Association between triglyceride-glucose-related indices and liver-related events in patients with type 2 diabetes

Background: Accumulating evidence has linked the triglyceride-glucose (TyG) index and its derived measures to a broad range of diabetic complications. However, the nature of the association between these indices and subsequent liver morbidity in type 2 diabetes (T2D) patients warrants further investigation. The present analysis assessed the prospective associations between four TyG-based parameters and the incidence of liver-related events (LRE) among people with T2D. Methods: This prospective cohort study included 18,105 participants with T2D from the UK Biobank. Four TyG-related indices were assessed, including TyG, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), and TyG-waist-to-height ratio (TyG-WHtR). Cox proportional hazards models and restricted cubic spline (RCS) were used to evaluate the associations between TyG-related indices and incident LRE risk. Results: During a median follow-up of 13.4 years, 507 T2D patients developed LRE. Compared to patients in the lowest quartile, those in the highest quartiles of both TyG-WC (HR = 1.63, 95% CI 1.12-2.38) and TyG-WHtR (HR = 1.98, 95% CI 1.36-2.89) were associated with increased risk of LRE. Restricted cubic spline models confirmed linear relationships for both TyG-WC and TyG-WHtR with LRE risk. No significant associations of TyG and TyG-BMI with LRE risk were observed. Subgroup analyses demonstrated that the associations between TyG-WC/TyG-WHtR and LRE were more pronounced in high-risk populations, including excessive alcohol consumers and individuals with FIB-4 scores ≥1.3 (indicating higher liver fibrosis risk). For instance, the association between TyG-WHtR and LRE was stronger in individuals with FIB-4 ≥1.3 (HR = 2.59, 95% CI 1.65-4.07) compared to those with FIB-4 <1.3 (HR = 1.58, 95% CI 0.76-3.29). Conclusion: Among T2D patients, TyG-WC and TyG-WHtR were consistently associated with increased risk of LRE, confirming the independent clinical utility of these indices. These findings demonstrate that both indices may serve as efficient, cost-effective, and practical tools for enhancing the identification and stratification of LRE risk in clinical practice.