​​TyG Index May Help Identify Those at Risk of Vision-threatening DR

The triglyceride-glucose (TyG) index—which combines fasting blood glucose and triglyceride levels—and its obesity-related derivatives have emerged as surrogate markers for metabolic dysfunction. It has even emerged as a significant tool in assessing the risk and management of diabetic retinopathy (DR) in patients with type 2 diabetes. Chinese researchers have recently conducted a comprehensive analysis of the cross-sectional and longitudinal associations between TyG-derived indices and various diabetic retinal microvascular abnormalities, including DR, advanced DR, vision-threatening DR (VTDR), diabetic macular edema (DME) and retinal vascular metrics changes.Their study determined that we identified significant associations of the TyG index and its derived indices (TyG x waist-to-hip ratio and TyG x waist-to-height ratio) with clinically significant diabetic retinal microvascular abnormalities, particularly with severe forms of DR as well as early retinal capillary manifestations such as soft exudate lesions, an early DR vascular abnormality. In patients with type 2 diabetes, TyG-derived indices can effectively predict both early and severe retinal outcomes, highlighting their potential clinical utility in identifying patients at risk for advanced DR, and clinicians should consider earlier retinal evaluations or OCT imaging. These graphs from the study show the increased odds of various DR subgroups for subjects with higher TyG index values. Photo: Wang Y, et al. Ophthalmol Sci. April 3, 2026. Click image to enlarge. “The strong TyG x waist-to-height ratio to soft exudate link in our study is potentially clinically useful,” the study authors wrote in their paper, which was published in Ophthalmology Science. “It can be calculated from a fasting lipid/glucose panel and a tape-measure; it offers a cheap, noninvasive triage tool to identify patients who should receive early fundus imaging or OCT angiography before VTDR emerges, and it provides a modifiable target for lifestyle or pharmacologic strategies aimed at trimming visceral fat and improving insulin sensitivity.”The prospective cohort study included 1,960 adults with type 2 diabetes, followed for a mean of 21.2 months. Associations of TyG and TyG-derived indices with these outcomes were assessed using regression models with multivariable adjustments.At baseline, TyG and TyG x waist-to-hip ratio were significantly associated with advanced DR (odds ratio, OR ≥2.12), VTDR (OR ≥1.77), and DME (OR ≥1.79). TyG and the TyG×waist-to-height ratio were also significantly linked to soft exudates (OR ≥1.71). Longitudinally, the TyG x waist-to-height ratio predicted incident advanced DR (OR range: 1.7 to 18.8). Mediation analysis showed HbA1c mediated these associations, suggesting both glycemic and non-glycemic mechanisms.“Our findings support the concept of cumulative metabolic burden exerting progressive retinal damage and underscore the TyG index's utility as a continuous marker for clinical risk stratification,” the researchers wrote.Nevertheless, the team did note the TyG index currently serves as a surrogate marker for insulin resistance rather than a direct measure, making it susceptible to confounding factors. Also, although longitudinal data were available, the relatively short follow-up period and limited number of incident retinal events constrained the study’s statistical power. Click here for the journal source. Wang Y, Zang B, Zhao J, et al. Triglyceride-glucose indexes are predictive of early and severe diabetic retinal microvascular abnormalities: a prospective cohort study. Ophthalmol Sci. April 3, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.