Huang Qiong, Nan Wenbin, He Baimei, Xing Zhenhua, Peng Zhenyu
Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, 410011, China.
National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Ministry of Education, Central South University, Changsha, 410011, China.
Cardiovasc Diabetol. 2025 Feb 7;24(1):66. doi: 10.1186/s12933-025-02622-x.
Cardiovascular autonomic neuropathy (CAN), characterized by disrupted autonomic regulation of the cardiovascular system, is a frequent complication associated with diabetes. The triglyceride-glucose (TyG) index represents a precise insulin resistance indicator. However, the influence of baseline and prolonged TyG index patterns on CAN risk in type 2 diabetes remains unclear.
Based on the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, multivariate logistic regression models and restricted cubic splines (RCS) were deployed for elucidating the relation between baseline TyG index and the incidence of CAN. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was used to assess the diagnostic value of the TyG index in predicting the risk of CAN. The relationship between TyG trajectory and the occurrence of CAN in individuals with diabetes was examined using Kaplan-Meier curve and a multivariable Cox proportional hazards regression model. Subgroup analysis was used to assess the robustness of the results. Additionally, we explored the impact of intensive glycemia treatment on the relationship between trajectory of TyG index and CAN risk.
In this study, these in the top quartile of the TyG index had a greater likelihood of developing CAN (TyG index Q4 vs. Q1 in Model II, OR = 1.29, 95% CI 1.03-1.62, P = 0.027). RCS indicated a rising trend in the TyG index in relation to the incidence of CAN. The AUC of the TyG index for predicting the occurrence of CAN was 0.636 (95% CI 0.620-0.651; P < 0.001), with the cut-off value of 0.208. During a 7-year follow-up period, three unique TyG trajectories were recognized: class 1 (n = 431, 23.26%), class 2 (n = 798, 27.57%), and class 3 (n = 293, 31.71%). Notable discrepancies in CAN risk across various trajectories were identified in Kaplan-Meier curve (P < 0.001). Cox regression analysis indicated that individuals in class 3 experienced a greater incidence of CAN in comparison to those in class 1 after adjusting for all covariates. Subgroup analysis found no significant effect modification in this relationship. Additionally, in the intensive glycemia group, class 2 had a reduced risk of CAN, while class 3 had an increased risk when compared to standard glycemia group.
Increased baseline levels and long-term trajectory of TyG index are associated with an increased incidence of CAN. Intensive glycemic therapy might influence the association between the trajectory of TyG index and the chance of developing CAN.
心血管自主神经病变（CAN）以心血管系统自主调节功能紊乱为特征，是糖尿病常见的并发症。甘油三酯-葡萄糖（TyG）指数是一种精确的胰岛素抵抗指标。然而，基线和长期TyG指数模式对2型糖尿病患者CAN风险的影响尚不清楚。
基于糖尿病心血管风险控制行动（ACCORD）试验，采用多因素逻辑回归模型和限制立方样条（RCS）来阐明基线TyG指数与CAN发病率之间的关系。采用受试者工作特征（ROC）曲线下面积（AUC）评估TyG指数预测CAN风险的诊断价值。使用Kaplan-Meier曲线和多变量Cox比例风险回归模型检验TyG轨迹与糖尿病患者CAN发生之间的关系。采用亚组分析评估结果的稳健性。此外，我们探讨了强化血糖治疗对TyG指数轨迹与CAN风险之间关系的影响。
在本研究中，TyG指数处于最高四分位数的患者发生CAN的可能性更大（模型II中TyG指数Q4与Q1相比，OR = 1.29，95%CI 1.03-1.62，P = 0.027）。RCS显示TyG指数与CAN发病率呈上升趋势。TyG指数预测CAN发生的AUC为0.636（95%CI 0.620-0.651；P < 0.001），截断值为0.208。在7年的随访期内，识别出三种独特的TyG轨迹：1类（n = 431，23.26%）、2类（n = 798，27.57%）和3类（n = 293，31.71%）。Kaplan-Meier曲线显示不同轨迹的CAN风险存在显著差异（P < 0.001）。Cox回归分析表明，在调整所有协变量后，3类患者的CAN发病率高于1类患者。亚组分析发现这种关系没有显著的效应修饰。此外，在强化血糖组中，与标准血糖组相比，2类患者的CAN风险降低，而3类患者的CAN风险增加。
TyG指数的基线水平升高和长期轨迹与CAN发病率增加有关。强化血糖治疗可能会影响TyG指数轨迹与发生CAN几率之间的关联。
