TRIGLYCERIDE-GLUCOSE INDEX: A REPLACEMENT MEASURE OF HOMEOSTASIS TO ASSESS INSULIN ESISTANCE AND FORECAST OF DIABETIC NEPHROPATHY
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Keywords
Diabetic nephropathy, Homeostasis model assessment, Triglyceride-glucose index
Abstract
BACKGROUND: The World Health Organization estimates that diabetes killed almost 1.5 million people in 2019. Diabetic nephropathy (DN) is the most common underlying cause of end-stage renal disease in people with diabetes. About 40% of people on Earth have DN. Albuminuria or a decrease in glomerular filtration rate (GFR) indicate chronic renal impairment, which accounts for 31% of all cases of diabetic kidney disease (DN) in Pakistan.
OBJECTIVE: In order to predict diabetic nephropathy, the current study sought to determine whether the TyG index is related to UACR or HOMA-IR in people with type 2 diabetes.
STUDY DESIGN: A cross-sectional study
PLACE AND DURATION: This study was conducted in Liaquat University of Medical and Health Sciences Jamshoro from January 2023 to January 2024
METHODOLOGY: The sample size was calculated using the formula Z2 (pq)/e2, with Z=1.96, p=prevalence of T2DM in Pakistan 17.1%, Using a non-probability sequential selection approach, a sample of patients visiting the diabetic clinic was selected. Included were known T2DM patients who had been diagnosed for one to five years and had a fasting plasma glucose (FPG) of 126 mg/dl or above. Venous blood samples (5 ml) were taken using special tubes for different parameters after a 10- to 12-hour overnight fast, and they were then refrigerated at -20°C. For HOMA-IR evaluation, the concentrations of insulin and FPG were measured. A spot urine sample was collected in order to calculate the ACR.
RESULTS: Among the 180 patients, 48.7±7.56 years was the average age. The average BMI for everyone was 28.63±4.56. When comparing Q4 to the other quartiles, there was a substantial increase in fasting plasma glucose, triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, and HOMA-IR (p<0.05
CONCLUSION: In T2DM patients, the TyG index outperformed HOMA-IR in predicting DN, exhibiting a substantial correlation with the latter. In T2DM patients, it accurately predicted the probability of micro-albuminuria and diabetic nephropathy at an early stage.
References
2. Addendum. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44(Suppl. 1):S15- S33. Diabetes Care 2021;44:2182. doi: 10.2337/dc21-ad09.
3. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022;183:109119. doi: 10.1016/j.diabres.2021.109119
4. International Diabetes Federation (IDF). Latest figures show over 19 million people now living with diabetes in Pakistan. [Online] 2019 [Cited 2022 September 15]. Available from URL: https://tradechronicle.com/latest-figures-show-over-19-million- people-now-living-with-diabetes-in-pakistan/
5. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019;157:107843. doi: 10.1016/j.diabres.2019.107843
6. Abro M, Zafar AB, Fawwad A, Mustafa N, Bilal Tahir B, Riaz M, et al. Prevalence of diabetic micro vascular complications at a tertiary care unit of Karachi, Pakistan. Int J Diabetes Dev Ctries 2019;39:325-30. doi: 10.1007/s13410-018-0683-5
7. Rossing P. Diabetic nephropathy: worldwide epidemic and effects of current treatment on natural history. Curr Diab Rep 2006;6:479-83. doi: 10.1007/s11892-006-0083-y.
1. 8. Faselis C, Katsimardou A, Imprialos K, Deligkaris P, Kallistratos M, Dimitriadis K. Microvascular Complications of Type 2 Diabetes Mellitus. Curr Vasc Pharmacol 2020;18:117-24. doi: 10.2174/1570161117666190502103733
8. Chiu H, Tsai HJ, Huang JC, Wu PY, Hsu WH, Lee MY, et al. Associations between Triglyceride-Glucose Index and Micro- and Macro- angiopathies in Type 2 Diabetes Mellitus. Nutrients 2020;12:328. doi: 10.3390/nu12020328
9. Wang J, Wang Y, Li Y, Hu Y, Jin L, Wang W, et al. High Normal Urinary Albumin-Creatinine Ratio Is Associated With Hypertension, Type 2 Diabetes Mellitus, HTN With T2DM, Dyslipidemia, and Cardiovascular Diseases in the Chinese Population: A Report From the REACTION Study. Front Endocrinol (Lausanne) 2022;13:864562. doi: 10.3389/fendo.2022.864562
10. Sasson AN, Cherney DZ. Renal hyperfiltration related to diabetes mellitus and obesity in human disease. World J Diabetes 2012;3:1-6. doi: 10.4239/wjd.v3.i1.1
11. Malik AR, Sultan S, Turner ST, Kullo IJ. Urinary albumin excretion is associated with impaired flow- and nitroglycerin-mediated brachial artery dilatation in hypertensive adults. J Hum Hypertens 2007;21:231-8. doi: 10.1038/sj.jhh.1002143
12. Liu L, Xia R, Song X, Zhang B, He W, Zhou X, et al. Association between the triglyceride-glucose index and diabetic nephropathy in patients with type 2 diabetes: A cross-sectional study. J Diabetes Investig 2021;12:557-65. doi: 10.1111/jdi.13371
13. Cochran WG. Sampling Techniques, 3rd ed. New York, USA: John Wiley & Sons, Inc; 1977.
14. National Kidney Foundation (NKF). Albumin-to-Creatinine Ratio (ACR). [Online] 2021 [Cited 2021 July 13]. Available from URL: https://www.kidney.org/kidneydisease/siemens_hcp_acr
15. Mao Q, Zhou D, Li Y, Wang Y, Xu SC, Zhao XH. The Triglyceride- Glucose Index Predicts Coronary Artery Disease Severity and Cardiovascular Outcomes in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome. Dis Markers 2019;2019: 6891537. doi: 10.1155/2019/6891537
16. Unger G, Benozzi SF, Perruzza F, Pennacchiotti GL. Triglycerides and glucose index: a useful indicator of insulin resistance. Endocrinol Nutr 2014;61:533-40. doi: 10.1016/j.endonu.2014.06.009.
17. Chan DC, Watts GF, Barrett PH, Mamo JC, Redgrave TG. Markers of triglyceride-rich lipoprotein remnant metabolism in visceral obesity. Clin Chem 2002;48:278-83.
18. Cho YR, Ann SH, Won KB, Park GM, Kim YG, Yang DH, et al. Association between insulin resistance, hyperglycemia, and coronary artery disease according to the presence of diabetes. Sci Rep 2019;9:6129. doi: 10.1038/s41598-019-42700-1
19. Palella E, Cimino R, Pullano SA, Fiorillo AS, Gulletta E, Brunetti A, et al. Laboratory Parameters of Hemostasis, Adhesion Molecules, and Inflammation in Type 2 Diabetes Mellitus: Correlation with Glycemic Control. Int J Environ Res Public Health 2020;17:300. doi: 10.3390/ijerph17010300
20. Viswanathan V, Tilak P, Meerza R, Kumpatla S. Insulin resistance at different stages of diabetic kidney disease in India. J Assoc Physicians India 2010;58:612-5.
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Muhammad Sohail Baig
Senior Registrar Medicine, Liaquat University of Medical and Health Sciences Jamshoro Pakistan.
Ravi Kumar
Senior Registrar Medicine, Altamash Institute of Dental Medicine Karachi Pakistan.
Sarfaraz Ahmed
Classified Medical Specialist Medicine, Pak Emirates military Hospital Rawalpindi Pakistan.
Mahesh Kumar
Assistant Professor Medicine, Muhammad Medical College and Hospital Mirpurkhas Pakistan.
Nasira Sohail
Assistant Professor Medicine, Karachi Adventist Hospital Karachi Pakistan
Saima Rafique
Assistant Professor Medicine, Bhitai Dental and Medical College Mirpurkhas Pakistan.