Trigliserid-glikoz İndeksi ve Trigliserid/HDL-kolesterol Oranının Tip 2 Diyabetli Yaşlı Hastalarda Kötü Glisemik Kontrolün Öngörücüsü Olarak Kullanılması

Münevver Gül Avşar; Aylia Yeşilova

doi:10.4274/BMB.galenos.2026.85520

Öz

Amaç

Glikozillenmiş hemoglobin (HbA1c) glisemik kontrolün standart ölçütüdür; ancak yaşlı bireylerde güvenilirliği sınırlıdır. Bu çalışmada, tip 2 diyabetli yaşlı hastalarda kötü glisemik kontrolün belirlenmesinde trigliserid-glukoz (TyG) indeksi ile trigliserid/HDL-kolesterol (TG/HDL-C) oranı karşılaştırıldı.

Yöntem

Bu kesitsel çalışmaya bir iç hastalıkları polikliniğine ardışık olarak başvuran, tip 2 diyabetli 65 yaş ve üzeri 137 hasta alındı. Lipid düşürücü tedavi alan ya da HbA1c yorumunu etkileyen durumları bulunan hastalar dışlandı. TyG indeksi Ln [trigliserid (mg/dL)×açlık plazma glukozu (mg/dL)/2] formülüyle hesaplandı. Hastalar iyi (HbA1c<%7) ve kötü (HbA1c≥%7) kontrol olarak sınıflandırıldı. Ayırt edicilik alıcı çalışma karakteristiği analiziyle değerlendirildi, eğri altı alanlar (EAA) DeLong testiyle karşılaştırıldı, bağımsız ilişkiler çok değişkenli lojistik regresyonla incelendi.

Bulgular

Hastaların 59’u (%43,1) iyi, 78’i (%56,9) kötü kontrole sahipti. TyG indeksi kötü kontrol grubunda daha yüksekti (9,47±0,62 ve 9,05±0,47; p<0,001); TG/HDL-C oranı ise gruplar arasında farklılık göstermedi (3,98±3,46 ve 3,24±2,30; p=0,125). TyG indeksi kötü kontrolü 0,711 EAA ile belirledi [%95 güven aralığı (GA) 0,624-0,798; p<0,001]; 9,35 kesim değerinde duyarlılık %57,7, özgüllük %79,7 idi. TG/HDL-C oranı ise şanstan daha iyi bir ayırt edicilik göstermedi (EAA 0,577; %95 GA 0,480-0,674; p=0,120); iki alan arasındaki fark anlamlıydı (DeLong p<0,001). Yaş, cinsiyet, diyabet süresi, beta-bloker kullanımı, DPP-4 inhibitörü kullanımı, diğer antidiyabetik tedavi ve vücut kitle indeksi için düzeltme yapıldıktan sonra TyG indeksi bağımsız olarak ilişkili kalırken [düzeltilmiş olasılık oranı (OO) 3,65; %95 GA 1,66-8,05; p=0,001], TG/HDL-C oranı için böyle bir ilişki saptanmadı (OO 1,08; %95 GA 0,94-1,23; p=0,276). Bulgular tüm duyarlılık analizlerinde doğrulandı.

Sonuç

Tip 2 diyabetli yaşlı hastalarda TyG indeksi kötü glisemik kontrolle bağımsız olarak ilişkili bulunmuş ve hiçbir ayırt edicilik göstermeyen TG/HDL-C oranından üstün çıkmıştır. Bu iki indeksten yalnızca TyG indeksi geriatrik diyabet bakımında bilgi verici görünmektedir.

Anahtar Kelimeler:

Glisemik kontrol, HbA1c, trigliserit/HDL-kolesterol oranı, trigliserit-glukoz indeksi, tip 2 diabetes mellitus, yaşlı

Kaynaklar

Lin L, Chen P, Zhang Y, Long J, Wang W, Sun X, et al. Burden of type 2 diabetes mellitus and risk factor attribution among older adults: a global, regional, and national analysis from 1990 to 2021, with projections up to 2040. Diabetes Obes Metab. 2025;27(8):4330-4343.

CrossRef

Jiang S, Yu T, Di D, Wang Y, Li W. Worldwide burden and trends of diabetes among people aged 70 years and older, 1990-2019: a systematic analysis for the global burden of disease study 2019. Diabetes Metab Res Rev. 2024;40(3):e3745.

American Diabetes Association Professional Practice Committee for Diabetes*. 13. older adults: standards of care in diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S277-S296.

CrossRef PubMed Google Scholar

Umegaki H. Management of older adults with diabetes mellitus: perspective from geriatric medicine. J Diabetes Investig. 2024;15(10):1347-1354.

CrossRef PubMed Google Scholar

Tang M, Berg A, Rhee EP, Allegretti AS, Nigwekar S, Karumanchi SA, et al. The impact of carbamylation and anemia on HbA1c’s association with renal outcomes in patients with diabetes and chronic kidney disease. Diabetes Care. 2023;46(1):130-137.

CrossRef

Lopez-Jaramillo P, Gomez-Arbelaez D, Martinez-Bello D, Abat MEM, Alhabib KF, Avezum Á, et al. Association of the triglyceride glucose index as a measure of insulin resistance with mortality and cardiovascular disease in populations from five continents (PURE study): a prospective cohort study. Lancet Healthy Longev. 2023;4(1):e23-e33.

Chen W, Ding S, Tu J, Xiao G, Chen K, Zhang Y, et al. Association between the insulin resistance marker TyG index and subsequent adverse long-term cardiovascular events in young and middle-aged US adults based on obesity status. Lipids Health Dis. 2023;22(1):65.

CrossRef

Aliyu U, Toor SM, Abdalhakam I, Elrayess MA, Abou Samra AB, Albagha OME. Evaluating indices of insulin resistance and estimating the prevalence of insulin resistance in a large biobank cohort. Front Endocrinol (Lausanne). 2025;16:1591677.

Gong R, Luo G, Wang M, Ma L, Sun S, Wei X. Associations between TG/HDL ratio and insulin resistance in the US population: a cross-sectional study. Endocr Connect. 2021;10(11):1502-1512.

Flores-Guerrero JL, Been RA, Shalaurova I, Connelly MA, van Dijk PR, Dullaart RPF. Triglyceride/HDL cholesterol ratio and lipoprotein insulin resistance score: associations with subclinical atherosclerosis and incident cardiovascular disease. Clin Chim Acta. 2024;553:117737.

CrossRef PubMed Google Scholar

Li H, Zuo Y, Qian F, Chen S, Tian X, Wang P, et al. Triglyceride-glucose index variability and incident cardiovascular disease: a prospective cohort study. Cardiovasc Diabetol. 2022;21(1):105.

Huang Q, Du X, Ouyang W, Wang J, Liu X. Relationship between triglyceride-glucose index and all-cause mortality in older adults with sarcopenic obesity. Metabol Open. 2025;27:100388.

CrossRef

Nakashima R, Ikeda S, Shinohara K, Matsumoto S, Yoshida D, Ono Y, et al. Triglyceride/high density lipoprotein cholesterol index and future cardiovascular events in diabetic patients without known cardiovascular disease. Sci Rep. 2025;15(1):9217.

Liu H, Liu J, Liu J, Xin S, Lyu Z, Fu X. Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, a simple but effective indicator in predicting type 2 diabetes mellitus in older adults. Front Endocrinol (Lausanne). 2022;13:828581.

Selvi NMK, Nandhini S, Sakthivadivel V, Lokesh S, Srinivasan AR, Sumathi S. Association of triglyceride-glucose index (TyG index) with HbA1c and insulin resistance in type 2 diabetes mellitus. Maedica (Bucur). 2021;16(3):375-381.

CrossRef PubMed Google Scholar

Jabeen WM, Jahangir B, Khilji S, Aslam A. Association of triglyceride glucose index and triglyceride HDL ratio with glucose levels, microvascular and macrovascular complications in diabetes mellitus type-2. Pak J Med Sci. 2023;39(5):1255-1259.

CrossRef PubMed Google Scholar

Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al.; Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385(19):1737-1749.

Babic N, Valjevac A, Zaciragic A, Avdagic N, Zukic S, Hasic S. The triglyceride/HDL ratio and triglyceride glucose index as predictors of glycemic control in patients with diabetes mellitus type 2. Med Arch. 2019;73(3):163-168.

CrossRef PubMed Google Scholar

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837-845.

CrossRef PubMed Google Scholar

Kim B, Kim GM, Huh U, Lee J, Kim E. Association of HOMA-IR versus TyG index with diabetes in ındividuals without underweight or obesity. Healthcare (Basel). 2024;12(23):2458.

CrossRef PubMed Google Scholar

Son DH, Lee HS, Lee YJ, Lee JH, Han JH. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome. Nutr Metab Cardiovasc Dis. 2022;32(3):596-604.

CrossRef PubMed Google Scholar

Simental-Mendía LE, Morales-Gurrola FG, Barragán-Zúñiga LJ. The triglyceride-glucose index as a surrogate measure to assess glycemic control in type 2 diabetes patients. Ir J Med Sci. 2025;194(2):515-520.

CrossRef PubMed Google Scholar

Lin Z, He J, Yuan S, Song C, Bian X, Yang M, et al. Glycemic control and cardiovascular outcomes in patients with diabetes and coronary artery disease according to triglyceride-glucose index: a large-scale cohort study. Cardiovasc Diabetol. 2024;23(1):11.

Gounden V, Devaraj S, Jialal I. The role of the triglyceride-glucose index as a biomarker of cardio-metabolic syndromes. Lipids Health Dis. 2024;23(1):416.

CrossRef PubMed Google Scholar

Shang H, Qin X, Li W, Xu Y, Wang W. Relationship between the triglyceride glucose index and time in range: a cross-sectional study based on patients with type 2 diabetes mellitus. J Int Med Res. 2025;53(9).

Tian J, Cao Y, Zhang W, Wang A, Yang X, Dong Y, et al. The potential of insulin resistance indices to predict non-alcoholic fatty liver disease in patients with type 2 diabetes. BMC Endocr Disord. 2024;24(1):261.

CrossRef

Mederos-Torres CV, Díaz-Burke Y, Muñoz-Almaguer ML, García-Zapién AG, Uvalle-Navarro RL, González-Sandoval CE. Triglyceride/high-density cholesterol ratio as a predictor of cardiometabolic risk in young population. J Med Life. 2024;17(7):722-727.

CrossRef PubMed Google Scholar

Alzahrani BA, Salamatullah HK, Alsharm FS, Baljoon JM, Abukhodair AO, Ahmed ME, et al. The effect of different types of anemia on HbA1c levels in non-diabetics. BMC Endocr Disord. 2023;23(1):24.

CrossRef

Elkanawati RY, Sumiwi SA, Levita J. Impact of lipids on insulin resistance: insights from human and animal studies. Drug Des Devel Ther. 2024;18:3337-3360.

CrossRef PubMed Google Scholar

Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Rev. 2018;98(4):2133-2223.

CrossRef PubMed Google Scholar

Ferrucci L, Fabbri E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol. 2018;15(9):505-522.

Yin JL, Yang J, Song XJ, Qin X, Chang YJ, Chen X, et al. Triglyceride-glucose index and health outcomes: an umbrella review of systematic reviews with meta-analyses of observational studies. Cardiovasc Diabetol. 2024;23(1):177.