The Atherogenic Index Log (Triglyceride/HDL‑Cholesterol) as a Biomarker to Identify Type 2 Diabetes Patients with Poor Glycemic Control

Identifying appropriate biomarkers for predicting type 2 diabetes (T2D) patients with increased HbA1c may prove helpful in preventing increased risk of cardiovascular disease (CVD). The present study was conducted to analyze the diagnostic performance of the atherogenic index log (TG/HDL‑C) in T2D patients with increased HbA1c.

Patients with T2D were classified into two groups according to having an HbA1c <8% or ≥8%. Atherogenic index was calculated from the logarithmic transformation of TG/HDL‑C. Receiver operating characteristic curve was used to evaluate the diagnostic performance of log (TG/HDL‑C). Insulin and fasting glucose concentrations were used to determine homeostasis model assessment for insulin resistance (HOMA‑IR).

Compared with the patients with HbA1c <8%, log (TG/HDL‑C) was significantly higher in the patients with HbA1c ≥8% (p = 0.025). The atherogenic index was a biomarker for the prediction of T2D patients with HbA1c ≥8% versus patients with HbA1c <8%, as shown in the area under the curve (AUC = 0.61, P = 0.013). The best cut‑off point of log (TG/ HDL‑C) for the discrimination between patients with HbA1c ≥8% versus patients with HbA1c <8% determined to be 0.44. Atherogenic index was significantly and positively correlated with HOMA‑IR in female patients (r = 0.313, P = 0.003) and in patients with an age ≥5o (r = 0.253, P = 0.021).

The log (TG/HDL‑C) in addition to its known association with enhanced CVD risk could be considered as a biomarker to predict T2D patients with poor glycemic control. Therefore, the increased ratio may provide a simple and useful way of identifying poor glycemic T2D patients who are possibly to be at elevated risk of CVD.