Associations of triglyceride–glucose index cumulative exposure and variability with the transitions from normoglycaemia to prediabetes and prediabetes to diabetes: Insights from a cohort study

Aim

This study aimed to investigate the separate and joint associations of triglyceride–glucose (TyG) index accumulation and variability with prediabetes and diabetes risk.

Methods

Health check-up participants who underwent 3 sequential health examinations during 2012–2016 and were followed up from 2017 to 2021 were enrolled and categorized into two subcohorts: (a) progression from normoglycaemia to prediabetes subcohort (n = 9373) and (b) progression from prediabetes to diabetes subcohort (n = 4563). Cumulative TyG (cumTyG) and TyG variability from Exams 1–3 were the exposures of interest in our study. The outcomes were newly incident prediabetes or diabetes.

Results

In the prediabetes development subcohort, 2,074 participants developed prediabetes over a 2.42-year follow-up. Higher cumTyG (HR, 2.02; 95 % CI, 1.70–2.41), but not greater TyG variability alone, was significantly associated with increased prediabetes risk. In the diabetes development subcohort, 379 participants developed diabetes over a 3.0-year follow-up. Higher cumTyG (HR, 3.54; 95 % CI, 2.29–5.46), but not greater TyG variability alone, was significantly associated with increased diabetes risk. The “cumTyG+variability” combination had the highest predictive value for prediabetes and diabetes beyond a single baseline TyG measurement.

Conclusion

Higher cumTyG exposure independently predicts prediabetes and diabetes incidence. Coexisting cumTyG and variability could further yield incrementally greater risks.