CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127, Padua, Italy.
Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090, Vienna, Austria.
Cardiovasc Diabetol. 2022 Oct 18;21(1):215. doi: 10.1186/s12933-022-01649-8.
The triglyceride-glucose index (TyG) has been proposed as a surrogate marker of insulin resistance, which is a typical trait of pregnancy. However, very few studies analyzed TyG performance as marker of insulin resistance in pregnancy, and they were limited to insulin resistance assessment at fasting rather than in dynamic conditions, i.e., during an oral glucose tolerance test (OGTT), which allows more reliable assessment of the actual insulin sensitivity impairment. Thus, first aim of the study was exploring in pregnancy the relationships between TyG and OGTT-derived insulin sensitivity. In addition, we developed a new version of TyG, for improved performance as marker of insulin resistance in pregnancy.
At early pregnancy, a cohort of 109 women underwent assessment of maternal biometry and blood tests at fasting, for measurements of several variables (visit 1). Subsequently (26 weeks of gestation) all visit 1 analyses were repeated (visit 2), and a subgroup of women (84 selected) received a 2 h-75 g OGTT (30, 60, 90, and 120 min sampling) with measurement of blood glucose, insulin and C-peptide for reliable assessment of insulin sensitivity (PREDIM index) and insulin secretion/beta-cell function. The dataset was randomly split into 70% training set and 30% test set, and by machine learning approach we identified the optimal model, with TyG included, showing the best relationship with PREDIM. For inclusion in the model, we considered only fasting variables, in agreement with TyG definition.
The relationship of TyG with PREDIM was weak. Conversely, the improved TyG, called TyGIS, (linear function of TyG, body weight, lean body mass percentage and fasting insulin) resulted much strongly related to PREDIM, in both training and test sets (R > 0.64, p < 0.0001). Bland-Altman analysis and equivalence test confirmed the good performance of TyGIS in terms of association with PREDIM. Different further analyses confirmed TyGIS superiority over TyG.
We developed an improved version of TyG, as new surrogate marker of insulin sensitivity in pregnancy (TyGIS). Similarly to TyG, TyGIS relies only on fasting variables, but its performances are remarkably improved than those of TyG.
甘油三酯-葡萄糖指数（TyG）已被提出作为胰岛素抵抗的替代标志物，而胰岛素抵抗是妊娠的典型特征。然而，很少有研究分析 TyG 作为妊娠胰岛素抵抗标志物的性能，而且它们仅限于空腹时的胰岛素抵抗评估，而不是在口服葡萄糖耐量试验（OGTT）期间的动态条件下进行评估，OGTT 可以更可靠地评估实际的胰岛素敏感性损害。因此，研究的首要目的是探讨 TyG 与 OGTT 衍生的胰岛素敏感性之间的关系。此外，我们开发了 TyG 的新版本，以提高其作为妊娠胰岛素抵抗标志物的性能。
在妊娠早期，109 名妇女接受了母体型和血液测试的评估，在空腹时测量了几个变量（第 1 次就诊）。随后（妊娠 26 周）重复了所有第 1 次就诊的分析（第 2 次就诊），并选择了一个亚组（84 名）接受了 2 小时 75 克 OGTT（30、60、90 和 120 分钟采样），以测量血糖、胰岛素和 C 肽，以可靠评估胰岛素敏感性（PREDIM 指数）和胰岛素分泌/β细胞功能。数据集随机分为 70%的训练集和 30%的测试集，通过机器学习方法，我们确定了最佳模型，该模型包含 TyG，与 PREDIM 的关系最佳。为了纳入模型，我们仅考虑了符合 TyG 定义的空腹变量。
TyG 与 PREDIM 的关系较弱。相反，称为 TyGIS 的改良 TyG（TyG 的线性函数，体重、瘦体重百分比和空腹胰岛素）与 PREDIM 的相关性更强，在训练集和测试集中均如此（R>0.64，p<0.0001）。Bland-Altman 分析和等效性检验证实了 TyGIS 在与 PREDIM 相关方面的良好表现。进一步的不同分析证实了 TyGIS 优于 TyG。
我们开发了 TyG 的改良版本，作为妊娠胰岛素敏感性的新替代标志物（TyGIS）。与 TyG 类似，TyGIS 仅依赖于空腹变量，但性能明显优于 TyG。
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