The Exploration of the Triglyceride-to-High-Density Lipoprotein Cholesterol Ratio and the Risk of Type 2 Diabetes Onset
LI Xiangbo
LIU Hongzhou
YAN Shuangtong
BAI Baojun
KANG Hui
Abstract：Objective To investigate the relationship between the triglyceride to high-density lipoprotein cholesterol(TG/HDL-C)ratio and the risk of developing type 2 diabetes mellitus(T2DM),and to determine its optimal cutoff value.Methods This retrospective cohort study included 12,483 adults who underwent health examinations at RICI Healthcare between 2010 and 2016.The dataset has been uploaded to the Dryad repository.Using the downloaded database,the TG/HDL-C ratio was calculated.Participants were divided into groups Q1,Q2,and Q3 according to tertiles of the TG/HDL-C ratio.Cox proportional hazards regression models were used to assess the association between the TG/HDL-C ratio,modeled as both a continuous variable and a categorical variable,and the risk of incident T2DM.Using the median TG/HDL-C ratio(0.8773),the 12 483 participants were divided into a low TG/HDL-C ratio group(n=6 241)and a high TG/HDL-C ratio group(n=6 242).Kaplan Meier curves were plotted to depict changes in T2DM incidence over follow-up time in the two groups,and the log-rank test was used to compare differences between them.Receiver operating characteristic(ROC)curve analysis was employed to determine the optimal cutoff value of the TG/HDL-C ratio for predicting T2DM risk at 3,4,and 5 years.Results After adjusting for other confounding factors,each 1-unit increase in the TG/HDL-C ratio was associated with a 1.19-fold higher risk of T2DM(HR=1.19,95%CI:1.10-1.28,P<0.001).Analysis by tertiles of the TG/HDL-C ratio showed that,after adjustment,the risks of T2DM in both the Q2 and Q3 groups were significantly higher than in the Q1 group.The risk in the Q2 group was 1.24 times that of the Q1 group(HR=1.24,95%CI:0.77-1.99,P=0.380),and the risk in the Q3 group was 1.91 times that of the Q1 group(HR=1.91,95%CI:1.21-2.99,P=0.005).The P-values for trend across the three models were all<0.001.Kaplan Meier curve analysis showed that T2DM incidence gradually increased over follow-up time in both the low and high TG/HDL-C ratio groups.The log-rank test indicated a higher risk of incident T2DM in the high TG/HDL-C ratio group compared to the low ratio group(Log-rank χ²=71.43,P<0.001).At the 3-year follow-up,the area under the ROC curve(AUC),cutoff value,sensitivity,specificity,and Youden index for predicting incident T2DM using the TG/HDL-C ratio were 0.675,0.766,61.08%,67.86%,and 0.289,respectively.At 4 years,the corresponding values were 0.688,0.713,59.92%,70.90%,and 0.308.At 5 years,they were 0.706,0.716,62.68%,72.43%,and 0.351.The AUC values at different time points from 2 to 5.5 years also gradually increased with longer follow-up duration.Conclusion The TG/HDL-C ratio,as a simple and effective biomarker,can be used for the early prediction of T2DM risk and demonstrates relatively high predictive value during long-term follow-up.
Keywords：triglycerideshigh-density lipoprotein cholesteroltype 2 diabetes mellitusriskCox proportional hazards model
Publication Date：2026-03-20
Online Publishing Date：2026-03-26(First online date of this platform, not the publication date of the document)
Pages：5( 516-520 )