Association of Triglyceride Glucose Index with Prevalence and Incidence of Diabetic Retinopathy in a Singaporean Population

Abstract

Objective

To examine the association of triglyceride glucose (TyG) index (product of fasting triglyceride and glucose) with prevalence and incidence of diabetic retinopathy (DR) in type 2 diabetes.

Methods

1339 patients from an ongoing Singapore Study of Macro-angiopathy and Micro-Vascular Reactivity in Type 2 Diabetes (SMART2D) were included in this study. Fasting triglyceride and glucose levels were quantified and color fundus photographs were assessed for DR presence and severity. Logistic regression models were used to evaluate associations of TyG index with DR prevalence and incidence (median follow-up period = 3.2 years).

Results

Mean TyG index was higher in patients with DR than no DR (9.24±0.7 versus 9.04± 0.6, p<0.001). TyG index was significantly associated with DR prevalence (OR=1.4, CI 1.1–1.7, p=0.002) and incidence (OR=1.8, CI 1.04–2.9, p=0.03), after adjusting for confounders. In a stratified analysis, the association between TyG index and DR prevalence reached significance only in the subgroup with HbA1c levels < 7.0% (OR=2, CI 1.1–3.8, p=0.03). TyG index significantly predicted DR prevalence and incidence with area under receiver operating curve as 0.77 (CI 0.74–0.80, p <0.001) and 0.66 (CI 0.57–0.76, p value <0.01), respectively.

Conclusion

TyG index is a good predictor for DR prevalence and incidence. It can also be a secondary treatment target for patients with optimally controlled levels of HbA1c.

Keywords:

• triglyceride glucose index
• diabetic retinopathy
• insulin resistance
• prevalence
• incidence

Abbreviations

TyG index, triglyceride glucose index; DR, diabetic retinopathy; IR, insulin resistance; NDR, No diabetic retinopathy; NPDR, non-proliferative; DR, PDR, proliferative DR; SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HbA1C, glycated hemoglobin; eGFR, estimated glomerular filtration rate; uACR, urinary albumin-to-creatinine ratio.

Acknowledgment

This study is supported by Singapore Ministry of Health’s National Medical Research Council under its CS-IRG (MOH-000066). The corresponding author is supported by the Singapore Ministry of Health’s National Medical Research Council under its Clinician Scientist Award (MOH-000714–01).

The authors would like to sincerely thank Esther Ho Lirong for helping with the revision and submission of the manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.