Evaluation of TG/ HDL ratio as a marker for insulin resistance in non-diabetic COPD patients: a comparative study with homeostasis model assessment for insulin resistance

Abstract Background Chronic obstructive pulmonary disease (COPD) is often associated with systemic inflammation and metabolic dysfunction, including insulin resistance (IR). The triglyceride-to-HDL cholesterol (TG/HDL-C) ratio has emerged as a potential surrogate marker of IR. Purpose The present study aimed to evaluate the TG/HDL-C ratio as a marker of IR in non-diabetic patients with COPD and compare it with the conventional HOMA-IR method. Design This is a hospital-based cross-sectional observational study. Methods The study included 80 non-diabetic patients with COPD aged ≤ 65 years, recruited from a tertiary care center. Patients were assessed for pulmonary function (spirometry) and categorized according to the GOLD criteria. Fasting blood samples were collected to measure lipid profiles, fasting and postprandial blood glucose levels, HbA1c levels, and plasma insulin levels. Correlation analysis was performed to assess the relationship between TG/HDL-C/HDL ratio, HOMA-IR, and clinical parameters. Results The TG/HDL-C ratio showed a strong positive correlation with HOMA-IR ( r = 0.669, p < 0.001), indicating its potential as a surrogate marker for IR. The area under the ROC curve for the TG/HDL-C ratio demonstrated high diagnostic accuracy, with a steep rise towards the top-left corner, reflecting high sensitivity and specificity. Age, smoking status, and disease severity (GOLD stage) were also positively associated with higher TG/HDL ratios in the present study. Conclusion The TG/HDL ratio is a simple, cost-effective surrogate marker for identifying IR in non-diabetic patients with COPD, offering a practical alternative to HOMA-IR for routine clinical use. Further studies are recommended to validate these findings in larger and more diverse populations.