| Background:Type 2 diabetes mellitus(T2DM)patients with long-term poor blood glucose control will cause oxidative stress reaction,endothelial tissue damage,and then activate inflammatory reaction leading to microvascular and nerve damage.Diabetes nephropathy(DN)is one of the microvascular complications in T2DM patients.Insulin resistance(IR)is the main characteristic of T2DM and an important risk factor for the occurrence and development of DN.In recent years,it has been found that IR surrogates are of high value in assessing insulin resistance status.Objectives:This research aims to evaluate the association between the surrogates of IR and DN in T2DM and to assess the predictive value of IR surrogates on DN.Methods:In total,1025 T2DM patients hospitalized in the Department of Endocrinology of Shandong Provincial Hospital from January 2021 to February 2022 were selected in our final analysis.Collect general and clinical data of patients and calculate simple IR indicators:triglyceride/high-density lipoprotein cholesterol ratio(TG/HDL-C),triglyceride glucose(TyG)index,triglyceride glucose-waist to height ratio(TyG-WHtR),triglyceride glucose-waist circumference(TyG-WC),triglyceride glucose-body mass index(TyG-BMI),visceral fat index(VAI),the metabolic score for insulin resistance(METS-IR)and lipid accumulation product(LAP).According to the urinary albumin creatinine ratio(UACR)and urinary albumin excretion rate(UAER)of patients,participants were divided into simple diabetes mellitus(SDM)group,early diabetes nephropathy(EDN)group and clinical diabetes nephropathy(CDN)group.EDN and CDN were grouped into DN group.The differences in general and clinical indicators among the three groups were compared and analyzed.The correlation between IR indicators and UACR was analyzed by Spearman correlation.In addition,multivariate logistic regression analysis was used to assess the correlation between IR indicators and the probability of DN in T2DM.The receiver operating characteristic(ROC)curve analyses were carried out to evaluate the predictive value of IR surrogates on DN.Results:1.The EDN and CDN groups had vastly greater levels of TyG-WC,TyG-WHtR,VAI,and LAP than the SDM group(P<0.05),and there was no statistically significant difference in TyG BMI and METS-IR among the three groups(P>0.05).2.After adjusting for age,gender and duration of diabetes,UACR was positively correlated with TG/HDL,TyG,TyG-WHtR,TyG BMI,TyG WC,METS-IR,LAP,and VAI(P<0.05).3.The results of multivariate logistic regression analysis showed that high levels of TG/HDL-C,TyG,TyG-WC,TyG-WHtR,VAI,and LAP were independent risk factors for the development of DN in T2DM after correction for relevant confounders.Taking the lowest quartile of IR indexes as a reference,the ORs(95%CI)of the highest quartiles for TG/HDL-C,TyG,TyG-WHtR,TyG-WC,LAP,and VAI were 5.83(3.04 11.21),8.27(4.25 16.09),7.42(3.18 17.29),4.54(1.87 11.06),3.77(1.80 7.92)and 5.62(2.97 10.65)(all P<0.05).4.The predictive value of IR surrogates on DN was analyzed by the ROC curve,and results showed that AUC(TyG)>AUC(VAI)>AUC(TG/HDL-C)>AUC(TyG-WHtR)>AUC(LAP)>0.7>AUC(TyG-WC)>AUC(METS-IR)>0.6>AUC(TyG-BMI)>0.5.For males,the AUCs of TG/HDL-C,TyG index,TyG-WHtR,and VAI were all greater than 0.7,with the highest AUC of 0.741(95%CI 0.700-0.783)for TyG index and a cut-off value of 9.415.In the female group,the AUCs for all IR surrogate indexes except TyG-BMI and METS-IR were greater than 0.7,with the highest AUC of 0.776(95%CI 0.726-0.825)for TyG index and a cut-off value of 9.406.Conclusion:1.High levels of TG/HDL-C,TyG,TyG-WC,TyG-WHtR,VAI and LAP were independent risk factors for the development of DN in T2DM.2.Surrogate indexes of IR had different predictive values for DN in T2DM.TG/HDL-C,TyG,TyG-WHtR,LAP,and VAI can effectively predict DN and were expected to be simple and economic biological indicators to predict the risk of DN. |
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