An affordable approach to classifying type 2 diabetes based on fasting plasma glucose, TyG index and BMI: a retrospective cohort study of NHANES Data from 1988 to 2014

Abstract

Background: The β-cell function and insulin resistance required by existing methods of classifying type 2 diabetes are not routinely adopted in most medical institutions of developing countries and regions. This study aims to propose a novel, affordable classification approach and evaluate its predictive ability for several health and mortality outcomes, including cardiovascular health (CVH), retinopathy, chronic kidney disease (CKD), nonalcoholic fatty liver disease (NAFLD), advanced liver fibrosis, and mortality caused by all-cause, cardiovascular disease (CVD), cancer. Methods: Based on 4060 participants with diabetes (aged ≥ 30 at the time of diagnosis) selected from the National Health and Nutrition Examination Survey III & 1999–2014, we proposed a novel, but simple classification approach based on the threshold of fasting plasma glucose (FPG), triglyceride-glucose (TyG) index and body mass index (BMI). We used logistic regression model to assess its predictability for diabetes complications, and Cox regression model to estimate the mortality risks. Results: By utilizing this approach, we characterized the subjects into four subgroups: subgroup A (obesity-related), which accounts for 37% of the total, subgroup B (age-related), 38%, subgroup C (insulin resistance), 20%, and subgroup D (severe insulin deficiency), 5%. Subjects in subgroup D had a higher risk of retinopathy, in subgroup B had a lower risk of poor cardiovascular health, nonalcoholic fatty liver disease, and advanced liver fibrosis, in subgroup C had a higher risk of all-cause mortality. Conclusions: This study proposes an affordable and practical method for classifying patients with type 2 diabetes into different subgroups, with a view to yield a high predictability of patient outcomes and to assist clinicians in providing better treatment.