The triglyceride-glucose index as a biomarker of diabetic retinopathy: a systematic review and meta-analysis

Adilet Amirashov, Aigul Balmukhanova, A. Koishybaev, Петрачков Денис Валериевич, Dana Koishybayeva, Altynay Balmukhanova, Nadiar Maratovich Mussin, Amin Tamadon

2025

Full text Open access: Gold Metadata (CSL-JSON)
DOI 10.3389/fmed.2025.1677818
Data confidence 70 medium
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Abstract

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 I 2 statistic. Publication bias was assessed via funnel plots and Egger's 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 ( I 2 > 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 Egger's 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.