TRIGLYCERIDE-TO-HIGH-DENSITY-LIPOPROTEIN RATIO HAS LIMITED DIAGNOSTIC ACCURACY FOR DETECTING EARLY INSULIN RESISTANCE

Therapeutic Area

Diabetes

Background

Type 2 diabetes mellitus (T2DM) and its complications pose a significant global health challenge, affecting 537 million individuals worldwide. Early identification of insulin resistance (IR) is crucial for managing the risk and preventing T2DM. Existing literature supports the use of the triglyceride-to-high-density lipoprotein ratio (TG/HDL) as a practical marker of IR and a component of metabolic syndrome (MetS). However, the compensatory hyperinsulinemia that precedes MetS and prediabetes may suppress this ratio and mask hidden IR. Hypothesis: For individuals with early metabolic imbalance (EMI), TG/HDL lacks the diagnostic power to detect compensated insulin resistance.

Methods

Leveraging data from the 2015-2018 U.S. National Health & Nutrition Examination Survey, we assigned each study participant to one of four groups: (1) healthy balanced metabolism, (2) EMI (includes early IR), (3) prediabetes and/or dyslipidemia and (4) T2DM and/or cardiovascular disease (CVD). The homeostatic model assessment of insulin resistance v.2 (HOMA2-IR) was the reference standard, with the median of groups 1 and 2 serving as the cut point. Population-weighted receiver operating characteristic (ROC) curves were used to assess predictive accuracy, measured by area-under-the-curve (AUC) with the 95% confidence interval (CI).

Results

ROC analysis 1 included all 4 groups: AUC=0.720 (95% CI: 0.701, 0.739). Analysis 2 included only groups 1-3: AUC=0.704 (95% CI: 0.683, 0.726). Analysis 3 included only groups 1 and 2: AUC=0.663 (95% CI: 0.621, 0.704).

Conclusions

This study highlights the limited diagnostic accuracy of TG/HDL ratio as a marker of insulin resistance for individuals with early metabolic imbalance. This condition includes compensated insulin resistance in the absence of prediabetes, MetS, T2DM and CVD. More effective markers are needed to screen for EMI, a hidden risk factor for T2DM and CVD.