Association analysis and exploratory mediation study of the stress-induced hyperglycaemia ratio and glycaemic ratio indices with diabetic retinopathy in patients with type 2 diabetes.

OBJECTIVE

Diabetic retinopathy (DR) is a major microvascular complication of type 2 diabetes mellitus (T2DM), and traditional glycaemic control indicators struggle to comprehensively predict its risk. This study aims to investigate the association between the stress hyperglycaemia ratio (SHR), fasting blood glucose/glycated hemoglobin (FBG/HbA1c), postprandial 2-h glucose/glycated hemoglobin (P2hBG/HbA1c) with DR in T2DM patients, and the mediating effects of non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (NHHR) and triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-C).

METHODS

This study is a retrospective cross-sectional study based on inpatients at a single center. A total of 1,924 T2DM patients were enrolled and grouped according to DR status and quartiles of SHR, FBG/HbA1c, and P2hBG/HbA1c. Multivariate logistic regression, subgroup analysis, restricted cubic spline (RCS) analysis, and mediation effect analysis were employed to validate the associations between indicators and their underlying mechanisms.

RESULTS

The DR group exhibited a considerably higher proportion of participants in the upper quartiles for SHR, FBG/HbA1c and P2hBG/HbA1c. In the fully adjusted model (Model 4), the following comparisons were made between the Q1 quartile and the Q2, Q3 and Q4 quartiles: Q2 (OR = 1.65, 95% CI: 1.24-2.21), Q3 (OR = 1.75, 95% CI: 1.31-2.33) and Q4 (OR = 2.51, 95% CI: 1.88-3.36). For FBG/HbA1c, the following comparisons were made between Q2 (OR = 1.42, 95% CI: 1.06-1.91), Q3 (OR = 1.85, 95% CI: 1.39-2.48) and Q4 (OR = 2.95, 95% CI: 2.21-3.94). For P2hBG/HbA1c, the fourth quartile (OR = 1.56, 95% CI: 1.17-2.08). Subgroup analysis and RCS analysis confirmed a consistent linear association across all subgroups, with no significant non-linearity. The present study demonstrated that NHHR and TG/HDL-C exhibited significant independent mediating effects in the association between these glycaemic markers and DR.

CONCLUSION

The present study found a positive correlation between SHR, FBG/HbA1c and P2hBG/HbA1c with the prevalence of DR in T2DM patients. Furthermore, NHHR and TG/HDL-C exhibited exploratory mediating effects in these associations.