ArticlePloS one2026
Association between the triglyceride-glycated hemoglobin index and diabetes risk among patients with Non-alcoholic fatty liver disease: A longitudinal cohort study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEmerging evidence suggests that the triglyceride-glycated hemoglobin index (TyH-i) may be a novel predictor of type 2 diabetes (T2D) risk. However, in patients diagnosed with NAFLD, the precise link between TyH-i and T2D is still not well elucidated. Currently, the literature lacks sufficient research on how this index affects the incidence of diabetes in the NAFLD population, highlighting a significant gap in our understanding of the interactions between these metabolic conditions. This research seeks to evaluate the association between the TyH-i and diabetes risk, as well as to investigate its predictive capability in patients with NAFLD concerning the triglyceride-glucose index (TyG-i).
methodsBased on the data of 2741 participants who had no diabetes at baseline and suffered from NAFLD, leveraging a nationwide retrospective cohort, we derived the TyH-i as the natural logarithm of [HbA1c (%) × fasting TG (mg/dL) ÷ 2].To assess the relationship between TyH-i and the risk of developing T2D, a Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI). Furthermore, the nonlinear correlations between them were also investigated using the restricted cubic spline model. We gauged the relative discriminatory capacity of TyH-i versus TyG-i by constructing time-dependent receiver-operating characteristic (ROC) plots and comparing the corresponding areas under the curve (AUC) with their 95% CI.
resultsIn a median follow-up duration of 5.21 years, incident diabetes was recorded in 223 individuals. The multivariable-adjusted analysis revealed that each unit increase in TyH-i corresponds to a 46% elevation in diabetes risk (HR: 1.75; 95%CI: 1.28-2.41; P = 0.0005). Additionally, a U-shaped relationship was identified between TyH-i levels and the occurrence of type 2 diabetes. Specifically, TyH-i values below 4.95 displayed a notable inverse association with the risk of type 2 diabetes (HR: 0.20, 95%CI: 0.05-0.78, P = 0.0206). Conversely, an elevation in TyH-i levels beyond this threshold was linked to a higher risk of developing type 2 diabetes (HR: 2.01, 95% CI: 1.45-2.39, P < 0.0001). Furthermore, the findings indicate that the Youden Index for both TyH-i and TyG-i is nearly identical, implying that TyH-i may serve as a valid marker for diabetes diagnosis.
conclusionAmong the patient population suffering from NAFLD, the initial TyH-i level demonstrated a U-shaped correlation with the emergence of type 2 diabetes. This indicated inflection point can act as a practical clinical threshold, allowing differentiation between individuals at low and high risk. The findings imply that keeping TyH-i close to this inflection may play a role in mitigating the progression to diabetes among NAFLD patients.
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