Impact of baseline and trajectory of the cardiometabolic indices on incident microvascular complications in patients with type 2 diabetes

Abstract

Background: For patients with type 2 diabetes (T2D), the triglyceride-glucose (TyG) index, the atherogenic index of plasma (AIP) and the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) are recognized as reliable predictors of cardiovascular diseases. However, the association of these predictors with microvascular complications (MVCs) in T2D remains controversial and warrants further investigation.

Methods: Using data from the Action to Control Cardiovascular Risk in Diabetes study, we examined the association of cardiometabolic indices with the risk of incident microvascular outcomes, including diabetic kidney disease (DKD), diabetic neuropathy (DN) and diabetic retinopathy (DR). Group-based trajectory models were used to determine cardiometabolic indices trajectories during the 24-month follow-up period. Restricted cubic spline analysis were conducted to assess the non-linear relationship between baseline indices and MVCs, and Cox proportional hazards regression models were employed to evaluate the associations of baseline and trajectory indices with MVCs.

Results: During a median follow-up of 3.69, 3.69 and 3.78 years, 2289 DKD, 2227 DN and 2420 DR events were recorded. Elevated TyG index, AIP, NHHR were significantly associated with an increased risk of DKD (P < 0.05), and AIP demonstrated superior predictive capacity. The fully-adjusted HR (95 % CI) for the highest quartile of TyG index, AIP and NHHR for DKD risk were 1.307 (1.174-1.455), 1.341 (1.202-1.496) and 1.341 (1.202-1.496), respectively. Three distinct trajectories of Tyg index, AIP, NHHR were identified: low-stable, moderate-stable and high-stable. The incidence of DKD in the TyG index, AIP and NHHR with high-stable trajectory increased by 41.3 %, 47.3 % and 20.7 %, respectively, whereas the incidence of DN in the AIP increased by 19.3 % compared with low-stable trajectory.

Conclusion: The baseline levels and trajectories of cardiometabolic indices are associated with an increase in the risk of MVCs in patients with T2D. Regular monitoring and sustained stabilization of these indicators at low levels are vital for preventing and managing MVCs. The graphical abstract is shown in Figure S1.

Keywords: Cardiometabolic indicator; Microvascular complication; Trajectory.