Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: The Rural Chinese Cohort Study

Abstract

Background: Risk of type 2 diabetes mellitus (T2DM) is increased in metabolically obese but normal-weight people. However, we have limited knowledge of how to prevent T2DM in normal-weight people. We aimed to evaluate the association between triglyceride glucose (TyG) index and incident T2DM among normal-weight people in rural China.

Methods: We included data from 5706 people with normal body mass index (BMI) (18.5-23.9 kg/m²) without baseline T2DM in a rural Chinese cohort followed for a median of 6.0 years. A Cox proportional-hazard model was used to assess the risk of incident T2DM by quartiles of TyG index and difference in TyG index between follow-up and baseline (TyG-D), estimating hazard ratios (HRs) and 95% confidence intervals (CIs). A generalized additive plot was used to show the nonparametric smoothed exposure-response association between risk of T2DM and TyG index as a continuous variable. TyG was calculated as ln [fasting triglyceride level (mg/dl) × fasting plasma glucose level (mg/dl)/2].

Results: Risk of incident T2DM was increased with quartiles 2, 3 and 4 versus quartile 1 of TyG index (adjusted HR [aHR] 2.48 [95% CI 1.20-5.11], 3.77 [1.83-7.79], and 5.30 [2.21-12.71], P _trend < 0.001 across quartiles of TyG index). Risk of incident T2DM was increased with quartile 4 versus quartile 1 of TyG-D (aHR 3.91 [2.22-6.87]). The results were consistent when analyses were restricted to participants without baseline metabolic syndrome and impaired fasting glucose level. The generalized additive plot showed cumulative increased risk of T2DM with increasing TyG index.

Conclusions: Risk of incident T2DM is increased with increasing TyG index among rural Chinese people, so the index might be an important indicator for identifying people at high risk of T2DM.

Keywords: Cohort study; Insulin resistance; Normal weight; Triglyceride glucose index; Type 2 diabetes mellitus.

Fig. 1

Cumulative incidence of type 2 diabetes mellitus (T2DM) by quartiles of triglyceride glucose (TyG) index. Gray dash line quartile 1; gray solid line quartile 2; black dash line quartile 3; black solid line quartile 4

Fig. 2

Association of T2DM and TyG index or TyG-D by sex and/or age groups. Data are hazard ratios (HRs) and 95% confidence limits (95% CLs). T2DM type 2 diabetes mellitus, TyG index triglyceride glucose index, TyG-D difference in TyG value at the end of follow-up minus that at baseline. Asterisk adjusted for gender, age, education level, marital status, smoking, alcohol consumption, physical activity, family history of diabetes and waist circumference (WC)

Fig. 3

ROC curves for TyG, WC, and WHtR for predicting T2DM among men (a), and women (b). ROC receiver operating characteristic, TyG index triglyceride glucose index, WC waist circumference, WHtR waist-to-height ratio, T2DM type 2 diabetes mellitus. Solid black line TyG; solid gray line,WC; dotted black line WHtR. Asterisk compared with TyG

Fig. 4

Generalized additive model plot for risk of T2DM and TyG index. Adjusted for gender, age, family history of diabetes, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). T2DM type 2 diabetes mellitus, TyG index triglyceride glucose index

Fig. 5

Generalized additive model plot for T2DM and TyG with participants without baseline IFG and MetS. IFG impaired fasting glucose, MetS metabolic syndrome, T2DM type 2 diabetes mellitus, TyG index triglyceride glucose index. Adjusted for gender, age, family history of diabetes, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)