Higher TyG Index Independently Predicts Carotid Plaque Progression in Type 2 Diabetes: Study
China: Researchers have discovered in a new study that in patients with type 2 diabetes mellitus, a higher triglyceride–glucose (TyG) index independently increases the risk of carotid plaque progression, indicating its value as a marker of atherosclerotic risk.
The findings are from a retrospective cohort study published in Frontiers in Endocrinology by Zhangxiang Zhu from the Department of Endocrinology, First Affiliated Hospital of Anhui Medical University, Hefei, China, and colleagues. The study sheds light on the potential role of the TyG index, a simple surrogate marker of insulin resistance derived from fasting triglyceride and glucose levels, in identifying patients with type 2 diabetes mellitus (T2DM) who are at heightened risk of vascular disease progression.
Insulin resistance is a well-recognized driver of atherosclerosis and cardiovascular complications in T2DM. While the TyG index has previously been linked to carotid vascular disease in the general population, its specific relationship with carotid plaque progression in patients with established T2DM has remained insufficiently explored. To address this gap, the researchers examined long-term clinical data from patients with diabetes who had undergone repeated hospitalizations and carotid ultrasound assessments.
The study included 548 patients with T2DM, with a mean age of approximately 56 years, and nearly two-thirds of the cohort being male. All participants were followed for a median duration of four years, with some observed for as long as seven years. Based on baseline TyG index values, patients were divided into three groups, allowing the investigators to evaluate trends across increasing levels of insulin resistance.
The following were the key findings of the study:
- The prevalence of carotid plaque progression increased progressively across higher triglyceride–glucose index tertiles.
- Patients in the highest TyG index group had a markedly greater likelihood of carotid plaque progression compared with those in the lowest tertile.
- Higher TyG index levels were associated with significantly faster increases in carotid plaque size, including both plaque length and width on the left and right carotid arteries.
- The relationship between the TyG index and carotid plaque progression remained significant after adjustment for age, sex, blood pressure, lipid parameters, glycemic status, and medication use.
- Each one-unit increase in the TyG index was independently linked to greater annual growth in carotid plaque measurements.
- Cox regression analysis showed that elevated TyG index levels were associated with a 24% to nearly 38% higher risk of carotid plaque progression in patients with type 2 diabetes mellitus.
To assess the clinical utility of the TyG index, the researchers performed receiver operating characteristic analysis. Although the TyG index alone showed only modest predictive ability for carotid plaque progression, adding it to a conventional risk prediction model significantly improved overall predictive performance. Measures such as the C-statistic, net reclassification improvement, and integrated discrimination improvement all showed meaningful enhancement when the TyG index was included.
The authors conclude that a higher TyG index serves as an independent risk factor for carotid plaque progression in patients with T2DM. Given its simplicity, low cost, and routine availability, the TyG index may be a practical tool for early risk stratification and vascular monitoring in this population. However, they emphasize that prospective studies are needed to determine whether early and targeted interventions aimed at improving glucose and lipid metabolism in patients with high TyG index values can effectively slow or prevent carotid plaque progression.
Reference:
Zhu, Z., Xu, X., Wang, G., Zhang, Q., Li, Y., Zhu, J., Chen, L., Ye, Q., & Chen, M. (2025). Association between the triglyceride-glucose index and carotid plaque progression in patients with type 2 diabetes mellitus: A retrospective cohort study. Frontiers in Endocrinology, 16, 1709079. https://doi.org/10.3389/fendo.2025.1709079
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