Authors: Chen Xi, Yuan Mingzhu, Xie Jinchi, Tan Yuhe, Yang Runze, Geng Tingting, Sun Xufang
Corresponding author: , Email: sunxufang2016@163.com
Published:2026-09-10
DOI: 10.3760/cma.j.cn115989-20260424-00188
ABSTRACT
Objective To investigate the association between the triglyceride-glucose (TyG) index and the risk of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM), and the effect modification of abdominal obesity.
Methods Based on data from the UK Biobank prospective cohort, 19 232 T2DM patients without DR at baseline were included (2006—2010). DR outcomes were identified through electronic health records. With age, sex, race, Townsend deprivation index, educational level, smoking status, alcohol consumption, leisure-time physical activity, history of cardiovascular disease, glycated hemoglobin, duration of diabetes, use of glucose-lowering, antihypertensive and lipid-lowering medications, and time since last food intake as covariates, Cox proportional hazards regression models were used to analyze the association between the TyG index and the risk of DR. Restricted cubic spline (RCS) analysis was used to assess the dose-response relationship. Stratified analysis and interaction analysis were performed to evaluate the modifying effect of abdominal obesity on this association, and a joint analysis of the TyG index and abdominal obesity was further conducted. The UK Biobank received ethical approval from the North West Multi-Centre Research Ethics Committee (06/MRE08/65), and all participants provided written informed consent. This study was conducted under UK Biobank Application (No. 88159).
Results During a median follow-up of 12.5 years, 1 542 participants developed DR. After adjustment for confounders, the TyG index was significantly associated with the risk of DR. Compared with the lowest quartile (Q1), the highest quartile (Q4) was associated with a 50% higher risk of DR, with a hazard ratio (HR) and 95% confidence interval ( CI) of 1.50 (1.30-1.73), and the test for trend was statistically significant ( P<0.001). When TyG was included as a continuous variable, each 1-unit increase in the TyG index was associated with a 28% higher risk of DR (HR=1.28, 95% CI: 1.20-1.37). Stratified analysis showed that among participants with abdominal obesity, the TyG index was significantly positively associated with the risk of DR; compared with Q1, the HR for Q4 was 1.50 (95% CI: 1.27-1.76; P<0.001). However, among participants without abdominal obesity, no significant association was observed (Q4 vs Q1: HR=1.19, 95% CI: 0.81-1.76; P=0.153). Interaction analysis showed that abdominal obesity significantly modified the association between the TyG index and the risk of DR ( P=0.031). Joint analysis showed that, with participants without abdominal obesity and in TyG Q1 as the reference group, the risk of DR generally increased with abdominal obesity status and higher TyG quartiles, and the trend test was statistically significant ( P=0.003).
Conclusions A higher TyG index is associated with an increased risk of DR in patients with T2DM. Abdominal obesity significantly and positively modifies the association between the TyG index and the risk of DR. When evaluating the risk of DR in T2DM, the assessment and management of abdominal obesity should also be emphasized alongside glucose and lipid metabolism.
KEYWORDS：
Diabetic retinopathy;Triglyceride-glucose index;Abdominal obesity;Waist-to-hip ratio;Cohort study;Effect modification
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Authors Info & Affiliations
Chen Xi
Department of Ophthalmology, Hubei Key Laboratory of Otolaryngologic and Ophthalmic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Yuan Mingzhu
Department of Ophthalmology, Hubei Key Laboratory of Otolaryngologic and Ophthalmic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Xie Jinchi
Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Tan Yuhe
Department of Ophthalmology, Hubei Key Laboratory of Otolaryngologic and Ophthalmic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Yang Runze
Department of Ophthalmology, Hubei Key Laboratory of Otolaryngologic and Ophthalmic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Geng Tingting
Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Sun Xufang
Department of Ophthalmology, Hubei Key Laboratory of Otolaryngologic and Ophthalmic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Figures & Tables
Figure 1 Flowchart of study population selection T2DM: type 2 diabetes mellitus; DR: diabetic retinopathy; TyG: triglyceride-glucose
Table 1 Comparison of baseline characteristics of study participants across different quartile groups of the TyG index Note: (a: One-way ANOVA; b: χ 2 test; c: Kruskal-Wallis rank sum test) TyG: triglyceride-glucose; Q: quartile; TDI: Townsend deprivation index; HbA1c: glycated hemoglobin; BMI: body mass index; MET: metabolic equivalent; eGFR: estimated glomerular filtration rate 1 mmHg=0.133 kPa
Figure 2 Dose-response relationship between TyG index and DR assessed by RCS analysis RCS: restricted cubic spline; TyG: triglyceride-glucose; DR: diabetic retinopathy; HR: hazard ratio; CI: confidence interval; TDI: Townsend deprivation index
Table 2 Cox regression analysis of the association between TyG index and the risk of DR Note: Model 1 adjusted for age, sex, race, and TDI; Model 2 further adjusted for educational level, smoking status, alcohol consumption, leisure-time physical activity, history of cardiovascular disease, HbA1c, and duration of diabetes based on the Model 1; Model 3 further adjusted for the use of glucose-lowering, antihypertensive, and lipid-lowering agents, and fasting time based on the Model 2 Q: quartile; TyG: triglyceride-glucose; DR: diabetic retinopathy; HR: hazard ratio; CI: confidence interval; TDI: Townsend deprivation index; HbA1c: glycated hemoglobin
Figure 3 Association between TyG index and risk of DR after stratification by abdominal obesity Model 1 adjusted for age, sex, race, and TDI; Model 2 further adjusted for educational level, smoking status, alcohol consumption, leisure-time physical activity, history of cardiovascular disease, HbA1c, and duration of diabetes; Model 3 further adjusted for the use of glucose-lowering, antihypertensive, and lipid-lowering medications, and fasting time. Abdominal obesity was defined as WHR >0.90 in men and >0.85 in women Q: quartile; TyG: triglyceride-glucose; DR: diabetic retinopathy; HR: hazard ratio; CI: confidence interval; TDI: Townsend Deprivation Index; HbA1c: glycated hemoglobin; WHR: waist-to-hip ratio
Figure 4 Joint analysis of abdominal obesity and TyG index on the risk of DR in patients with T2DM Model 1 adjusted for age, sex, race, and TDI; Model 2 further adjusted for educational level, smoking status, alcohol consumption, leisure-time physical activity, history of cardiovascular disease, HbA1c, and duration of diabetes based on the Model 1; Model 3 further adjusted for the use of glucose-lowering, antihypertensive, and lipid-lowering medications, and fasting time based on the Model 2. Abdominal obesity was defined as WHR>0.90 in men and >0.85 in women Q: quartile; TyG: triglyceride-glucose; T2DM: type 2 diabetes mellitus; DR: diabetic retinopathy; HR: hazard ratio; CI: confidence interval; TDI: Townsend deprivation index; HbA1c: glycated hemoglobin; WHR: waist-to-hip ratio
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