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01-06-2020 | Insulins | Original Article

The triglyceride and glucose index is a useful biomarker to recognize glucose disorders in apparently healthy children and adolescents

Authors: Luis E. Simental-Mendía, Claudia I. Gamboa-Gómez, Celia Aradillas-García, Martha Rodríguez-Morán, Fernando Guerrero-Romero

Published in: European Journal of Pediatrics | Issue 6/2020

Abstract

It has been suggested that the triglyceride and glucose (TyG) index is an early indicator for type 2 diabetes (T2D) in adults. Thus, the aim of this study was to evaluate whether the TyG index is useful in the screening of glucose disorders (GD) in apparently healthy children and adolescents. Eligible participants were apparently healthy children and adolescents. Individuals with new diagnosis of GD were allocated into the study groups with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and T2D. Participants with normal glucose tolerance (NGT) were the control group. In total, 1872 children and adolescents were enrolled and allocated into the study groups. Diagnosis of NGT, IFG, IGT, and T2D was established in 1541 (82.3%), 256 (13.7%), 66 (3.5%), and 9 (0.4%) children, respectively. In girls, the best cutoff points of the TyG index for identifying IFG, IGT, and T2D were 4.51 (sensitivity 59.8%, specificity 59.8%), 4.55 (sensitivity 63.0%, specificity 64.3%), and 4.63 (sensitivity 75.0%, specificity 74.6%), respectively; and in boys were 4.52 (sensitivity 62.8%, specificity 64.2%), 4.54 (sensitivity 71.8%, specificity 65.1%), and 4.82 (sensitivity 91.0%, specificity 990.6%), respectively.

Conclusion: Our results suggest that the TyG index may be a useful tool for screening GD in healthy children and adolescents.

What is Known: • Prevalence of prediabetes and type 2 diabetes is increasing worldwide among young adults and adolescents. • Elevated fasting glucose and triglyceride concentrations have been recognized as independent risk factors for type 2 diabetes.
What is New: • The TyG index exhibited highest sensitivity and specificity to detect impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes. • The TyG index may be a useful tool for the screening of glucose disorders in apparently healthy children and adolescents.

Giannini C, Caprio S (2013) Progression of β-cell dysfunction in obese youth. Curr Diab Rep 13(1):89–95. https://doi.org/10.1007/s11892-012-0347-7 CrossRefPubMed

Ludwig DS, Ebbeling CB (2001) Type 2 diabetes mellitus in children: primary care and public health considerations. JAMA. 286(12):1427–1430CrossRef

Tirosh A, Shai I, Bitzur R, Kochba I, Tekes-Manova D, Israeli E, Shochat T, Rudich A (2008) Changes in triglyceride levels over time and risk of type 2 diabetes in young men. Diabetes Care 31(10):2032–2037. https://doi.org/10.2337/dc08-0825 CrossRefPubMedPubMedCentral

Tirosh A, Shai I, Tekes-Manova D, Israeli E, Pereg D, Shochat T, Kochba I, Rudich A, Israeli Diabetes Research Group (2005) Normal fasting plasma glucose levels and type 2 diabetes in young men. N Engl J Med 353(14):1454–1462CrossRef

Guerrero-Romero F, Aradillas-García C, Simental-Mendia LE, Monreal-Escalante E, de la Cruz ME, Rodríguez-Moran M (2010) Birth weight, family history of diabetes, and metabolic syndrome in children and adolescents. J Pediatr 156(5):719–723. https://doi.org/10.1016/j.jpeds.2009.11.043 CrossRefPubMed

Simental-Mendía LE, Castañeda-Chacón A, Rodriguez-Morán M, Aradillas-García C, Guerrero-Romero F (2015) Relationship between elevated triglyceride levels with the increase of HOMA-IR and HOMA-β in healthy children and adolescents with normal weight. Eur J Pediatr 174(5):597–605. https://doi.org/10.1007/s00431-014-2426-z CrossRefPubMed

Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A, Nathan D, Palmer J, Rizza R, Saudek C, Shaw J, Steffes M, Stern M, Tuomilehto J, Zimmet P, Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26(11):3160–3167CrossRef

Lee SH, Kwon HS, Park YM, Ha HS, Jeong SH, Yang HK, Lee JH, Yim HW, Kang MI, Lee WC, Son HY, Yoon KH (2014) Predicting the development of diabetes using the product of triglycerides and glucose: the Chungju Metabolic Disease Cohort (CMC) study. PLoS One 9(2):e90430. https://doi.org/10.1371/journal.pone.0090430 CrossRefPubMedPubMedCentral

Lee DY, Lee ES, Kim JH, Park SE, Park CY, Oh KW, Park SW, Rhee EJ, Lee WY (2016) Predictive value of triglyceride glucose index for the risk of incident diabetes: a 4-year retrospective longitudinal study. PLoS One 11(9):e0163465. https://doi.org/10.1371/journal.pone.0163465 CrossRefPubMedPubMedCentral

10.

Navarro-González D, Sánchez-Íñigo L, Pastrana-Delgado J, Fernández-Montero A, Martinez JA (2016) Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: the Vascular-Metabolic CUN cohort. Prev Med 86:99–105. https://doi.org/10.1016/j.ypmed.2016.01.022 CrossRefPubMed

11.

Rodríguez-Moran M, Aradillas-García C, Simental-Mendia LE, Monreal-Escalante E, de la Cruz ME, Dávila Esqueda ME, Guerrero-Romero F (2010) Family history of hypertension and cardiovascular risk factors in prepubertal children. Am J Hypertens 23(3):299–304. https://doi.org/10.1038/ajh.2009.257 CrossRefPubMed

12.

Sacks D, Canadian Paediatric Society, Adolescent Health Committee (2003) Age limits and adolescents. Paediatr Child Health 8(9):577–578CrossRef

13.

Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F (2008) The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 6(4):299–304. https://doi.org/10.1089/met.2008.0034 CrossRefPubMed

14.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al (2003) Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 42:1206–1252CrossRef

15.

Lee SH, Han K, Yang HK, Kim MK, Yoon KH, Kwon HS, Park YM (2015) Identifying subgroups of obesity using the product of triglycerides and glucose: the Korea National Health and Nutrition Examination Survey, 2008-2010. Clin Endocrinol 82:213–220CrossRef

16.

Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X (2014) Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 13:146CrossRef

17.

Espinel-Bermúdez MC, Robles-Cervantes JA, Del Sagrario V-HL, Villaseñor-Romero JP, Hernández-González SO, González-Ortiz M, Martínez-Abundis E, Pérez-Rubio KG (2015) Insulin resistance in adult primary care patients with a surrogate index, Guadalajara, Mexico, 2012. J Investig Med 63:247–250CrossRef

18.

Unger G, Benozzi SF, Perruzza F, Pennacchiotti GL (2014) Triglycerides and glucose index: a useful indicator of insulin resistance. Endocrinol Nutr 61:533–540CrossRef

19.

Lucatello F, Vigna L, Carugno M, Tirelli AS, Bertazzi PA, Riboldi L (2012) Comparison of indexes for assessing insulin resistance for the health surveillance among workers. G Ital Med Lav Ergon 34(3 Suppl):748–749PubMed

20.

Vasques AC, Novaes FS, de Oliveira Mda S, Souza JR, Yamanaka A, Pareja JC, Tambascia MA, Saad MJ, Geloneze B (2011) TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract 93:e98–e100CrossRef

21.

Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M (2012) Prediabetes: a high-risk state for diabetes development. Lancet. 379(9833):2279–2290. https://doi.org/10.1016/S0140-6736(12)60283-9 CrossRefPubMedPubMedCentral

22.

Faerch K, Vaag A, Holst JJ, Glümer C, Pedersen O, Borch-Johnsen K (2008) Impaired fasting glycaemia vs impaired glucose tolerance: similar impairment of pancreatic alpha and beta cell function but differential roles of incretin hormones and insulin action. Diabetologia. 51(5):853–861. https://doi.org/10.1007/s00125-008-0951-x CrossRefPubMed

23.

Weyer C, Bogardus C, Pratley RE (1999) Metabolic characteristics of individuals with impaired fasting glucose and/or impaired glucose tolerance. Diabetes. 48(11):2197–2203CrossRef

24.

Laakso M, Zilinskaite J, Hansen T, Boesgaard TW, Vänttinen M, Stancáková A, Jansson PA, Pellmé F, Holst JJ, Kuulasmaa T, Hribal ML, Sesti G, Stefan N, Fritsche A, Häring H, Pedersen O, Smith U, EUGENE2 Consortium (2008) Insulin sensitivity, insulin release and glucagon-like peptide-1 levels in persons with impaired fasting glucose and/or impaired glucose tolerance in the EUGENE2 study. Diabetologia. 51(3):502–511CrossRef

25.

Bock G, Dalla Man C, Campioni M, Chittilapilly E, Basu R, Toffolo G, Cobelli C, Rizza R (2006) Pathogenesis of pre-diabetes: mechanisms of fasting and postprandial hyperglycemia in people with impaired fasting glucose and/or impaired glucose tolerance. Diabetes. 55(12):3536–3549CrossRef

26.

Abdul-Ghani MA, Jenkinson CP, Richardson DK, Tripathy D, DeFronzo RA (2006) Insulin secretion and action in subjects with impaired fasting glucose and impaired glucose tolerance: results from the Veterans Administration Genetic Epidemiology Study. Diabetes. 55(5):1430–1435CrossRef

27.

Meyer C, Pimenta W, Woerle HJ, Van Haeften T, Szoke E, Mitrakou A, Gerich J (2006) Different mechanisms for impaired fasting glucose and impaired postprandial glucose tolerance in humans. Diabetes Care 29(8):1909–1914CrossRef

28.

Faerch K, Vaag A, Holst JJ, Hansen T, Jørgensen T, Borch-Johnsen K (2009) Natural history of insulin sensitivity and insulin secretion in the progression from normal glucose tolerance to impaired fasting glycemia and impaired glucose tolerance: the Inter99 study. Diabetes Care 32(3):439–444. https://doi.org/10.2337/dc08-1195 CrossRefPubMedPubMedCentral

29.

American Diabetes Association (2000) Type 2 diabetes in children and adolescents. Pediatrics. 105(3 Pt 1):671–680CrossRef

30.

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee (2008) Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 32(Suppl. 1):S168–S180

31.

Morrison KM, Xu L, Tarnopolsky M, Yusuf Z, Atkinson SA, Yusuf S (2012) Screening for dysglycemia in overweight youth presenting for weight management. Diabetes Care 35(4):711–716. https://doi.org/10.2337/dc11-1659 CrossRefPubMedPubMedCentral

32.

Shashaj B, Bedogni G, Graziani MP, Tozzi AE, DiCorpo ML, Morano D, Tacconi L, Veronelli P, Contoli B, Manco M (2014) Origin of cardiovascular risk in overweight preschool children: a cohort study of cardiometabolic risk factors at the onset of obesity. JAMA Pediatr 168(10):917–924. https://doi.org/10.1001/jamapediatrics.2014.900 CrossRefPubMed

33.

Hagman E, Reinehr T, Kowalski J, Ekbom A, Marcus C, Holl RW (2014) Impaired fasting glucose prevalence in two nationwide cohorts of obese children and adolescents. Int J Obes 38(1):40–45. https://doi.org/10.1038/ijo.2013.124 CrossRef

34.

Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S (2002) Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 346(11):802–810CrossRef

35.

Di Bonito P, Pacifico L, Chiesa C, Valerio G, Miraglia Del Giudice E, Maffeis C, Morandi A, Invitti C, Licenziati MR, Loche S, Tornese G, Franco F, Manco M, Baroni MG, “CARdiometabolic risk factors in overweight and obese children in ITALY” (CARITALY) Study Group (2017) Impaired fasting glucose and impaired glucose tolerance in children and adolescents with overweight/obesity. J Endocrinol Investig 40(4):409–416. https://doi.org/10.1007/s40618-016-0576-8

36.

Guerrero-Romero F, Violante R, Rodríguez-Morán M (2009) Distribution of fasting plasma glucose and prevalence of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes in the Mexican paediatric population. Paediatr Perinat Epidemiol 23(4):363–369. https://doi.org/10.1111/j.1365-3016.2009.01035.x CrossRefPubMed

Title: The triglyceride and glucose index is a useful biomarker to recognize glucose disorders in apparently healthy children and adolescents
Authors: Luis E. Simental-Mendía
Claudia I. Gamboa-Gómez
Celia Aradillas-García
Martha Rodríguez-Morán
Fernando Guerrero-Romero
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Insulins
Prediabetes
Insulins
Type 2 Diabetes
Published in: European Journal of Pediatrics / Issue 6/2020
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-020-03570-2

At a glance: The STEP trials

Springer Medicine

The triglyceride and glucose index is a useful biomarker to recognize glucose disorders in apparently healthy children and adolescents

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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