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Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test

Received: 19 June 2024     Accepted: 17 July 2024     Published: 29 July 2024
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Abstract

The Triglyceride-Glucose (TyG) index is a marker used to assess insulin resistance which is associated with the occurrence of gestational diabetes. The aim of this study is to determine the benefit of the TyG within the diagnosis of insulin resistance in pregnant women in an orally induced hyperglycaemia test. This study was conducted at the Department of Biochemistry, at Aristide le Dantec University Hospital in collaboration with the department of gynaecology. Women with fasting blood glucose < 0.92 g/L at 12 weeks of age benefited from the OGTT 75 test following the WHO protocol. The TyG index was calculated using the formula: Ln [fasting triglyceridemia (mg/dL) × fasting blood glucose (mg/dL)]/2. Data were analysed using SPSS v.26 and a p< value of 0.05 was considered statistically significant. A total of 102 patients were included in the study with a mean age of 29± to 5.9 years. The OGTT 75 test was positive in 24 women (23.5%) with a predominance in the third trimester (19.4%). TyG values were significantly higher in women with gestational diabetes (8.76, ±0.5vs8.2±, 0.5; p<0.0001), in contrast to the HOMA index (6.43, ±16.8, ±1.15±, 0.9; p=0.138). The AUC of the ROC curve for the TyG-H0, TyG-H1 and TyG-H2 indices were 0.808 (95% CI)=0.70-0.92), 0.808 (95% CI)=0.698-0.918), 0.818 (95% CI)=0.70-0.93, respectively. For the HOMA-IR index, the AUC was 0.799 (95% CI = 0.69-0.91). The cut-off value for the TyG-H1 index was 9.5 with a sensitivity and specificity of 79.2% and 71.8%, respectively. The TyG index is a better way to assess the level of insulin resistance in pregnant women than using the HOMA index, especially after the first hour of a glucose load of 75g.

Published in Advances in Biochemistry (Volume 12, Issue 3)
DOI 10.11648/j.ab.20241203.11
Page(s) 92-98
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

TyG Index, HOMA-IR, Insulin Resistance, OGTT 75g, Gestational Diabetes

1. Introduction
Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance of varying severity that first appears during pregnancy. It is a common condition affecting 2 to 3% of pregnant women. Its prevalence varies from one country to another, with a clearer expansion in developing countries. In Senegal, the hospital prevalence is 34.5% while at the national level, it remains unclear.
The pathophysiological mechanism is thought to be a disturbance of carbohydrate homeostasis underpinned by insulin resistance at the origin of various metabolic disorders. Insulin resistance (IR) is characterized by hyperinsulinemia secondary to a decrease in insulin sensitivity on target organs and tissues. It is responsible for several types of complications during intra-uterine development. . The evaluation of this IR is not easy in clinical practice due to the lack of standardization of insulin dosage and especially because of the cost of its dosage in developing countries, thus making it difficult to evaluate the IR using the HOMA index (HOMA-IR).
The biological follow-up of pregnancy often involves the measurement of fasting blood sugar and lipid profile, including triglyceridemia. The TyG index is derived from fasting blood glucose and fasting triglyceridemia. This is a simple and reliable parameter in the evaluation of the IR . Many studies have reported a good correlation between the HOMA-IR index and the Triglyceride-Glucose Index (TyG) in the assessment of IR.
The aim of this study is to determine the performance of the TyG index in the diagnosis of insulin resistance during pregnancy.
2. Materials and Methods
This is a retrospective and analytical study conducted at the Biochemistry Department of the Aristide le Dantec Hospital in collaboration with the Gynaecology Department. Women with fasting blood glucose < 0.92 g/L at 12 weeks of amenorrhea (WA) benefited from the OGTT 75 test according to the WHO protocol. .
The data collected were age, age of pregnancy, a laboratory assessment with FBG, insulin and lipid profile with the determination of total cholesterol, its HDL and LDL fractions and triglycerides.
Assays were performed on Abbot’s Architect Ci4100. Blood glucose, urea, total cholesterol, HDL cholesterol and triglycerides were determined by enzymatic method. LDL cholesterol by Friedewall's formula and insulin by chemiluminescence.
The TyG index was calculated using the formula: Ln [fasting triglyceridemia (mg/dL) × fasting blood glucose (mg/dL)]/2 . The TyG index was calculated for the 3 blood glucose measurements, namely at H0 (TyG-H0), H1 (TyG-H1) and H2 (TyG-H2). The HOMA-IR was calculated by the formula: [GAJ (mmol/L)*Insulin (IU/mL)]/22.5 .
The statistical analysis was done using SPSS v.26 software. Bivariate analysis was performed with Spearman correlation and Fisher test allowed analysis of distribution parameters. The performance of the TyG index was assessed by the ROC curve. A value of p<0.05 was considered significant.
3. Results
The present study included 102 patients with a mean age of 29±5.9 years and extremes of 18 and 45 years. 62.7% of the women were in the third quarter of pregnancy.
The prevalence of gestational diabetes was 23.5% (N=24/102) (Table 1) and was higher in women under 30 years of age (n=14; 13.7%) and in women in the third trimester of pregnancy (n=18; 17.6%) (Table 2).
Table 1. Characteristics of the study population.

Characteristics

Number

Percentage

Age (years)

< 30

51

50

< 30

51

50

OGTT Test Period

2nd quarter

29

28,4

3rd quarter

64

62.7

Not determined

9

8.8

OPGH 75 Test

Positive

24

23.5

Negative

78

76.5

Table 2. Distribution of the study population by age and period of pregnancy.

Gestational diabetes

Yes (n=24)

No (n=78)

Age (years)

< 30

19 (18.6)

28 (27.5)

> 30

5 (4.9)

50 (49)

Test period

2nd quarter

18 (17.6)

20 (19.6)

3rd quarter

6 (5.9)

58 (56.9)

The table shows that blood glucose values are significantly higher in women with gestational diabetes as are the TyG index values for all three times (H0 (8.8±0.5vs8.2±0.5), H1 (9.6±0.3vs9.2±0.4) and H2 (9.1±0.4vs8.6±0.4); p< 0.001). There was no significant difference for the HOMA-IR index (6.4±16.8vs1.2±0.9, p=0.138) despite a higher mean value in women with gestational diabetes (Table 3).
Table 3. Variation in parameters by gestational diabetes.

Characteristics

General population

Gestational diabetes

Yes

No

p

Age (years)

29.1±5.9

29.9±6.4

28.8±5.7

0,480

H0 blood glucose (g/l)

0.8±0.2

1±0.2

0.7±0.1

< 0.0001*

H1 blood glucose (g/l)

1.4±0.3

1.8±0.3

1.2±0.2

< 0.0001*

H2 blood glucose (g/l)

1.2±0.4

1.7±0.4

1.1±0.2

< 0.0001*

Total cholesterol

1.9±0.6

2±0.8

1.8±0.6

0.340

HDL cholesterol

0.7±0.2

0.7±0.3

0.7±0.2

0.896

LDL cholesterol

1.1±0.5

1.2±0.6

1±0.4

0.265

Triglycerides

1.2±0.6

1.4±0.7

1.1±0.5

0.019*

Insulin

9.7±22.6

21.1±44.7

6.1±4.4

0.115

HOMA-IR

2.4±8.4

6.4±16.8

1.2±0.9

0.138

TyG_H0

8.3±0.5

8.8±0.5

8.2±0.5

< 0.0001*

TyG_H1

9.3±0.4

9.6±0.3

9.2±0.4

< 0.0001*

TyG_H2

8.7±0.5

9.1±0.4

8.6±0.4

< 0.0001*

*=p < 0.05, HDL=high-density lipoprotein, LDL=low-density lipoprotein, HOMA-IR=Homeostasic model assessment of insulin resistance
The TyG indices are not correlated with the age and its weakly correlated with the HOMA-IR index for the evaluation of insulin resistance, especially for TyG at the first hour of intake of the 75g glucose solution.
Table 4. Result of the bivariate analysis of the TyG indices and other parameters.

TyG-H0

TyG-H1

TyG-H2

r

p

r

p

r

p

Age

0.214

0.031

0.110

0.273

0.027

0.785

H0 blood glucose (g/l)

0.463

< 0.0001

0.386

< 0.0001

0.250

0.008

H1 blood glucose (g/l)

0.400

< 0.0001

0.725

< 0.0001

0.448

< 0.0001

H2 blood glucose (g/l)

0.419

< 0.0001

0.566

< 0.0001

0.613

< 0.0001

Total cholesterol

0.612

< 0.0001

0.534

< 0.0001

0.793

< 0.0001

HDL cholesterol

0.353

< 0.0001

0.497

< 0.0001

0.480

< 0.0001

LDL cholesterol

0.555

< 0.0001

0.458

< 0.0001

0.796

< 0.0001

Triglycerides (g/l)

0.885

< 0.0001

0.504

< 0.0001

0.631

< 0.0001

Insulin

0.223

0.025

0.206

0.038

0.171

0.151

IR-HOMA

0.314

0.001

0.405

< 0.0001

0.330

0.001

The analysis of the Receiver Operating Characteristic (ROC) curve shows a larger IR (AUC) with 0.818 () with the TyG index for a cut-off of 9.50 with a sensitivity and specificity of 79.2% and 71.8% respectively (Table 5, Figure 1).
Table 5. Distribution of performance indices for the evaluation of insulin resistance.

Clues

Cut-off

Se

Sp

AUC (CI)

p

TyG-H0

8.37

83.3

64.1

0.808 (0.70 – 0.92)

0.000 <1

TyG-H1

9.50

79.2

71.8

0.818 (0.70 – 0.93

TyG-H2

8.88

70.8

83.3

0.799 (0.69 – 0.91)

HOMA-IR

1.63

62.5

79.5

0.746 (0.63 – 0.86)

Se=Sensibility; Sp=Specificity.
Table 6 shows that all the indicators show the presence of insulin resistance in women with gestational diabetes with risk levels ranging from 6 to 10. During the index, the TyG-H2 index at the 8.88 threshold seems to better predict the risk of insulin resistance occurring during gestational diabetes.
Table 6. Association of insulin resistance with the occurrence of gestational diabetes.

Gestational diabetes

Yes (n=24)

No (n=78)

OR (IC)

p

TyG-H0

Yes

19 (18.6)

28 (27.5)

6.79 (2.3 – 20.1)

< 0.0001*

No

5 (4.9)

50 (49)

TyG-H1

Yes

18 (17.6)

20 (19.6)

8.7 (3 – 25)

< 0.0001*

No

6 (5.9)

58 (56.9)

TyG-H2

Yes

16 (15.7)

13 (12.7)

10 (3.5 – 28.2)

< 0.0001*

No

8 (7.8)

65 (63.7)

HOMA-IR

Yes

8 (7.8)

6 (5.9)

6 (1.8 – 19.7)

0.004

No

16 (15.7)

72 (70.6)

4. Discussion
This study was designed to evaluate insulin resistance in pregnant women with TyG indices obtained during an oral induced hyperglycaemia (OGTT) test of 75g.
A total of 102 pregnant patients with a mean age of 29±5.9 years (18-45 years) were included in the study. The prevalence of gestational diabetes was 23.5% (n=24). This prevalence is lower than the Leye et al study (34.3%) with patients whose average age is similar to this study (29.8 ± 6.2 years). Ozyildirim et al reported comparable results to the Leye et al study with a mean age of 33.1±4.9 when assessing cardiovascular risk in women with gestational diabetes. These results show that pregnancies generally occur at a very young age with the onset of earlier gestational diabetes, as we reported in this study with 79.17% of gestational diabetes cases occurring in women under 30 years of age.
Gestational diabetes occurs during an episode of insulin resistance with a decrease in glucose tolerance . To evaluate insulin resistance, several algorithms are proposed, including the TyG index, which takes into account both carbohydrate and lipid metabolism, including triglycerides. . The TyG index is a marker that correlates perfectly with other insulin resistance assessment algorithms such as the HOMA-IR. .
The correlations found were positive but relatively weak (r(TyG-H0)=0.314; r(TyG-H1)=0.405; r(TyG-H2)=0.330) with the HOMA-IR. This moderate correlation is also reported by Nachimuthu et al (r=474; p<0.0001), Wu et al (r=51) as well as in Yoon's study in diabetic children and adolescents (r=0.189). .
The study of the performance of the TyG indices during the OGTT test showed that the index at the 1st hour (TyG-H1) with an AUC=0.818 (0.7 – 0.93) and a cut-off of 9.50 had a sensitivity and specificity of 79.2% and 71.8% respectively which were better. However, the TyG-H0 index shows a higher sensitivity of 83.3% with a cut-off of 8.37 and the TyG-H2 index shows a higher specificity of 83.3% with a cut-off of 8.88. Zeng et al reported a lower AUC=0.57 (CI=0.5 – 0.62) and performance (Se=40.34% and Sp=74.54) with a cut-off of 9.07 . Other authors have reported lower performance of the TyG index for RI assessments during gestational diabetes. This is the case of the study by Guo et al (AUC=0.641(0.611-0.671); Se=61.7% and Sp=61.7%) and Selvi et al (AUC=0.802 (0.73-0.875)) .
Women with gestational diabetes had significantly higher blood glucose, triglyceride and TyG values at the various times of the OGTT 75 test. Zeng et al also reported significantly higher blood glucose (0.81vs1 g/L; p<0.001) and TyG index (8.68vs8.82; p=0.023) in women with gestational diabetes. However, in Zeng's study, women with gestational diabetes had lower triglyceride values (1.65vs1.61 g/L) as well as for other lipid parameters . In the Ozyildirim study, lipid parameters as well as blood glucose levels are more disturbed in women with gestational diabetes compared to control .
5. Conclusion
The Triglycerides-Glucose Index (TyG) is a good marker for the assessment of insulin resistance in gestational diabetes. It is most interesting when determined at the first of an orally induced hyperglycaemia test with 75g of glucose.
Abbreviations

AUC

Area Under the Curve

CI

Confidence Interval

FBG

Fasting Blood Glucose

GDM

Gestational Diabetes Mellitus

HDL

High-Density Lipoprotein

HOMA-IR

Homeostasic Model Assessment of Insulin Resistance

LDL

Low-Density Lipoprotein

OGTT

Ora Glucose Tolerance Test

ROC

Receiver Operating Characteristic

Se

Sensitivity

Sp

Specificity

TyG

Triglycerides-Glucose Index

WHO

World Health Organization

WA

Weeks of Amenorrhea

Author Contributions
Thiam Souleymane: Conceptualization, Data curation, Formal Analysis, Methodology, Resources, Software, Writing – original draft, Writing – review & editing
Soumah Idrissa Yaya: Conceptualization, Investigation, Methodology
Samba Adourahmane: Conceptualization, Investigation, Methodology, Validation
Diedhiou Fatou: Investigation, Methodology
Dia Fatou Kine Sy Thorpe: Investigation, Methodology
Ba Ramatoulaye: Investigation, Methodology
Tounkara Abdoulaye Racine: Investigation, Methodology
Agossou Hortence Honrine Medece: Investigation, Methodology
Coly Najah Fatou: Investigation, Methodology
Diouf Niokhor N. dande: Investigation, Methodology
Ndiaye Arame: Supervision, Validation
Doupa Dominique: Supervision, Validation
Cisse Fatou: Supervision, Validation, Visualization, Writing – review & editing
Diatta Alassane: Supervision, Visualization, Writing – review & editing
Diallo Fatou: Supervision, Validation, Visualization, Writing – review & editing
Conflicts of Interest
The authors declare no conflicts of interest.
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    Souleymane, T., Yaya, S. I., Adourahmane, S., Fatou, D., Thorpe, D. F. K. S., et al. (2024). Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test. Advances in Biochemistry, 12(3), 92-98. https://doi.org/10.11648/j.ab.20241203.11

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    Souleymane, T.; Yaya, S. I.; Adourahmane, S.; Fatou, D.; Thorpe, D. F. K. S., et al. Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test. Adv. Biochem. 2024, 12(3), 92-98. doi: 10.11648/j.ab.20241203.11

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    AMA Style

    Souleymane T, Yaya SI, Adourahmane S, Fatou D, Thorpe DFKS, et al. Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test. Adv Biochem. 2024;12(3):92-98. doi: 10.11648/j.ab.20241203.11

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  • @article{10.11648/j.ab.20241203.11,
      author = {Thiam Souleymane and Soumah Idrissa Yaya and Samba Adourahmane and Diedhiou Fatou and Dia Fatou Kine Sy Thorpe and Ba Ramatoulaye and Tounkara Abdoulaye Racine and Agossou Hortence Honrine Medece and Coly Najah Fatou and Diouf Niokhor N. dande and Ndiaye Arame and Doupa Dominique and Cisse Fatou and Diatta Alassane and Diallo Fatou},
      title = {Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test
    },
      journal = {Advances in Biochemistry},
      volume = {12},
      number = {3},
      pages = {92-98},
      doi = {10.11648/j.ab.20241203.11},
      url = {https://doi.org/10.11648/j.ab.20241203.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ab.20241203.11},
      abstract = {The Triglyceride-Glucose (TyG) index is a marker used to assess insulin resistance which is associated with the occurrence of gestational diabetes. The aim of this study is to determine the benefit of the TyG within the diagnosis of insulin resistance in pregnant women in an orally induced hyperglycaemia test. This study was conducted at the Department of Biochemistry, at Aristide le Dantec University Hospital in collaboration with the department of gynaecology. Women with fasting blood glucose 1 index was 9.5 with a sensitivity and specificity of 79.2% and 71.8%, respectively. The TyG index is a better way to assess the level of insulin resistance in pregnant women than using the HOMA index, especially after the first hour of a glucose load of 75g.},
     year = {2024}
    }
    

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    T1  - Contribution of the Triglycerides-Glucose Index (TyG) in the Assessment of Insulin Resistance in Pregnant Women During an OGTT Test
    
    AU  - Thiam Souleymane
    AU  - Soumah Idrissa Yaya
    AU  - Samba Adourahmane
    AU  - Diedhiou Fatou
    AU  - Dia Fatou Kine Sy Thorpe
    AU  - Ba Ramatoulaye
    AU  - Tounkara Abdoulaye Racine
    AU  - Agossou Hortence Honrine Medece
    AU  - Coly Najah Fatou
    AU  - Diouf Niokhor N. dande
    AU  - Ndiaye Arame
    AU  - Doupa Dominique
    AU  - Cisse Fatou
    AU  - Diatta Alassane
    AU  - Diallo Fatou
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    AB  - The Triglyceride-Glucose (TyG) index is a marker used to assess insulin resistance which is associated with the occurrence of gestational diabetes. The aim of this study is to determine the benefit of the TyG within the diagnosis of insulin resistance in pregnant women in an orally induced hyperglycaemia test. This study was conducted at the Department of Biochemistry, at Aristide le Dantec University Hospital in collaboration with the department of gynaecology. Women with fasting blood glucose 1 index was 9.5 with a sensitivity and specificity of 79.2% and 71.8%, respectively. The TyG index is a better way to assess the level of insulin resistance in pregnant women than using the HOMA index, especially after the first hour of a glucose load of 75g.
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