Insulin Resistance Indexes, Predictors of Diabetic Kidney Disease in Elderly Iraqis
Article Sidebar
Main Article Content
Abstract
This cross-sectional study aimed to evaluate the utility of three surrogate markers of insulin resistance, TyG, TG/HDL, and TyG-BMI in clinical practice by examining their association with diabetic kidney disease (DKD). Results: Of 476 patients with type 2 diabetes (T2DM), 42 (8.8%) had DKD. Patients with DKD showed significantly higher levels of BMI, fasting blood glucose, HbA1c, lipids, markers of renal dysfunction and three IR indices (TyG, TG/HDL and TyG-BMI) than those without DKD compared to those without DKD. Crosstabs/Risk analysis revealed that TyG index (OR = 1.39, 95% CI =1.218-1.587, p= 0.002), TG/HDL (OR =1.356, 1.189-1.545, p= 0.004), and TyG-BMI (OR =1.247, 1.073-1.450, p= 0.043). Based on the receiver operating characteristic curve, the areas under ROC with best cutoff values of TyG index, TG/HDL and TyG-BMI, were 0.762, 0.720 and 0.654, respectively and 9.5, 2.19 and 225, respectively. DKD patients >40 years had a significantly increased TyG index (p = 0.047) of 67.0% compared to patients <40 years of age of 50.0%. Conclusion: Among T2DM patients, the risk of DKD increases with the increase of TyG index, TG/HDL and TyG-BMI, with their respective cut-off values being 9.5, 2.19 and 225. The TyG performed best in predicting DKD, followed by TG/HDL and then TyG-BMI. Age was positively associated with TyG index, indicating a higher prevalence of DND in patients with T2DM.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Yi-Chih Lin, Yu-Hsing Chang, Shao-Yu Yang, Kwan-Dun Wu, Tzong-Shinn Chu, (2018). Update of pathophysiology and management of diabetic kidney disease,Journal of the Formosan Medical Association,Volume 117, Issue 8, 662-675,ISSN 0929-6646,https://doi.org/10.1016/j.jfma.2018.02.007. [PubMed]
Chen L, Hu Y, Ma Y, Wang H (2023). Non-linear association of fasting C-peptide and uric acid levels with renal dysfunction based on restricted cubic spline in patients with type 2 diabetes: A real-world study. Front Endocrinol (Lausanne) 14:1157123. doi: 10.3389/fendo.2023.1157123 [DOI] [PMC free article] [PubMed] [Google Scholar]
Li D, Hsu FC, Palmer ND, Liu L, Choi YA, Murea M, et al. (2024). Multi-omics analyses identify AKR1A1 as a biomarker for diabetic kidney disease. Diabetes, db230540. doi: 10.2337/db23-0540 [DOI] [PMC free article] [PubMed] [Google Scholar]
Al Tuhaifi T, Zhong J, Yang HC, Fogo AB (2024). Effects of dipeptidyl peptidase-4 inhibitor and angiotensin-converting enzyme inhibitor on experimental diabetic kidney disease. Lab Invest 104(2):100305. doi: 10.1016/j.labinv.2023.100305 [DOI] [PMC free article] [PubMed] [Google Scholar]
Adeva-Andany MM, Adeva-Contreras L, Fernández-Fernández C, Carneiro-Freire N, Domínguez-Montero A (2023). Histological manifestations of diabetic kidney disease and its relationship with insulin resistance. Curr Diabetes Rev. 19(1):e280322202705. doi: 10.2174/1573399818666220328145046 [DOI] [PubMed] [Google Scholar]
Akhtar M, Taha NM, Nauman A, Mujeeb IB, Al-Nabet ADMH (2020). Diabetic kidney disease: past and present. Adv Anat Pathol. 27(2):87–97. doi: 10.1097/PAP.0000000000000257 [DOI] [PubMed] [Google Scholar]
Artunc F, Schleicher E, Weigert C, Fritsche A, Stefan N, Häring HU (2016). The impact of insulin resistance on the kidney and vasculature. Nat Rev Nephrol. 12(12):721–37. doi: 10.1038/nrneph.2016.145 [DOI] [PubMed] [Google Scholar]
De Cosmo S, Menzaghi C, Prudente S, Trischitta V (2013). Role of insulin resistance in kidney dysfunction: insights into the mechanism and epidemiological evidence. Nephrol Dial Transpl. 28(1):29–36. doi: 10.1093/ndt/gfs290 [DOI] [PubMed] [Google Scholar]
Nabipoorashrafi SA, Adeli A, Seyedi SA, Rabizadeh S, Arabzadeh Bahri R, Mohammadi F, et al. (2023). Comparison of insulin resistance indices in predicting albuminuria among patients with type 2 diabetes. Eur J Med Res. 28(1):166. doi: 10.1186/s40001-023-01134-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
Leyking S and Fliser D (2014). Insulin resistance in CKD. Clin J Am Soc Nephrol 9(4):638–40. doi: 10.2215/CJN.01290214 [DOI] [PMC free article] [PubMed] [Google Scholar]
Xu X, Tang X, Che H, et al. (2021). [Triglyceride-glucose product is an independent risk factor for predicting chronic kidney disease in middle-aged and elderly population: a prospective cohort study] Nan Fang Yi Ke Da Xue Xue Bao. 41(11):1600-1608. PubMed Google Scholar
Li X, Wang L, Zhou H, Xu H (2024). Association between triglyceride-glucose index and chronic kidney disease: results from NHANES 1999-2020. Int Urol Nephrol. 56(11):3605-3616. doi: 10.1007/s11255-024-04103-8. Epub 2024 Jun 10. PMID: 38856937; PMCID: PMC11464617. PubMed
Low S, Pek S, Moh A, et al. (2022). Triglyceride-glucose index is prospectively associated with chronic kidney disease progression in Type 2 diabetes - mediation by pigment epithelium-derived factor. Diabetes Vasc Dis Res. 19(4):14791641221113784. doi: 10.1177/14791641221113784. Crossref Scopus (14) PubMed Google Scholar
Zhu Q, Chen Y, Cai X, et al. (2022). The non-linear relationship between triglyceride-glucose index and risk of chronic kidney disease in hypertensive patients with abnormal glucose metabolism: a cohort study. Front Med (Lausanne). 20;9:1018083. doi: 10.3389/fmed.2022.1018083. Crossref Scopus (26) Google Scholar
Amouzegar A, Honarvar M, Masoumi S, et al. (2023). Sex-specific Trajectories of Insulin Resistance Markers and Reduced Renal Function During 18 Years of Follow-up: TLGS. J Clin Endocrinol Metab. 17;108(6):e230-e239. doi: 10.1210/clinem/dgac735. Crossref Scopus (7) PubMed Google Scholar
Chen T, Wang X, Wang X, et al. (2020). Comparison of Novel Metabolic Indices in Estimation of Chronic Kidney Diseases in a Southern Chinese Population. Diabetes Metab Syndr Obes. 13:4919-4927. doi: 10.2147/DMSO.S286565. Crossref Scopus (15) PubMed Google Scholar
Pan Y, Zhong S, Zhou K, Tian Z, Chen F, et al. (2021). Association between Diabetes Complications and the Triglyceride-Glucose Index in Hospitalized Patients with Type 2 Diabetes. J Diabetes Res. 2021, 8757996. doi: 10.1155/2021/8757996. Crossref Scopus (41) Google Scholar
Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, et al. (2010). The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 95(7):3347–51. doi: 10.1210/jc.2010-0288. PubMed Abstract | CrossRef Full Text | Google Scholar
Li HF, Miao X, Li Y (2023). The Triglyceride Glucose (TyG) Index as a Sensible Marker for Identifying Insulin Resistance and Predicting Diabetic Kidney Disease. Med Sci Monit . 29:e939482. doi: 10.12659/MSM.939482. PubMed Abstract | CrossRef Full Text | Google Scholar
Chinese Diabetes Society; National Offic for Primary Diabetes Care. [National guidelines for the prevention and control of diabetes in primary care (2018)]. Zhonghua Nei Ke Za Zhi. 2018 Dec 1;57(12):885-893. Chinese. doi: 10.3760/cma.j.issn.0578-1426.2018.12.003. PMID: 30486556. PubMed Abstract | CrossRef Full Text | Google Scholar
Jiang Y and Lai X (2024). Association between the triglyceride glucose index, triglyceride glucose body mass index and diabetic kidney disease in adults with newly diagnosed type 2 diabetes. Front Med (Lausanne) 11:1328601. doi: 10.3389/fmed.2024. 1328601. PubMed
Spoto B, Pisano A, Zoccali C (2016). Insulin resistance in chronic kidney disease: a systematic review. Am J Physiol Renal Physiol. 311(6):F1087–f1108. doi: 10.1152/ ajprenal.00340.2016. Epub 2016 Oct 5. PMID: 27707707. PubMed
Laakso M and Kuusisto J (2014). Insulin resistance and hyperglycemia in cardiovascular disease development. Nat Rev Endocrinol. 10(5):293–302. doi: 10.1038/ nrendo.2014.29. Epub 2014 Mar 25. PMID: 24663222. PubMed
Pérez-Morales RE, Del Pino MD, Valdivielso JM, Ortiz A, Mora-Fernández C, Navarro-González JF (2019). Inflammation in diabetic kidney disease. Nephron. 143(1):12–6. doi: 10.1159/000493278. Epub 2018 Oct 1. PMID: 30273931. PubMed
Kojta I, Chacińska M, Błachnio-Zabielska A (2020). Obesity, bioactive lipids, and adipose tissue inflammation in insulin resistance. Nutrients. 12(5):1305. doi: 10.3390/ nu12051305. PMID: 32375231; PMCID: PMC7284998. PubMed
Fritz J, Brozek W, Concin H, Nagel G, Kerschbaum J, Lhotta K, et al. (2021). The Triglyceride-Glucose Index and Obesity-Related Risk of End-Stage Kidney Disease in Austrian Adults. JAMA Netw Open. 4(3):e212612. doi: 10.1001/ jamanetworkopen.2021.2612. PMID: 33787913; PMCID: PMC8013829. PubMed
Wang X, Liu J, Cheng Z, Zhong Y, Chen X, Song W (2021). Triglyceride glucose-body mass index and the risk of diabetes: a general population-based cohort study. Lipids Health Dis. 2021 Sep 6;20(1):99. doi: 10.1186/s12944-021-01532-7. PMID: 34488806; PMCID: PMC8420033. PubMed
Er LK, Wu S, Chou HH, Hsu LA, Teng MS, Sun YC (2016). Triglyceride Glucose-Body Mass Index Is a Simple and Clinically Useful Surrogate Marker for Insulin Resistance in Nondiabetic Individuals. PLoS One. 2016 Mar 1;11(3):e0149731. doi: 10.1371/journal.pone.0149731. PMID: 26930652; PMCID: PMC4773118. PubMed
Locateli JC, Lopes WA, Simões CF, de Oliveira GH, et al. (2019) Triglyceride/glucose index is a reliable alternative marker for insulin resistance in South American overweight and obese children and adolescents. J Pediatr Endocrinol Metab. 32(10):1163-1170. doi: 10.1515/jpem-2019-0037. PMID: 31472061. [DOI] [PubMed] [Google Scholar]
Mu X, Wu A, Hu H, Yang M, Zhou H (2023). Correlation between alternative insulin resistance indexes and diabetic kidney disease: a retrospective study. Endocrine.84(1):136-147. doi: 10.1007/s12020-023-03574-6. Epub 2023 Oct 31. PMID: 37906402. [PubMed]
Xu X, Tang X, Che H, Guan C, Zhao N, Fu S, Liu L, et al. (2021). [Triglyceride-glucose product is an independent risk factor for predicting chronic kidney disease in middle-aged and elderly population: a prospective cohort study]. Nan Fang Yi Ke Da Xue Xue Bao. 41(11):1600-1608. Chinese. doi: 10.12122/j.issn.1673-4254.2021.11.02. PMID: 34916184; PMCID: PMC8685706. [PubMed]
Cha E, Pasquel FJ, Yan F, Jacobs DR Jr, Dunbar SB, Umpierrez G, et al. (2021). Characteristics associated with early- vs. later-onset adult diabetes: the CARDIA study. Diabetes Res Clin Pract. 182:109144. doi: 10.1016/j.diabres.2021.109144. Epub 2021 Nov 11. PMID: 34774915; PMCID: PMC8688278. [PubMed]
Jiang W, Wang J, Shen X, Lu W, Wang Y, Li W, et al. (2020). Establishment and Validation of a Risk Prediction Model for Early Diabetic Kidney Disease Based on a Systematic Review and Meta-Analysis of 20 Cohorts. Diabetes Care. 43(4):925–933. doi: 10.2337/ dc19-1897. PMID: 32198286. [PubMed]