Elevated Triglyceride-Glucose Index as a Risk Stratification Marker for Diabetic Retinopathy in Type 2 Diabetes Mellitus: The Influence of Glycemic Control

Xiaohua Wan,1– 3 Ruihuan Zhang,4 Adilan Abudukeranmu,5 Wei Wei,6 Hong Zhu,5 Lin Zhang,6– 8 Yanwei Hu1,2 1Department of Clinical Laboratory, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Beijing Center for Clinical Laboratories, Beijing, People’s Republic of China; 3Department of Clinical Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 4The Inner Mongolia Medical Intelligent Diagnostics Big Data Research Institute, Hohhot, Inner Mongolia, People’s Republic of China; 5Department of Epidemiology and Biostatistics, School of Public Health/Tianjin Key Laboratory of Environment, Nutrition and Public Health/Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People’s Republic of China; 6Department of Medical Record, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 7Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 8Beijing Diabetes Research Institute, Beijing, People’s Republic of ChinaCorrespondence: Yanwei Hu, Department of Clinical Laboratory, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Center for Clinical Laboratories, GongTiNanLu 8&num;, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-10-85231575, Email [email protected] Lin Zhang, Department of Medical Record, Beijing Tongren Hospital, Capital Medical University. Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing Diabetes Research Institute, No. 1, Dongjiaomin Lane, Dongcheng District, Beijing, 100730, People’s Republic of China, Tel +86-10-58533988, Email [email protected]: Diabetic retinopathy (DR) is a common microvascular complication observed in people with type 2 diabetes mellitus (T2DM). The triglyceride-glucose (TyG) index, an indicator of insulin resistance, has an uncertain role in glycemic management in T2DM patients at risk for DR. This study aimed to evaluate the association between the TyG index and DR risk across different glycemic control status.Methods: A total of 4,372 T2DM in-patients from Beijing Tongren Hospital (2013– 2024) were included in this study. The patients were categorized into four groups based on TyG index quartiles (Q1-Q4). Participants were stratified by TyG index quartiles (Q1-Q4) and glycemic control status (HbA1c < 7%, 7– 9%, and > 9%). Restricted cubic spline (RCS) analysis, logistic regression, and subgroup analyses were employed to explore the associations among the TyG index, glycemic control and DR risk.Results: Overall, there were positive association of the TyG index and DR risk. The highest TyG Q4 was significantly associated with an increased risk of DR (odds ratio [OR]: 1.289; 95% confidence interval [CI]: 1.008– 1.648, P< 0.05), compared with the lowest TyG Q1. Significant interaction was observed between the TyG index and glycemic control (P for interaction < 0.05). Notably, the association was strongest in patients with HbA1c > 9%.Conclusion: The relationship between high TyG index and DR risk was more pronounced in patients with HbA1c > 9% group, indicating that TyG index may serve as a useful tool for making risk stratification on glycemic control in T2DM patients.Keywords: diabetes retinopathy, triglyceride-glucose index, glycemic control, glycated hemoglobin A1c, insulin resistance, diabetes mellitus