Moh Mei Chung, Cheng Anton, Tan Chun Hai, Low Serena, Tan Bo Chuan, Ng Deborah, Subramaniam Tavintharan, Sum Chee Fang, Lim Su Chi
Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
Obes Surg. 2023 Jan;33(1):164-172. doi: 10.1007/s11695-022-06342-z. Epub 2022 Nov 14.
The utility of insulin resistance (IR) as a predictor of diabetes remission after metabolic surgery is not well-defined. We assessed the association of baseline surrogate IR indices including triglyceride-glucose (TyG) index and homeostatic model assessment for IR (HOMA-IR) with glycemic control and diabetes remission after metabolic surgery.
Patients with type 2 diabetes scheduled for metabolic surgery were recruited at a single-center (n = 149; age: 44 ± 10 years, 47.7% men, body mass index: 41.5 ± 7.5 kg/m), and followed-up for 12 months postoperatively. The relationships between the IR indices and poor glycemic control (HbA1c ≥ 7%) at baseline or complete diabetes remission (HbA1c < 6% without glucose-lowering medications at 12 months) post-surgery were examined.
Elevated TyG index was associated with poor glycemic control cross-sectionally. Compared with non-remitters, lower baseline TyG index levels were observed in individuals with complete diabetes remission after surgery (P = 0.012); whereas HOMA-IR was not significantly different. Consistently, the proportion of diabetes non-remitters (compared to remitters) increased with increasing TyG tertiles from 1 to 3 (P = 0.015). Both TyG index (relative risk = 0.62, 95% CI = 0.42-0.91, P = 0.014) and TyG tertile 1 (relative risk = 1.99, 95% CI = 1.25-3.24, P = 0.003) independently predicted diabetes remission. The TyG index identified diabetes remission with an area under the curve of 0.68. The optimal TyG threshold was 9.41, yielding a sensitivity of 69.6%, specificity of 60.9%, positive predictive value of 64.0%, and negative predictive value of 66.7%.
TyG index, previously suggested to predominantly reflect muscle IR, outperforms HOMA-IR as an IR indicator associated with glycemic control and diabetes remission after metabolic surgery.
胰岛素抵抗（IR）作为代谢手术后糖尿病缓解预测指标的效用尚未明确界定。我们评估了包括甘油三酯 - 葡萄糖（TyG）指数和稳态模型评估的胰岛素抵抗（HOMA - IR）在内的基线替代IR指标与代谢手术后血糖控制及糖尿病缓解之间的关联。
在单中心招募计划进行代谢手术的2型糖尿病患者（n = 149；年龄：44±10岁，男性占47.7%，体重指数：41.5±7.5kg/m²），并在术后随访12个月。研究了IR指标与基线时血糖控制不佳（糖化血红蛋白[HbA1c]≥7%）或术后完全糖尿病缓解（12个月时HbA1c<6%且无需降糖药物）之间的关系。
横断面研究显示，TyG指数升高与血糖控制不佳相关。与未缓解者相比，术后完全糖尿病缓解的个体基线TyG指数水平较低（P = 0.012）；而HOMA - IR无显著差异。一致地，随着TyG三分位数从1增加到3，糖尿病未缓解者（与缓解者相比）的比例增加（P = 0.015）。TyG指数（相对风险 = 0.62，95%置信区间 = 0.42 - 0.91，P = 0.014）和TyG三分位数1（相对风险 = 1.99，95%置信区间 = 1.25 - 3.24，P = 0.003）均独立预测糖尿病缓解。TyG指数识别糖尿病缓解的曲线下面积为0.68。最佳TyG阈值为9.41，敏感性为69.6%，特异性为60.9%，阳性预测值为64.0%，阴性预测值为66.7%。
TyG指数先前被认为主要反映肌肉IR，作为与代谢手术后血糖控制和糖尿病缓解相关的IR指标优于HOMA - IR。
