Objective:

To compare the associations and discriminatory ability of 12 surrogate insulin resistance indexes for prevalent type 2 diabetes mellitus among community-dwelling older adults with metabolic dysfunction-associated fatty liver disease.

Approach:

• Study Design: Cross-sectional study based on a health examination cohort from a community in northwestern China.
• Participants: 2641 eligible participants, including 605 older adults with metabolic dysfunction-associated steatotic liver disease.
• Methods: Multivariable logistic regression, ROC curve analysis, RCS analysis, subgroup analysis, and exploratory internal model-discrimination analyses were performed.

Key Findings:

• After multivariable adjustment, TyG, TyG-ABSI, TyG-WWI, and TyG-WC were significantly associated with prevalent T2DM (all P < 0.05).
• TyG showed the highest discriminatory ability (AUC = 0.726, 95% CI: 0.686-0.766) with an optimal cut-off value of 9.225.
• After Bonferroni correction, TyG performed significantly better than other indicators.
• TyG remained the best-performing index even after excluding T2DM cases defined solely by fasting plasma glucose (AUC = 0.707).

Interpretation:

TyG and its variants are associated with prevalent T2DM and demonstrate moderate discriminatory ability in older adults with metabolic dysfunction-associated steatotic liver disease.

Limitations:

• The study is cross-sectional, limiting causal inferences.
• Data were extracted from routine health examination records, which may have inherent biases.

Conclusion:

TyG is a simple, integrated metabolic marker for identifying prevalent T2DM in older adults with metabolic dysfunction-associated fatty liver disease.