Shan Yingqi, Liu Qingyang, Gao Tianshu
Graduate School of Liaoning University of Traditional Chinese Medicine, No. 79 Chongshan East Road, Huanggu District, Shenyang, Liaoning, 110033, China.
Department of Endocrinology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 79 Chongshan East Road, Huanggu District, Shenyang, Liaoning, 110033, China.
BMC Endocr Disord. 2025 May 9;25(1):126. doi: 10.1186/s12902-025-01947-8.
Triglyceride-to-glucose index (TyG index) and inflammation are both independent risk factors for diabetes. However, only a few studies have combined TyG index with inflammation indices to predict diabetes risk. C-reactive protein-triglyceride-to-glucose index (CTI index), as a new type of lipid and inflammation marker, can comprehensively assess the severity of insulin resistance and inflammation. This study explores the association between CTI index and diabetes risk.
We recruited a total of 6,728 participants from the China Health and Retirement Longitudinal Study (CHARLS) who had no history of diabetes at baseline. After determining the key predictors using the least absolute shrinkage and selection operator (LASSO) technique, the relationship between the CTI index and the risk of new-onset diabetes was assessed using multivariate COX regression, the mediating effect between insulin resistance and inflammatory indicators was explored, and restricted cubic splines (RCS) were applied to explore the association between the CTI index and the risk of new-onset diabetes. In addition, we used decision tree analysis to identify people at high risk of diabetes, calculated time-dependent Harrell's C index (95% CI) to assess the predictive ability of TyG, CRP, CTI and CRP + TyG for new-onset diabetes, and further calculated IDI and NRI to assess the predictive ability of CTI and TyG. Finally, we performed subgroup analyses for different subgroups using stratified COX proportional hazard regression models; and a series of sensitivity analyses were performed to verify the robustness of our results.
The incidence of diabetes was 15.9% during the 9-year follow-up. COX regression analysis showed that the risk ratio for diabetes increased gradually with an increase in the CTI index. The RCS curve confirmed the existence of a linear relationship between the CTI index and the risk of diabetes. Decision tree analysis showed that the CTI index was a key indicator of diabetes risk. In addition, the CTI index is a much better predictor of the onset of diabetes risk than the TyG index, as demonstrated by the integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
An increase in CTI levels is closely related to diabetes risk, and the CTI index may become a unique predictor of diabetes risk.
Not applicable.
甘油三酯与血糖指数（TyG指数）和炎症均为糖尿病的独立危险因素。然而，仅有少数研究将TyG指数与炎症指标相结合来预测糖尿病风险。C反应蛋白 - 甘油三酯与血糖指数（CTI指数）作为一种新型的脂质和炎症标志物，能够全面评估胰岛素抵抗和炎症的严重程度。本研究探讨CTI指数与糖尿病风险之间的关联。
我们从中国健康与养老追踪调查（CHARLS）中总共招募了6728名在基线时无糖尿病病史的参与者。使用最小绝对收缩和选择算子（LASSO）技术确定关键预测因素后，采用多变量COX回归评估CTI指数与新发糖尿病风险之间的关系，探讨胰岛素抵抗与炎症指标之间的中介作用，并应用受限立方样条（RCS）来探究CTI指数与新发糖尿病风险之间的关联。此外，我们使用决策树分析来识别糖尿病高危人群，计算时间依赖性Harrell's C指数（95%可信区间）以评估TyG、CRP、CTI和CRP + TyG对新发糖尿病的预测能力，并进一步计算综合判别改善（IDI）和净重新分类改善（NRI）以评估CTI和TyG的预测能力。最后，我们使用分层COX比例风险回归模型对不同亚组进行亚组分析；并进行了一系列敏感性分析以验证我们结果的稳健性。
在9年的随访期间，糖尿病的发病率为15.9%。COX回归分析表明，糖尿病的风险比随着CTI指数的升高而逐渐增加。RCS曲线证实了CTI指数与糖尿病风险之间存在线性关系。决策树分析表明，CTI指数是糖尿病风险的关键指标。此外，如综合判别改善（IDI）和净重新分类改善（NRI）所示，CTI指数对糖尿病风险发作的预测能力比TyG指数要好得多。
CTI水平的升高与糖尿病风险密切相关，CTI指数可能成为糖尿病风险的独特预测指标。
不适用。
