TRIGLYCERIDE GLUCOSE INDEX – A PREDICTIVE MARKER FOR CORONARY ARTERY DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract

Background: The diagnostic standard of coronary artery disease (CAD) is coronary angiography (CAG). Since CAG is an invasive procedure underscores the need for identifying non-invasive, effective, and innovative biomarkers. Coronary artery disease is a leading complication among individuals with uncontrolled type 2 diabetes mellitus (T2DM), often linked to insulin resistance. The Triglyceride-Glucose (TyG) index, derived from fasting triglycerides and glucose levels, has emerged as a promising surrogate marker for insulin resistance and early predictor of cardiovascular risk.

Objective: To evaluate the TyG Index as a simple, cost-effective, and non-invasive predictive marker for CAD in patients with T2DM and to assess its association with inflammatory and cardiometabolic risk parameters for early identification of high-risk diabetic individuals.

Methods: This prospective, cross-sectional study was conducted at MGM Medical College and Hospital, Kamothe, Navi Mumbai, involving 393 subjects (30–60 years), divided equally into healthy controls (n=131), T2DM without CAD (n=131), and T2DM with angiographically confirmed CAD (n=131). The TyG index was calculated using fasting triglyceride and glucose values, and other parameters including diabetic and lipid profile, hsCRP were assessed. Statistical analysis was performed using SPSS version 25. Data were expressed as mean ± SD; Chi-square test, independent t-test, one-way ANOVA, Pearson's correlation, and ROC curve analysis were applied as appropriate, with p < 0.05 considered statistically significant.

Results: Diabetic profile and lipid profile with TyG index, and high-sensitivity C-reactive protein (hs-CRP) significantly differed among the three groups. The TyG index demonstrated higher values in CAD patients with T2DM (9.92 ±0.21) and patient with only T2DM (9.61±0.71) compared to those with healthy controls (8.2±0.21). The AUC of the TyG index was 0.872 (95% confidence interval (CI), P <0.001), with a cut-off value of >9, with excellent sensitivity and specificity for predicting future CAD risk in uncontrolled type 2 diabetic patients. The TyG index was significantly elevated in Group III (T2DM with CAD) compared to both Group I and Group II (p<0.001). Furthermore, the TyG index showed a strong positive correlation with hsCRP, total cholesterol, LDL, and triglyceride levels, and a negative correlation with HDL in diabetic patients.

Conclusion: The TyG index is a simple, economical, and reliable marker useful to improve diagnostic efficiency, suggesting its potential role as a novel indicator for predicting and diagnosing CAD risk in uncontrolled T2DM patients.