Elevated triglyceride-glucose index is associated with increased risk of chronic kidney disease and end-stage renal disease in type 1 diabetes: Nationwide cohort study

Aims: Prognostic markers for microvascular complications in type 1 diabetes are needed because factors beyond hyperglycaemia contribute to this risk. The triglyceride-glucose (TyG) index is an established marker of vascular complications in type 2 diabetes; however, its clinical significance in type 1 diabetes remains unknown. We aimed to investigate the association between the TyG index and long-term renal outcomes in a nationwide cohort of adults with type 1 diabetes. Materials and Methods: In this nationwide cohort study of 14 782 adults with type 1 diabetes from the Korean National Health Insurance Service database, we used Cox proportional hazards models to evaluate the risk of incident chronic kidney disease (CKD) and end-stage renal disease (ESRD) across quartiles of the baseline TyG index during a median follow-up of 7.04 years. Results: A significant dose–response relationship was observed between the TyG index and adverse renal outcomes. After multivariable adjustment, the highest TyG quartile (Q4) had a 2.15-fold (95% confidence interval, 1.87–2.48) and a 2.90-fold (95% confidence interval, 2.25–3.75) higher risk of developing CKD and ESRD, respectively, than the lowest quartile (Q1) (p for trend <0.001 for both). These associations remained significant in a competing-risk analysis that included all-cause mortality. Additionally, higher TyG quartiles were associated with a progressively worsening distribution of 5-year CKD stages. Conclusions: The TyG index may serve as a valuable clinical indicator to identify individuals with type 1 diabetes at high risk for developing incident CKD and ESRD.