The threshold effect of triglyceride glucose index on diabetic kidney disease risk in patients with type 2 diabetes: unveiling a non-linear association

Abstract

Background: Previous studies have confirmed that the triglyceride glucose (TyG) index, recognized as a reliable marker of insulin resistance, is an important risk factor for diabetic kidney disease (DKD). However, it is still unclear whether the DKD risk continues to increase linearly with the elevation of TyG index. This study aimed to thoroughly investigated the intrinsic relationship between TyG index and DKD risk in type 2 diabetes (T2D).

Methods: This cross-sectional study included 933 patients with T2D in China, who were categorized into DKD and non-DKD groups and stratified by TyG index levels. Logistic regression analysis identified the independent risk factors for DKD. The association between DKD risk and TyG index was evaluated using the restricted cubic spline (RCS) curves analysis. The R package 'CatPredi' was utilized to determine the optimal cut-off point for the relationship between DKD risk and TyG index, followed by threshold effect analysis.

Results: The prevalence of DKD was 33.01%. After adjusting for confounding factors, TyG index was identified as a prominent clinical risk factor for DKD, showing the highest odds ratio (OR 1.57 (1.26 - 1.94), P<0.001). RCS analysis revealed a non-linear relationship with a threshold interval effect between the TyG index and DKD risk. When TyG index ≤ 9.35, DKD risk plateaued at a low level; however, when TyG index > 9.35, DKD risk increased gradually with rising TyG index. Among patients with TyG index > 9.35, each 1-unit increase was associated with a 1.94-fold increased DKD risk (OR=1.94 (1.10 - 3.43), P=0.022).

Conclusion: The DKD risk presented a threshold effect with the increase of TyG index, initially stable at a low level, and then gradually rising when the TyG index is above 9.35.

Keywords: diabetic kidney disease; insulin resistance; threshold effect; triglyceride glucose index; type 2 diabetes.

Figure 1

Forest plots of clinical factors associated with DKD adjusted for age, gender, hypertension, diabetic duration, and ACEI/ARB usage. DKD, diabetic kidney disease; DBP, diastolic blood pressure; SBP, systolic blood pressure; BMI, body mass index; HbA1c, glycated hemoglobin; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; TG, triglycerides; TyG, triglyceride glucose; TyG-BMI, triglyceride glucose index × body mass index; OR, odds ratio.

Figure 2

The RCS analysis revealed a non-linear relationship between the DKD risk and the TyG index after adjustment for age, gender, hypertension, diabetic duration, ACEI/ARB usage, HbA1c, HDL-C, and LDL-C. RCS, restricted cubic spline; DKD, diabetic kidney disease; TyG, triglyceride glucose; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides; HbA1c, glycated hemoglobin; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; OR, odds ratio.