Clinical Scorecard: Correlation of Triglyceride-Glucose Index with Diabetic Retinopathy in Diabetic Patients in Nepal: A Cross-Sectional Analysis

At a Glance

Key Highlights

• Diabetic retinopathy affects nearly one-third of individuals with diabetes and is a leading cause of preventable visual impairment.
• The triglyceride–glucose (TyG) index is a validated surrogate marker of insulin resistance using fasting plasma glucose and triglyceride levels.
• This study evaluates the TyG index as a screening tool for diabetic retinopathy severity in a Nepalese clinical setting.

Guideline-Based Recommendations

Diagnosis

• Use fasting plasma glucose and triglyceride levels to calculate the TyG index as a surrogate marker of insulin resistance.
• Perform dilated fundus examination and classify diabetic retinopathy severity using the International Clinical Diabetic Retinopathy (ICDR) Severity Scale.

Management

• Identify patients with elevated TyG index for early risk stratification of diabetic retinopathy.
• Manage modifiable risk factors including glycaemic control, lipid levels, and blood pressure to reduce progression of diabetic retinopathy.

Monitoring & Follow-up

• Regular ophthalmic assessments for diabetic patients, especially those with higher TyG index values.
• Monitor HbA1c, lipid profile, and blood pressure alongside TyG index for comprehensive risk evaluation.

Risks

• Higher TyG index is associated with increased risk and severity of diabetic retinopathy.
• Insulin resistance contributes to microvascular complications through metabolic and inflammatory pathways.

Patient & Prescribing Data

Adult diabetic patients attending tertiary care hospital in Nepal

TyG index can aid in identifying patients at higher risk for diabetic retinopathy to optimize management and monitoring strategies.

Clinical Best Practices

• Calculate TyG index using routinely available fasting plasma glucose and triglyceride measurements for insulin resistance assessment.
• Use standardized diabetic retinopathy classification scales for consistent severity grading.
• Incorporate TyG index into risk stratification models alongside traditional clinical and laboratory parameters.
• Exclude confounding conditions affecting lipid or glucose metabolism when interpreting TyG index.
• Apply multivariable logistic regression to adjust for confounders when assessing TyG index association with diabetic retinopathy.

References

• International Clinical Diabetic Retinopathy Severity Scale
• Validation of TyG index as surrogate marker of insulin resistance
• Prevalence of diabetic retinopathy in diabetes