The triglyceride-glucose index as a biomarker of diabetic retinopathy: a systematic review and meta-analysis
Amirashov A. Balmukhanova A. Koishybayev A. Petrachkov D. Koishybayeva D. Balmukhanova A. Mussin N.M. Tamadon A.
2025Frontiers Media SA
Frontiers in Medicine
2025#12
Background: The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has been linked to various diabetic complications. However, its association with diabetic retinopathy (DR) remains inconsistent. We conducted a systematic review and meta-analysis to evaluate the relationship between TyG index levels and the risk of DR. Methods: We searched PubMed, Scopus, and Web of Science from inception to July 2025 for observational studies reporting the association between TyG index and DR in adults with type 1 or type 2 diabetes. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Agency for Healthcare Research and Quality (AHRQ) checklist and Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was evaluated with the I2 statistic. Publication bias was assessed via funnel plots and Eggers test. Subgroup and meta-regression analyses were conducted to explore heterogeneity. Results: Sixteen studies with a total of 33,436 participants were included. The pooled OR for the association between higher TyG index and DR was 1.89 (95% CI: 1.27–2.82) when TyG was treated as a categorical variable, and 1.57 (95% CI: 1.25–1.98) when treated as continuous. Significant heterogeneity was observed (I2 > 87%). Subgroup analyses revealed stronger associations in studies with smaller sample sizes and higher male proportions. Meta-regression showed that male proportion accounted for 48.71% of the heterogeneity. In categorical analyses, funnel-plot asymmetry and Eggers test indicated small-study effects; after trim-and-fill adjustment the pooled effect attenuated and was no longer significant, suggesting sensitivity to publication bias. Conclusions: While higher TyG levels correlate with DR—particularly when modeled continuously—the signal is heterogeneity- and bias-sensitive in categorical analyses. Our moderator analyses newly indicate a sex-composition effect, and the current lack of harmonized clinical TyG thresholds limits immediate translation. Copyright
diabetes mellitus , diabetic retinopathy , meta-analysis , triglyceride-glucose index , TyG , TyG index
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Department of Otorhinolaryngology, Ophthalmology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Department of Surgical Disciplines, Caspian University, Almaty, Kazakhstan
Department of Oncology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Krasnov Research Institute of Eye Diseases, Moscow, Russian Federation
Department of Surgical Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Department of Policy and Healthcare Management, Al-Farabi Kazakh National University, Almaty, Kazakhstan
Department of Surgery No. 2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Department of Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Department of Otorhinolaryngology
Department of Surgical Disciplines
Department of Oncology
Krasnov Research Institute of Eye Diseases
Department of Surgical Diseases-2
Department of Policy and Healthcare Management
Department of Surgery No. 2
Department of Natural Sciences
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