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The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: A nested case control study.

ABSTRACT: Insulin resistance is usually a key factor in the development of type 2 diabetes. The triglyceride glucose (TyG) index is a marker of insulin resistance which is also implicated in the risk of nephropathy among people with type 2 diabetes. This study aimed to examine associations and potential thresholds between TyG index and the risk of newly diagnosed biopsy-proven diabetic nephropathy in people with type 2 diabetes. A nested case-control study incorporating 950 incident biopsy-proven diabetic nephropathy cases and age, gender matched 4750 patients with treated type 2 diabetes as controls selected by risk-set sampling method was implemented. The dose-response association between TyG index with subsequent risk of newly diagnosed biopsy-proven diabetic nephropathy after adjustment for age, gender, blood pressure, and other major cardiovascular risk factors were examined by conditional logistic regression model. A non-linear relationship was identified between TyG index and the risk of newly diagnosed biopsy-proven diabetic nephropathy with a potential threshold of TyG at 9.05-9.09. Similar relationships with the same threshold were also found in the analyses by fasting glucose and triglyceride levels. TyG index might be a prognostic factor in predicting newly development of biopsy-proven diabetic nephropathy among patients with treated type 2 diabetes. In people with type 2 diabetes, TyG index above 9.05-9.09 could be a prognostic threshold to identify individuals at high risk of diabetic nephropathy. Further replication studies are warranted.

SUBMITTER: Shang J

PROVIDER: S-EPMC6867726 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: A nested case control study.

Shang Jin J Yu Dahai D Cai Yamei Y Wang Zheng Z Zhao Bin B Zhao Zhanzheng Z Simmons David D

Medicine 20191101 46

Insulin resistance is usually a key factor in the development of type 2 diabetes. The triglyceride glucose (TyG) index is a marker of insulin resistance which is also implicated in the risk of nephropathy among people with type 2 diabetes. This study aimed to examine associations and potential thresholds between TyG index and the risk of newly diagnosed biopsy-proven diabetic nephropathy in people with type 2 diabetes. A nested case-control study incorporating 950 incident biopsy-proven diabetic ...[more]

PMID: 31725665

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Project description:OBJECTIVE: We evaluated the structural-functional relationships and the prognostic factors for renal events, cardiovascular events, and all-cause mortality in type 2 diabetic patients with biopsy-proven diabetic nephropathy. RESEARCH DESIGN AND METHODS: Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy (n = 260) were enrolled. Patients were stratified by albuminuria (proteinuria) and estimated glomerular filtration rate (eGFR) at the time of renal biopsy. The outcomes were the first occurrence of renal events (requirement of dialysis or a 50% decline in eGFR from baseline), cardiovascular events (cardiovascular death, nonfatal myocardial infarction, coronary interventions, or nonfatal stroke), and all-cause mortality. RESULTS: The factors associated with albuminuria (proteinuria) regardless of eGFR were hematuria, diabetic retinopathy, low hemoglobin, and glomerular lesions. The factors associated with low eGFR regardless of albuminuria (proteinuria) were age and diffuse, nodular, tubulointerstitial, and vascular lesions. The glomerular, tubulointerstitial, and vascular lesions in patients with normoalbuminuria (normal proteinuria) and low eGFR were more advanced compared to those in patients with normoalbuminuria (normal proteinuria) and maintained eGFR. In addition, compared to patients with micro-/macroalbuminuria (mild/severe proteinuria) and low eGFR, their tubulointerstitial and vascular lesions were similar or more advanced in contrast to glomerular lesions. The mean follow-up period was 8.1 years. There were 118 renal events, 62 cardiovascular events, and 45 deaths. The pathological determinants were glomerular lesions, interstitial fibrosis and tubular atrophy (IFTA), and arteriosclerosis for renal events, arteriosclerosis for cardiovascular events, and IFTA for all-cause mortality. The major clinical determinant for renal events and all-cause mortality was macroalbuminuria (severe proteinuria). CONCLUSIONS: Our study suggests that the characteristic pathological lesions as well as macroalbuminuria (severe proteinuria) were closely related to the long-term outcomes of biopsy-proven diabetic nephropathy in type 2 diabetes.

Project description:Aims/introductionThe triglyceride-glucose (TyG) index has been proposed as a reliable and simple marker of insulin resistance. We investigated the association between TyG index and diabetic nephropathy (DN) in patients with type 2 diabetes.Materials and methodsA consecutive case series of 682 adult patients with type 2 diabetes hospitalized in the Department of Endocrinology at the Tongji Hospital (Wuhan, Hubei, China) from January 2007 to December 2009 was included in this cross-sectional analysis. Receiver operating characteristics curve analysis, correlation analysis and multiple logistic regression analysis were carried out.ResultsA total of 232 (34.0%) participants were identified with DN. Compared with the non-DN group, the DN group had longer disease duration, and higher bodyweight, systolic blood pressure, diastolic blood pressure, glycated hemoglobin, triglycerides, total cholesterol, serum uric acid, 24 h-urinary albumin, TyG index and homeostasis model assessment 2 estimates for insulin resistance (HOMA2-IR; P < 0.05 for each). The TyG index with an optimal cut-off point >9.66 showed a higher area under the receiver operating characteristic curve of 0.67 (P = 0.002) than HOMA2-IR (area under the curve 0.61, P = 0.029) on receiver operating characteristic curve analysis for DN identification. Additionally, the TyG index positively correlated with the levels of metabolic indicators (bodyweight, glycated hemoglobin, triglycerides, total cholesterol, serum uric acid, fasting glucose and HOMA2-IR) and natural logarithmic 24 h-urinary albumin (P < 0.05 for each), but not natural logarithm of estimated glomerular filtration rate. On multiple regression analysis, an increased TyG index was shown to be an independent risk factor (odds ratio 1.91, P = 0.001) for DN.ConclusionsThe TyG index was independently associated with DN in patients with type 2 diabetes, and was a better marker than HOMA2-IR for identification of DN in type 2 diabetes patients.

Project description:Background and objectivesSome biomarkers of renal tubular injury are reported to be useful for predicting renal prognosis in the early stage of diabetic nephropathy (DN). Our study compared predictions of the renal prognosis by such biomarkers and by histologic tubulointerstitial damage.Design, setting, participants, & measurementsAmong 210 patients with type 2 diabetes and biopsy-proven DN managed from 1985 to 2011, 149 patients with urinary N-acetyl-?-d-glucosaminidase (NAG) and urinary ?2-microglobulin (?2-MG) data at the time of renal biopsy were enrolled. The primary outcome was a decline in eGFR of ?50% from baseline or commencement of dialysis for ESRD.ResultsThe median follow-up period was 2.3 years (interquartile range, 1.1-5.3), and the primary outcome was noted in 94 patients. Mean eGFR was 46.3±23.2 ml/min per 1.73 m(2), and 132 patients (89%) had overt proteinuria at baseline. Cox proportional hazards analysis revealed that the association of urinary NAG and ?2-MG with the outcome was attenuated after adjustment for known promoters of progression (+1 SD for log NAG: hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 0.84 to 1.55; +1 SD for log ?2-MG: HR, 1.23; 95% CI, 0.94 to 1.62). In contrast, the interstitial fibrosis and tubular atrophy (IFTA) score was still significantly correlated with the outcome after adjustment for the same covariates (+1 for IFTA score: HR, 2.31; 95% CI, 1.56 to 3.43). Moreover, adding the IFTA score to a model containing known progression indicators improved prediction of the outcome (increase of concordance index by 0.02; 95% CI, 0.00 to 0.05; category-free net reclassification improvement by 0.54; 95% CI, 0.03 to 1.05; and relative integrated discrimination improvement by 0.07; 95% CI, -0.08 to 0.22).ConclusionsAdding urinary NAG and ?2-MG excretion to known promoters of progression did not improve prognostication, whereas adding the IFTA score did. The IFTA score may be superior to these tubulointerstitial markers for predicting the renal prognosis in advanced DN.

Dataset Information

The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: A nested case control study.

Publications

The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes: A nested case control study.

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