Association Between the Triglyceride-to-HDL Cholesterol Ratio and Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Real-World Retrospective Study.

Background and

Objectives

The triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) is a simple lipid index associated with insulin resistance and atherogenic dyslipidemia. Previous evidence has supported the TG/HDL-C ratio as a simple surrogate marker of insulin resistance and an adverse metabolic profile. However, its relationship with glycemic control in real-world patients with type 2 diabetes mellitus (T2DM) remains uncertain. This study evaluated the association between the TG/HDL-C ratio and poor glycemic control in patients with T2DM. Materials and

Methods

This retrospective observational study included patients with T2DM followed in outpatient clinics. Poor glycemic control was defined as glycated hemoglobin A1c (HbA1c) ≥ 7%. The association between the TG/HDL-C ratio and glycemic control was assessed using group comparisons, Spearman correlation, tertile analysis, and multivariable logistic regression adjusted for age, sex, LDL-C, total cholesterol, insulin use, statin use, and fenofibrate use. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminatory performance of the TG/HDL-C ratio for identifying poor glycemic control. A sensitivity analysis was performed after excluding patients receiving fenofibrate.

Results

A total of 1001 patients with T2DM were included, of whom 568 (56.7%) had poor glycemic control. The mean age was 60.9 ± 11.4 years, and 57.1% of participants were women. The poor- and adequate-glycemic-control groups were comparable with respect to age and sex. The TG/HDL-C ratio was higher in patients with HbA1c ≥7% than in those with HbA1c < 7% [3.35 (2.35-5.00) vs. 2.74 (1.87-3.82), p < 0.001] and increased progressively across tertiles. In multivariable analysis, the TG/HDL-C ratio remained associated with poor glycemic control after adjustment for available covariates (OR: 1.201, 95% CI: 1.125-1.282, p < 0.001). The association remained significant after excluding fenofibrate users. ROC analysis showed modest discrimination (AUC: 0.601, 95% CI: 0.566-0.636).

Conclusions

The TG/HDL-C ratio was associated with poor glycemic control in patients with T2DM, showing a graded association across tertiles. However, its standalone discriminatory performance is modest. Given its modest discriminatory performance, the TG/HDL-C ratio should not be considered a standalone diagnostic or predictive tool for poor glycemic control; rather, it may serve as an accessible adjunctive metabolic marker associated with an adverse glycemic and lipid profile.