Triglyceride Glucose Index and the Risk of Diabetic Nephropathy in
                    Patients with Type 2 Diabetes: A Meta-Analysis

Sheng Deng; Ling Peng

doi:10.1055/a-2376-6044

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2025; 57(02): 106-116
DOI: 10.1055/a-2376-6044

Original Article: Endocrine Care

Triglyceride Glucose Index and the Risk of Diabetic Nephropathy in Patients with Type 2 Diabetes: A Meta-Analysis

Sheng Deng

¹Department of Medical Laboratory, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China (Ringgold ID: RIN87803)

,

Ling Peng

²Department of Nephrology, Xiangya Hospital Central South University, Changsha, China (Ringgold ID: RIN159374)

› Author Affiliations

Abstract

Diabetic nephropathy (DN) is a leading cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). This meta-analysis aims to evaluate the association between the triglyceride glucose (TyG) index, a novel marker reflecting insulin resistance, and the risk of developing DN in patients with T2DM. We conducted a comprehensive literature search in PubMed, Embase, and Web of Science databases up to May 12, 2024. Studies assessing the TyG index in relation to DN risk among T2DM patients were included. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of eight longitudinal follow-up studies encompassing 15 889 patients with T2DM were included. The pooled analysis revealed a significant association between a higher TyG index and an increased risk of DN in patients with T2DM (RR=1.53, 95% CI: 1.37–1.71, p<0.001; I²=35%). The results of meta-regression analysis suggested that the cutoff of TyG index was positively associated with the RR for the association between TyG index and DN. Subgroup analyses demonstrated that the association was stronger in studies with cutoff of TyG index ≥9.5 as compared to those with the cutoff <9.5 (RR: 1.73 vs. 1.40, p for subgroup difference <0.05). The association was not significantly affected by study design, mean age of the patients, proportion of men, or follow-up durations. In conclusion, higher TyG index is significantly associated with an increased risk of DN in patients with T2DM.

Keywords

triglyceride glucose index - diabetic nephropathy - type 2 diabetes - meta-analysis - insulin resistance

Full Text

References

References
1 Gupta S, Dominguez M, Golestaneh L. Diabetic kidney disease: an update. Med Clin North Am 2023; 107: 689-705
2 Selby NM, Taal MW. An updated overview of diabetic nephropathy: Diagnosis, prognosis, treatment goals and latest guidelines. Diabetes Obes Metab 2020; 22: 3-15
3 Pugliese G. Updating the natural history of diabetic nephropathy. Acta Diabetol 2014; 51: 905-915
4 GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395: 709-733
5 Zhang XX, Kong J, Yun K. Prevalence of diabetic nephropathy among patients with type 2 diabetes mellitus in China: a meta-analysis of observational studies. J Diabetes Res. 2020: 2315607
6 Rossing P, Persson F, Frimodt-Moller M. Prognosis and treatment of diabetic nephropathy: recent advances and perspectives. Nephrol Ther 2018; 14: S31-S37
7 Thipsawat S. Early detection of diabetic nephropathy in patient with type 2 diabetes mellitus: a review of the literature. Diab Vasc Dis Res 2021; 18 14791641211058856
8 Sarafidis PA, Ruilope LM. Insulin resistance, hyperinsulinemia, and renal injury: mechanisms and implications. Am J Nephrol 2006; 26: 232-244
9 Groop PH, Forsblom C, Thomas MC. Mechanisms of disease: Pathway-selective insulin resistance and microvascular complications of diabetes. Nat Clin Pract Endocrinol Metab 2005; 1: 100-110
10 Darenskaya M, Kolesnikov S, Semenova N. et al. Diabetic nephropathy: significance of determining oxidative stress and opportunities for antioxidant therapies. Int J Mol Sci 2023; 24: 12378
11 Ramdas Nayak VK, Satheesh P, Shenoy MT. et al. Triglyceride glucose (TyG) index: a surrogate biomarker of insulin resistance. J Pak Med Assoc 2022; 72: 986-988
12 Yin JL, Yang J, Song XJ. et al. Triglyceride-glucose index and health outcomes: an umbrella review of systematic reviews with meta-analyses of observational studies. Cardiovasc Diabetol 2024; 23: 177
13 Sanchez-Garcia A, Rodriguez-Gutierrez R, Mancillas-Adame L. et al. Diagnostic accuracy of the triglyceride and glucose index for insulin resistance: a systematic review. Int J Endocrinol 2020; 4678526
14 Kurniawan LB. Triglyceride-glucose index as a biomarker of insulin resistance, diabetes mellitus, metabolic syndrome, and cardiovascular disease: a review. eJIFCC 2024; 35: 44-51
15 Minh HV, Tien HA, Sinh CT. et al. Assessment of preferred methods to measure insulin resistance in Asian patients with hypertension. J Clin Hypertens (Greenwich) 2021; 23: 529-537
16 Luo P, Cao Y, Li P. et al. TyG index performs better than HOMA-IR in Chinese type 2 diabetes mellitus with a BMI <35 kg/m2: a hyperglycemic clamp validated study. Medicina (Kaunas) 2022; 58: 876
17 Son DH, Lee HS, Lee YJ. et al. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome. Nutr Metab Cardiovasc Dis 2022; 32: 596-604
18 Parwani K, Mandal P. Role of advanced glycation end products and insulin resistance in diabetic nephropathy. Arch Physiol Biochem 2023; 129: 95-107
19 Opazo-Rios L, Mas S, Marin-Royo G. et al. Lipotoxicity and diabetic nephropathy: novel mechanistic insights and therapeutic opportunities. Int J Mol Sci 2020; 21: 2632
20 Chiu H, Tsai HJ, Huang JC. et al. Associations between triglyceride-glucose index and micro- and macro-angiopathies in type 2 diabetes mellitus. Nutrients 2020; 12: 328
21 Nabipoorashrafi SA, Adeli A, Seyedi SA. et al. Comparison of insulin resistance indices in predicting albuminuria among patients with type 2 diabetes. Eur J Med Res 2023; 28: 166
22 Jiang Y, Lai X. Association between the triglyceride glucose index, triglyceride-glucose body mass index and diabetic kidney disease in adults with newly diagnosed type 2 diabetes. Front Med (Lausanne) 2024; 11: 1328601
23 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
24 Higgins J, Thomas J, Chandler J. et al. Cochrane handbook for systematic reviews of interventions version 6.2. The Cochrane Collaboration. 2021 www.training.cochrane.org/handbook
25 Wells GA, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010 http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
26 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
27 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
28 Shang J, Yu D, Cai Y. et al. The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: a nested case control study. Medicine (Baltimore) 2019; 98: e17995
29 Lv L, Zhou Y, Chen X. et al. Relationship between the TyG index and diabetic kidney disease in patients with type-2 diabetes mellitus. Diabetes Metab Syndr Obes 2021; 14: 3299-3306
30 Low S, Pek S, Moh A. et al. Triglyceride-glucose index is prospectively associated with chronic kidney disease progression in Type 2 diabetes – mediation by pigment epithelium-derived factor. Diab Vasc Dis Res 2022; 19 14791641221113784
31 Zhu Q, Chen Y, Cai X. et al. The non-linear relationship between triglyceride-glucose index and risk of chronic kidney disease in hypertensive patients with abnormal glucose metabolism: a cohort study. Front Med (Lausanne) 2022; 9: 1018083
32 Liu S, Sun H, Liu J. et al. Accessing the relationship between six surrogate insulin resistance indexes and the incidence of rapid kidney function decline and the progression to chronic kidney disease among middle-aged and older adults in China: Results from the China health and retirement longitudinal study. Diabetes Res Clin Pract 2024; 212: 111705
33 Mu X, Wu A, Hu H. et al. Correlation between alternative insulin resistance indexes and diabetic kidney disease: a retrospective study. Endocrine 2024; 84: 136-147
34 Yan H, Zhou Q, Wang Y. et al. Associations between cardiometabolic indices and the risk of diabetic kidney disease in patients with type 2 diabetes. Cardiovasc Diabetol 2024; 23: 142
35 Zhang F, Han Y, Zheng G. et al. Gender differences in the incidence of nephropathy and changes in renal function in patients with type 2 diabetes mellitus: a retrospective cohort study. Diabetes Metab Syndr Obes 2024; 17: 943-957
36 Dengel DR, Goldberg AP, Mayuga RS. et al. Insulin resistance, elevated glomerular filtration fraction, and renal injury. Hypertension 1996; 28: 127-132
37 Qadir E, Porter JP. Effect of insulin on regional vascular resistances in conscious rats. Am J Physiol 1996; 270: R450-R455
38 Masenga SK, Kabwe LS, Chakulya M. et al. Mechanisms of oxidative stress in metabolic syndrome. Int J Mol Sci 2023; 24: 7898
39 Daroux M, Prevost G, Maillard-Lefebvre H. et al. Advanced glycation end-products: implications for diabetic and non-diabetic nephropathies. Diabetes Metab 2010; 36: 1-10
40 Castro BBA, Foresto-Neto O, Saraiva-Camara NO. et al. Renal lipotoxicity: Insights from experimental models. Clin Exp Pharmacol Physiol 2021; 48: 1579-1588
41 Brennan E, Kantharidis P, Cooper ME. et al. Pro-resolving lipid mediators: regulators of inflammation, metabolism and kidney function. Nat Rev Nephrol 2021; 17: 725-739