The Correlation Between Triglyceride Glucose Index And Diabetic Kidney Disease In Patients With Type 2 Diabetes

Objective:Diabetic kidney disease(DKD)is the most common and serious diabetic microvascular complication.Triglyceride glucose(Ty G)index is a simple and reliable indicator of insulin resistance,and has significant correlation with DKD.However,the wide range of cut-off points of Ty G for predicting DKD in previous studies limited its clinical application.Therefore,this cross-sectional study was performed to evaluate the predictive ability of Ty G for DKD in type 2 diabetic mellitus patients with different disease backgrounds and to explore their cut-off points using logistic regression and decision tree model.Methods:A total of 2415 patients with type 2 diabetes mellitus aged>18 years hospitalized in the Affiliated Hospital of Jining Medical University and screened for diabetic kidney disease from Jul 1,2017 to Apr 30,2021 were included in this research.The information including anthropometric and biochemical parameters,diabetes complications,history about hypertension,dyslipidemia,drugs treatment,smoking and drinking were collected.An independent sample t-test or Mann–Whitney U test was used to compare the data between the two groups.Categorical data were presented in terms of frequency or percentage and analyzed with Chi-square tests.Binary logistic regression was performed to analyze the independent related factors of DKD,and then the decision tree model was used to analyze the predictive ability of Ty G for DKD in type 2 diabetic mellitus patients with different disease backgrounds.Subgroup analyses were performed according to gender to confirm the stability of the results.Results:(1)Characteristics of enrolled patients A total of 2415patients with type 2 diabetes mellitus were enrolled,with an average age of 54.77±12.08 years and an average disease duration of 8.74±6.92 years.Compared with non-DKD patients,DKD patients showed a higher Ty G index.(2)Independent factors of DKD:Logistic regression analysis showed that the duration of diabetes(OR=1.029),systolic blood pressure(OR=1.008),aspartate aminotransferase(OR=1.012),Ty G index(OR=1.021),BMI(OR=1.033),gender(male,OR=1.430),hypertension(OR=1.868)and dyslipidemia(OR=1.886)were independent risk factors for DKD in the total population.In male patients,hemoglobin(OR=0.982),Ty G index(OR=1.022),BMI(OR=1.076),hypertension(OR=1.882)and dyslipidemia(OR=2.095)are independent risk factors for DKD.In female patients,diabetic duration(OR=1.026),hemoglobin(OR=0.985),systolic blood pressure(OR=1.009),aspartate aminotransferase(OR=1.016),Ty G index(OR=1.026),hypertension(OR=1.750)and dyslipidemia(OR=1.734)were independent risk factors for DKD.(3)Predictive ability of Ty G:In the total population analysis,hypertension was the most important predictor of DKD,and Ty G was the most important predictor of DKD in the subgroup with hypertension with the best predictive cut-off points 4.73 and 8.18.In the male population analysis,hypertension was still the most important predictor,and Ty G was an important predictor of DKD in the subgroup with hypertension and BMI≤27.8kg/m~2with the best cut-off point 4.84.In the female population analysis,hypertension was also the most important predictor of DKD,and Ty G was an important predictor of DKD in subgroups with and without hypertension with the best predictive cut-off points 7.81 and3.18,respectively.In the subgroups of total and male populations without hypertension,dyslipidemia is an important predictor of DKD.Conclusion:Compared to non-DKD patients,DKD patients showed higher Ty G index.Diabetic duration,hypertension,dyslipidemia,high levle of Ty G index,obesity and male were independent risk factors of DKD.Ty G is an important predictor of DKD second only to hypertension.The cut-off point of Ty G for predicting DKD is around 8 in individuals with high risk and is range 3 to 5 in individuals with low risk.The combination of hypertension and Ty G improves the predictive accuracy of DKD.