Relationship Between the TyGH Index (Based on Triglycerides and HbA1c) and Diabetic Kidney Disease in Patients with Type 2 Diabetes: A Real-World Study

Jiayu Ma,* Kangtao Jin,* Yuankai Wang, Xiaohong Wang, Xiaojia Lou, Xiyu Liu, Lulu Cao Department of Endocrinology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiayu Ma, Email [email protected]: The triglyceride-glucose index (TyG index) is significantly associated with diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D). Glycated hemoglobin A1c (HbA1c) is more stable and repeatable than fasting plasma glucose. Limited studies have combined HbA1c and triglyceride (TG) to investigate their relationship with DKD in patients with T2D. We aimed to investigate the association of the triglyceride-glycated hemoglobin (TyGH) index with DKD risk in Chinese adults with T2D compared with the TyG index.Methods: This was a cross-sectional observational study that included 2721 patients with T2D. Demographic, anthropometric, and laboratory measurements were collected. An endocrinologist diagnosed DKD based on the data from the estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (UACR). The TyGH index was determined as ln(TG [mg/dL] × HbA1c [%] * 18/2), and the TyG index was calculated as ln(TG [mg/dL] × FPG [mg/dL]/2).Results: The prevalence values of DKD from the lowest to the highest tertile of the TyGH index were 29.7%, 35.2%, and 38.9%, respectively. The TyGH index was significantly higher in participants with macro- and microalbuminuria than in those with normoalbuminuria. In the multivariable logistic analyses, each unit of the TyGH index was associated with a 1.59-fold (1.33– 1.90, P < 0.001) higher prevalence rate of DKD; however, there was no significant association between TyG index and DKD prevalence. This association remained consistent in the subgroup analysis. Receiver operating characteristic analysis indicated that the TyGH index has superior diagnostic value for DKD compared to the TyG index, TG, or HbA1c alone.Conclusion: Compared with the TyG index, the TyGH index demonstrates a stronger and more independent association with DKD in patients with T2D, suggesting its potential as a superior clinical biomarker.Keywords: triglyceride-glycated hemoglobin A1c index, triglyceride-glucose index, diabetic kidney disease, type 2 diabetes