Using the triglyceride-glucose index and derived indexes to forecast progression from pre-diabetes to diabetes: A 3-year follow-up study

doi:10.4239/wjd.v17.i2.114253

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. Feb 15, 2026; 17(2): 114253
Published online Feb 15, 2026. doi: 10.4239/wjd.v17.i2.114253

Using the triglyceride-glucose index and derived indexes to forecast progression from pre-diabetes to diabetes: A 3-year follow-up study

Bing Wang, Ming-Chuan Liu, Xu-Han Liu, Zhu Zhu, Ying-Shu Liu, Ting-Ting Zhang, Xin-Yu Li, Zheng-Nan Gao

Bing Wang, Xu-Han Liu, Zhu Zhu, Ying-Shu Liu, Ting-Ting Zhang, Xin-Yu Li, Zheng-Nan Gao, Department of Endocrinology and Metabolism, Central Hospital of Dalian University of Technology, Dalian 116033, Liaoning Province, China

Ming-Chuan Liu, Graduate School, Dalian Medical University, Dalian 116044, Liaoning Province, China

Co-corresponding authors: Xin-Yu Li and Zheng-Nan Gao.

Author contributions: Wang B was the guarantor and designed the study, and was responsible for conceptualization, project administration, supervision, methodology, writing, review and editing; Liu MC and Liu XH were responsible for data curation, methodology, supervision and participated in formal analysis; Zhu Z and Zhang TT participated in data curation; Liu YS was responsible for formal analysis; Li XY and Gao ZN were responsible for methodology, formal analysis, writing, review and editing.

Supported by the National Science and Technology Support Program Project, No. 2013BAI09B13; Natural Science Foundation of Liaoning Province, No. 2021-BS-294; and Dengfeng Project of Dalian Medical Discipline Priority, No. 2022ZZ258, No. 2023ZZ025, No. 2024ZZ016 and No. 2024ZZ034.

Institutional review board statement: The study was approved by the Institutional Research Ethics Committee of Ruijin Hospital Affiliated to the Medical School of Shanghai Jiao Tong University.

Clinical trial registration statement: This study is an observational cohort study and does not fall under the definition of a clinical trial requiring registration.

Informed consent statement: All subjects participated in the study voluntarily and provided informed consent prior to enrollment.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: For privacy and ethical reasons, the individual-level data from this clinical trial cannot be made publicly available. However, de-identified data may be made available to qualified researchers upon reasonable request, subject to a data sharing agreement and approval from the corresponding author and the institutional ethics committee.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Zheng-Nan Gao, MD, Professor, Department of Endocrinology and Metabolism, Central Hospital of Dalian University of Technology, No. 826 Xinan Road, Dalian 116033, Liaoning Province, China. gao2008@163.com

Received: September 23, 2025
Revised: October 25, 2025
Accepted: December 17, 2025
Published online: February 15, 2026
Processing time: 136 Days and 1.1 Hours

Abstract

BACKGROUND

Pre-diabetes is a transitional metabolic stage between health and diabetes, serving as a critical warning signal for disease progression. Early intervention targeting risk factors in prediabetic individuals prevents the progression to type 2 diabetes.

AIM

To investigate the predictive value of the triglyceride-glucose (TyG) index and its derived indicators for new-onset diabetes in patients with pre-diabetes.

METHODS

A prospective community-based cohort study was carried out based on subjects aged over 40 years with pre-diabetes in Dalian, Liaoning Province, China. A total of 1352 subjects with complete follow-up data attended the follow-up survey. Multivariable Cox regression models were performed to assess the association of the TyG index and its derived indicators with risk of diabetes in patients with pre-diabetes. The diagnostic values of the TyG index and derived indicators in predicting new-onset diabetes were analyzed, and suitable cutting points were determined using the receiver operating characteristic (ROC) curve.

RESULTS

During a 3-year follow-up period, 153 cases with incident diabetes were identified, with a cumulative incidence of diabetes of 11.3%; 12.6% (43/341) in males and 10.9% (110/1011) in females (χ² = 0.760, P = 0.375). After adjusting for confounding factors including age, gender, body mass index (BMI) and insulin levels, the risk of diabetes with higher TyG and derived indexes [TyG-BMI and TyG-waist circumference index (TyG-WC)] increased significantly. The TyG index [hazard ratio (HR) = 1.389, 95% confidence interval (CI): 1.011-1.908, P = 0.043], TyG-BMI (HR = 1.010, 95%CI: 1.005-1.015, P = 0.000) and TyG-WC (HR = 1.003, 95%CI: 1.001-1.005, P = 0.001) were all strongly positively correlated with the risk of future diabetes. The ROC curve analysis showed that the area under the curve (AUCs) of the TyG, TyG-BMI and TyG-WC for predicting new diabetes were 0.578 (95%CI: 0.533-0.624), 0.622 (95%CI: 0.574-0.670) and 0.609 (95%CI: 0.562-0.657), respectively. The difference in AUC between TyG-BMI and TyG was significant (P = 0.047), while the differences between TyG-BMI and TyG-WC (P = 0.464) and between TyG-WC and TyG (P = 0.175) were not. The TyG-BMI had a larger AUC than the TyG and TyG-WC, and its difference from TyG was significant. The best cut-off points for predicting new diabetes were TyG > 8.6, TyG-BMI > 247 and TyG-WC > 860. Although the AUC values were modest, these indices may serve as preliminary screening tools in resource-limited settings.

CONCLUSION

The TyG index and its derived indicators were risk factors for the pre-diabetes to diabetes outcome, and may be regarded as predictors of the outcome. The risk of conversion of pre-diabetes to diabetes increased with increases in the TyG index and its derived indicators. The TyG-BMI was better than TyG and TyG-WC in predicting the 3-year outcome for diabetes. Although these indices could aid in the initial risk stratification in primary care, their modest accuracy warrants cautious interpretation.

Keywords: Triglyceride-glucose index; Triglyceride-glucose-body mass index; Triglyceride-glucose-waist circumference index; Pre-diabetes; Diabetes; Prospective cohort study

Core Tip: Pre-diabetes is an abnormal state of glucose metabolism between normal glucose tolerance and diabetes. If early intervention is carried out for risk factors in a pre-diabetic population, the occurrence and development of diabetes can be prevented. The triglyceride-glucose (TyG) index is a new index calculated according to triglycerides and fasting plasma glucose test. The latest research suggests that the TyG index and its derivative indexes, such as the product of TyG index and body mass index and the product of TyG index and waist circumference are novel and surrogate markers for insulin resistance. We prospectively investigated the relationship between TyG index and derived indexes and incident type 2 diabetes using a large sample, community-based cohort, aim at to find a simple indicator predicting the progression of a pre-diabetic population to diabetes, to allow relevant early-stage intervention in a pre-diabetic population and so reduce diabetes incidence.