Abstract
BACKGROUND: To explore the relationship between the triglyceride-glucose (TyG) index and arteriosclerosis in patients with type 2 diabetes mellitus (T2DM), evaluate the direct and indirect effects of the TyG index on arteriosclerosis, and identify potential mediating variables. METHODS: A total of 410 patients with type 2 diabetes mellitus (T2DM) hospitalized at the Third Affiliated Hospital of Soochow University from January 2021 to December 2023 were included. The patients were divided into an arteriosclerosis group (n = 298) and a non-arteriosclerosis group (n = 112) based on brachial-ankle pulse wave velocity (ba-PWV) values. Clinical data and glucose-lipid metabolism indicators were collected. The association between the TyG index and arteriosclerosis was analyzed using multivariable logistic regression. Curve fitting was performed using a generalized additive model, and stratified analysis was conducted to evaluate the interaction between subgroups. Finally, a mediation effect model was used to analyze the direct and indirect effects of the TyG index on arteriosclerosis. RESULTS: After adjusting for confounding factors, an elevated TyG index significantly increased the risk of arteriosclerosis (OR = 2.748, 95% CI: 1.442–5.237, P = 0.002). The risk was substantially higher in the group with high TyG levels (OR = 3.420, 95% CI: 1.458–8.023, P = 0.005), and the trend test showed that the risk increased with higher TyG index levels (P for trend = 0.005). A smooth curve fitting showed a positive linear relationship between the TyG index and arteriosclerosis (P = 0.002). Stratified analysis revealed no significant interaction between the TyG index and arteriosclerosis across different blood pressure parameters and ankle-brachial index (ABI) subgroups (all P > 0.05). Mediation effect analysis indicated that the mediating effect of ABI in this relationship accounted for -10.9% (P = 0.030). CONCLUSION: The TyG index is significantly associated with the risk of arteriosclerosis in patients with type 2 diabetes, with ABI partially mediating this relationship.