0.05 or P<0.01),while the value of HDL-C was significantly decreased(P<0.01).The incidence of abnormal albuminuria increased gradually in the three groups(P<0.05).(2)Correlation analysis showed that TyG index was positively correlated with UACR,BMI,HOMA-IR,HbA1 c,TC,LDL-C,SUA and blood urea nitrogen(BUN)(P<0.05 or P<0.01),negatively correlated with HDL-C(P<0.01).After adjusting for sex,age,BMI and T2 DM duration,TyG index was still significantly positively correlated with UACR,HOMA-IR,HbA1 c,TC,LDL-C,SUA,BUN and serum creatinine(SCr)(P<0.05 or P<0.01),and was significantly negatively correlated with HDL-C(P<0.01).(3)Compared with the normal albuminuria group,TyG index,HOMA-IR,HbA1 c,FPG,TG,TC and hypertension in the microalbuminuria group and macroalbuminuria group were significantly increased(P<0.05 or P<0.01),while the value of HDL-C was significantly decreased(P<0.01).Compared with the microalbuminuria group,TyG index,HbA1 c,TG,TC,SUA,BUN and SCr significantly increased in macroalbuminuria group(P<0.05 or P<0.01),while the value of estimated glomerular filtration rate(eGFR)was significantly decreased(P<0.01).(4)Multiple linear regression analysis showed that after adjusting for sex,age,BMI,T2 DM duration,hypertension,TC,HDL-C,LDL-C and HbA1 c,TyG index was independently associated with UACR [B(95% CI): UACR 0.443(0.373~0.513),P<0.001].(5)Taken the the albuminuria(normal albuminuria=1,microalbuminuria=2,macroalbuminuria=3)as the dependent variable,Logistic regression analysis showed that higher TyG index(OR=6.18,95%CI:3.99~9.59,P<0.001)was independent risk factor for thedevelopment of albuminuria in T2 DM even adjustment for sex,age,BMI,T2 DM duration,hypertension,TC,HDL,LDL-C,HbA1 c.(6)The area under the curve(AUC)of abnormal albuminuria diagnosed by TyG index was 0.834(95%CI:0.799~0.865),which was significantly greater than HOMA-IR,FPG and TG(P<0.01).When TyG index was 9.57,the jorden index was the largest(0.53,sensitivity was 66.10%,specificity was 87.30%),which was the best for judging the critical value of abnormal albuminuria in T2 DM.ConclusionThe TyG index gradually increased with the progression of albuminuria in T2 DM patients.High level of TyG index was an independent risk factor for the development of albuminuria in patients with T2 DM.TyG index had a good predictive value for the occurrence of abnormal albuminuria in patients with T2 DM,and was expected to become a new and simple and practical biological indicator for the prediction of the risk of DKD.