Composite metabolic indices for the assessment of early biochemical and metabolic alterations in Iraqi children and adolescents with type 1 diabetes: an exploratory case–control study

To evaluate hepatic, renal, and lipid biomarkers together with composite metabolic indices for identifying early metabolic alterations and metabolic risk assessment in Iraqi children and adolescents with type 1 diabetes (T1D). A case-control study was conducted involving 100 children and adolescents with T1D and 100 age-and sex-matched healthy controls. Biochemical parameters were measured, and composite indices including atherogenic index of plasma (AIP), triglyceride-glucose index (TyG), fatty liver index (FLI), and De Ritis ratio were calculated. Receiver operating characteristic (ROC) analysis, Subgroup analyses, and multivariable logistic regression were used to investigate discriminatory performance and independent associations. Significant alterations in renal, hepatic, and lipid biomarkers were observed in T1D patients (p < 0.05). Composite indices demonstrated excellent discriminating power (AUC 0.92-0.97). Exploratory subgroup analyses suggested that patients receiving lipid-lowering therapy exhibited lower values of several composite metabolic indices, whereas RAS blockers use was associated with lower renal-related indices. Composite metabolic indices, particularly TyG, FLI, and AIP, may provide complementary exploratory markers of early metabolic and biochemical alterations in pediatric T1D. These findings require validation in larger prospective multicenter studies before clinical application.