Objective To investigate the effects of triglyceride-glucose(TyG)index and its variability on diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods This study was a prospective cohort study.A total of 1 986 patients with T2DM who had regular visits at 6 centers of the Lee's United Clinics in Taiwan,China from January 1,2002 to December 31,2018 and no DKD at baseline were selected as the study subjects,and prospective follow-up was performed.Age,sex,serum creatinine,triglycerides(TG),fasting plasma glucose(FPG),urine microalbumin and urine creatinine were collected,and the TyG index,estimated glomerular filtration rate(eGFR)and urinary albumin-to-creatinine ratio(UACR)were calculated,and the mean value of TyG index and the variability of TyG index were calculated according to the TyG index once a year at baseline and follow-up years.DKD was diagnosed according to the diagnostic criteria of the Clinical guideline for the prevention and treatment of diabetic kidney disease in China(2021 Edition).According to whether the patients had DKD at the end of the follow-up,they were divided into DKD group and non-diabetic kidney disease(NDKD)group,and according to the mean value of TyG index,the patients were divided into T1 group(mean TyG index＜8.67),T2 group(8.67≤ mean TyG index＜9.09)and T3 group(mean TyG index ≥9.09),and according to the variability of TyG index,the patients were divided into T',group(TyG index variability＜0.29)and T'2 group(0.29≤ TyG index variability＜0.43)and T'3 group(TyG index variability ≥0.43).The t-test of two independent samples was used to compare the differences in the relevant indexes between the DKD group and the NDKD group,the Cox proportional hazards regression model was used to study the relationship between TyG index and DKD,and between TyG index variability and DKD,and the generalized linear mixed model was used to explore the effects of factors including TyG index on DKD.Results The follow-up period was(7.27±3.48)years.At the end of follow-up,of the 1 986 patients with T2DM,676 were in the DKD group and 1 310 were in the NDKD group.Compared with the NDKD group,the UACR,mean TyG index and TyG index variability in patients with T2DM in the DKD group were higher,while the eGFR was lower(all P＜0.05).The results of Cox proportional hazards regression model showed that after adjusting for confounding variables,the risk of DKD in patients with T2DM in the T3 group was the highest compared with that in the T1group,which was 68.9％higher than that in the T1 group(HR=1.689,95％CI 1.376-2.073,P＜0.001);compared with the T'1 group,the risk of DKD was highest in the T'3 group,which was 74.2％higher than that in the T'1 group(HR=1.742,95％CI 1.421-2.135,P＜0.001).The results of the generalized linear mixed model show that the TyG index of each year during the follow-up process has a significant effect on the occurrence of DKD(β=0.244,95％CI 0.111-0.376,P＜0.001).Conclusion Elevated TyG index and its variability both increase the risk of DKD in patients with T2DM,and the TyG index and its variability are independent risk factors for the DKD.
维普
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