Fasting triglycerides and glucose index: a useful screening test for assessing insulin resistance in patients diagnosed with rheumatoid arthritis and systemic lupus erythematosus

Betsabe Contreras-Haro; Sandra Ofelia Hernandez-Gonzalez; Laura Gonzalez-Lopez; Maria Claudia Espinel-Bermudez; Leonel Garcia-Benavides; Edsaul Perez-Guerrero; Maria Luisa Vazquez-Villegas; Jose Antonio Robles-Cervantes; Mario Salazar-Paramo; Diana Mercedes Hernandez-Corona; Arnulfo Hernan Nava-Zavala; Jorge I Gamez-Nava

doi:10.1186/s13098-019-0495-x

Fasting triglycerides and glucose index: a useful screening test for assessing insulin resistance in patients diagnosed with rheumatoid arthritis and systemic lupus erythematosus

Diabetol Metab Syndr. 2019 Nov 27:11:95. doi: 10.1186/s13098-019-0495-x. eCollection 2019.

Authors

Affiliations

¹ 1Departamento de Ciencias Biomédicas, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco Mexico.
² 2Unidad de Investigación Biomédica 02, and División de Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco Mexico.
³ 3Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco Mexico.
⁴ 4Programa de Doctorado en Salud Publica e Instituto de Investigación en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (U de G), Guadalajara, Jalisco Mexico.
⁵ Division of Internal Medicine, Jalisco Institute of Reconstructive Surgery "Dr. José Guerrerosantos", Guadalajara, Jalisco Mexico.
⁶ 6Programa Internacional, Facultad de Medicina, Universidad Autónoma de Guadalajara, Av. Patria No. 1201, Lomas del Valle, CP 45129 Zapopan, Jalisco Mexico.
⁷ 7Departamento de Inmunología y Reumatología, Hospital General de Occidente, Secretaria de Salud Jalisco, Zapopan, Jalisco Mexico.

Abstract

Background: Insulin resistance (IR) is frequently observed in patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). In clinical practice, IR assessment is limited to a low proportion of patients due to cost and equipment and technical expertise requirements. The surrogate index of triglycerides and glucose (TyG index) has been validated in non-rheumatic populations, showing adequate sensitivity and specificity for IR, although this index has not yet been used in connective tissue disorders. The aim of this study was to evaluate the frequency of insulin resistance (IR) using the validated surrogate index of triglycerides and glucose (TyG index) and to explore factors associated with IR in Mexican women with RA or SLE.

Methods: Ninety-five female RA and 57 SLE patients were included in a cross-sectional study. Clinical and epidemiological variables were evaluated. IR was assessed using the TyG index with a cutoff value of > 4.68. Logistic regression analysis was performed to identify factors associated with IR excluding confounders.

Results: IR frequency in the entire sample was 50%, higher than the 10% observed in non-rheumatic controls (p < 0.001). The frequency of IR was similar in SLE (49.1%) and RA (50.5%, p = 0.8) patients. IR was associated with a longer duration of hypertension and higher total cholesterol and low density lipoprotein cholesterol levels. Based on multivariate analysis, the duration of hypertension (OR: 1.06; 95% CI 1.002-1.12, p = 0.04), waist circumference (OR: 1.04; 95% CI 1.01-1.08, p = 0.007), uric acid levels (OR: 1.46; 95% CI 1.08-1.97, p = 0.01), RA (OR: 4.87; 95% CI 1.31-18.78, p = 0.01) and SLE (OR: 4.22; 95% CI 1.06-16.74, p = 0.04) were the main risk factors for IR.

Conclusions: This study shows that the TyG index is a useful screening test for IR in RA and SLE patients. Future longitudinal studies should be performed with the aim of identifying the predictive value of TyG index results for identifying complications linked to IR.

Keywords: Connective tissue diseases; Insulin resistance; Screening test.