Discriminating prevalent type 2 diabetes among community-dwelling older adults with metabolic dysfunction-associated steatotic liver disease: a comparative analysis of 12 insulin resistance surrogates.
Metabolic dysfunction-associated steatotic liver disease frequently coexists with type 2 diabetes mellitus (T2DM). Because the gold standard for assessing insulin resistance (IR) is difficult to implement in primary care settings, this cross-sectional study aimed to compare the associations and discriminatory ability of 12 surrogate IR indexes for prevalent T2DM among community-dwelling older adults with metabolic dysfunction-associated fatty liver disease.
This study was based on a health examination cohort from a community in northwestern China and included 2641 eligible participants, of whom 605 were older adults with metabolic dysfunction-associated steatotic liver disease. Multivariable logistic regression, receiver operating characteristic (ROC) curve analysis, restricted cubic spline (RCS) analysis, subgroup analysis, and exploratory internal model-discrimination analyses were performed to evaluate the associations and discriminatory ability of 12 surrogate IR indexes for prevalent T2DM.
After multivariable adjustment, TyG, TyG-ABSI, TyG-WWI, and TyG-WC were significantly associated with prevalent T2DM in participants with metabolic dysfunction-associated steatotic liver disease (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, it performed significantly better than the other indicators. Sensitivity analyses addressing the mathematical coupling between TyG and T2DM diagnostic criteria confirmed the robustness of these findings. Even after excluding T2DM cases defined solely by fasting plasma glucose, TyG remained the best-performing index (AUC = 0.707). RCS analyses showed significant overall associations but did not support statistically significant nonlinearity for TyG, TyG-ABSI, TyG-WWI, or TyG-WC (all P-nonlinear > 0.05). No significant interactions were observed in subgroup analyses.
TyG, TyG-ABSI, TyG-WWI, and TyG-WC were associated with prevalent T2DM and showed moderate discriminatory ability. Sensitivity analyses addressing the shared FPG component confirmed the robustness of these associations. These findings support TyG as a simple, integrated metabolic marker for alerting to prevalent T2DM in this population.
This study was based on a health examination cohort from a community in northwestern China and included 2641 eligible participants, of whom 605 were older adults with metabolic dysfunction-associated steatotic liver disease. Multivariable logistic regression, receiver operating characteristic (ROC) curve analysis, restricted cubic spline (RCS) analysis, subgroup analysis, and exploratory internal model-discrimination analyses were performed to evaluate the associations and discriminatory ability of 12 surrogate IR indexes for prevalent T2DM.
After multivariable adjustment, TyG, TyG-ABSI, TyG-WWI, and TyG-WC were significantly associated with prevalent T2DM in participants with metabolic dysfunction-associated steatotic liver disease (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, it performed significantly better than the other indicators. Sensitivity analyses addressing the mathematical coupling between TyG and T2DM diagnostic criteria confirmed the robustness of these findings. Even after excluding T2DM cases defined solely by fasting plasma glucose, TyG remained the best-performing index (AUC = 0.707). RCS analyses showed significant overall associations but did not support statistically significant nonlinearity for TyG, TyG-ABSI, TyG-WWI, or TyG-WC (all P-nonlinear > 0.05). No significant interactions were observed in subgroup analyses.
TyG, TyG-ABSI, TyG-WWI, and TyG-WC were associated with prevalent T2DM and showed moderate discriminatory ability. Sensitivity analyses addressing the shared FPG component confirmed the robustness of these associations. These findings support TyG as a simple, integrated metabolic marker for alerting to prevalent T2DM in this population.