Triglyceride Glucose Index: As A Glycemic Control Indicator

Abstract

Background: Type-2 Diabetes Mellitus (T2DM) continues to be the most common endocrine disease today. Easily accessible, accurate and reproducible markers are needed in addition to the accepted markers to evaluate insulin resistance (IR) and glycemic control. Therefore, our study aimed to evaluate the use of triglyceride glucose index (TyGI) as an indicator for insulin resistance and glycemic control. Materials and Methods: Triglyceride(TG), HbA1c, fasting blood glucose (FBG), and total insulin (TI) values of 953 samples, studied simultaneously in our Faculty of Medicine Hospital Laboratory between March 2023 and August 2023, were retrospectively evaluated. The patients were divided into two groups as good and/or poor glycemic control regarding their HbA1c, and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values. Receiver Operating Characteristic (ROC) analysis was performed to assess the ability of TyGI to discriminate between good and/or poor glycemic control for each of HOMA-IR and HbA1c. Statistical significance level was accepted as p<0.05. Multivariate logistic regression analysis was performed as well. Results: A total of 953 patients; with the mean age of 40,83±16,78 participated in the study. According to gender, all parameters except age (p: 0,613) showed significant differences (p<0.001). There were significant differences for FBG, HbA1c, HOMA-IR, TI, TG and TyGI parameters according to cut-off values in all two study groups (p<0.001). TG showed high positive correlation with TyGI (r: 0.796, p<0.001) and moderate positive correlation with FBG (r: 0.616, p<0.001) for both study groups, but low positive correlation with the others. TyGI, had a high selectivity and specificity for HOMA-IR with ≥8,76 cut-off value (AUC:0,72, Se:65%, Sp:70% (p<0.001: 95% CI:0,69-0,75)). In ROC analysis, TyGI had the highest AUC value for HbA1c, and the lowest for HOMA-IR group. The risk of poor glycemic control for HOMA-IR in men is 2.247 times higher than in women. As age increases by one unit, the risk of poor glycemic cont-rol for HOMA-IR increases by 1.045 times. Conclusions: TyGI was significantly raised in incident T2DM patients with poor glycemic control. TyGI can act as s simple and useful markers that have the strong predictive capability to identify insuline re-sistance and anticipate the development of incident T2DM.

Keywords

• Diabetes Mellitus
• Insulin Resistance
• Glycemic Control
• Triglyceride
• Glucose

Glisemik Kontrol Belirteci Olarak Trigliserid Glukoz İndeksi

Abstract

Amaç: Tip-2 Diyabetes Mellitus (T2DM) günümüzde en yaygın endokrin hastalık olmaya devam etmekte-dir. İnsülin direncini (İD) ve glisemik kontrolü değerlendirmek için kabul görmüş belirteçlere ek olarak kolay erişilebilir, doğru ve tekrarlanabilir belirteçlere ihtiyaç duyulmaktadır. Bu nedenle çalışmamızda insülin direnci ve glisemik kontrol için bir gösterge olarak trigliserid glikoz indeksinin (TyGI) kullanımını değerlendirmeyi amaçladık. Materyal ve Metod: Mart 2023 ile Ağustos 2023 tarihleri arasında Tıp Fakültesi Hastanesi Laboratuvarı-mızda eş zamanlı olarak incelenen 953 örneğin trigliserid (TG), HbA1c, açlık kan şekeri (AKŞ) ve toplam insülin (Tİ) değerleri geriye dönük olarak incelendi. Hastalar; HbA1c ve homeostasis model değerlendir-mesiyle tahmin edilen insülin direnci (HOMA-İD) değerleri açısından iyi glisemik kontrol ve/veya kötü glisemik kontrol olmak üzere iki gruba ayrıldı. TyGI'nin, HOMA-İD ve HbA1c'nin her biri için iyi ve/veya kötü glisemik kontrol arasında ayrım yapabilme yeteneğini değerlendirmek amacıyla Duyarlılık ve Özgül-lük Analizi (DÖA) yapıldı. İstatistiksel anlamlılık düzeyi p<0,05 olarak kabul edildi. Ayrıca çok değişkenli lojistik regresyon analizi yapıldı. Bulgular: Çalışmaya yaş ortalaması 40,83±16,78 olan toplam 953 hasta katıldı. Cinsiyete göre yaş (p: 0,613) hariç tüm parametreler anlamlı farklılıklar gösterdi (p<0,005). Her iki çalışma grubunda da kesme değerlerine göre AKŞ, HbA1c, HOMA-İD, Tİ, TG ve TyGI parametreleri için anlamlı farklılıklar vardı (p<0,001). TG, her iki çalışma grubu için de TyGI ile yüksek pozitif korelasyon (r: 0,796, p<0,001) ve AKŞ ile orta derecede pozitif korelasyon (r: 0,616, p<0,001) gösterdi ancak diğerleri ile düşük pozitif korelas-yon gösterdi. TyGI, ≥8,76 kesim değeri (Eğri Altı Alan (EAA):0,72, Duyarlılık:%65, Seçicilik:%70 (p<0.001: %95 GA:0,69-0,75)) ile HOMA-İD için yüksek seçiciliğe ve duyarlılığa sahipti. TyGI; HbA1c için en yüksek EAA’ya ve HOMA-İD grubu için ise en düşük EAA’ya sahipti. Erkeklerde HOMA-İD için kötü glisemik kontrol riski kadınlara göre 2.247 kat daha fazladır. Yaş bir birim arttıkça, HOMA-İD için kötü glisemik kontrol riski 1.045 kat artmaktadır. Sonuç: TyGI, kötü glisemik kontrole sahip yeni T2DM hastalarında önemli ölçüde yükselmiştir. TyGI, insülin direncini belirlemek ve yeni T2DM gelişimini önceden tespit etmek için güçlü öngörücü yetene-ğe sahip basit ve kullanışlı bir belirteç olarak işlev görebilir.

Keywords

• Diabetes Mellitus
• İnsülin Direnci
• Glisemik Kontrol
• Trigliserit
• Glikoz

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