Comparative predictive value of three non-insulin-based insulin resistance indices for subclinical left ventricular dysfunction in type 2 diabetes mellitus

Current research indicates that novel non-insulin-based insulin resistance indicators—including the triglyceride-glucose (TyG) index, triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C), and Metabolic Score for Insulin Resistance (METS-IR)—are closely associated with cardiovascular disease risk in patients with type 2 diabetes mellitus (T2DM). Notably, the TyG index demonstrates significant correlation with subclinical left ventricular dysfunction (SLVD), making it a potential biomarker for early detection of SLVD in T2DM patients. However, the predictive value of TG/HDL-C and METS-IR in this context remains unclear, and no comparative analysis of their predictive efficacy has been conducted. The objective of this study is to evaluate and compare the predictive value of these three indices for SLVD in T2DM patients. A total of 221 hospitalized patients with T2DM from the Department of Endocrinology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), between June 2024 and February 2025, were included. Participants were categorized into SLVD (left ventricular global longitudinal strain, GLS < 18%) and non-SLVD (GLS ≥ 18%) groups based on speckle-tracking echocardiography. Univariate logistic regression was used to identify factors associated with SLVD. Multivariate logistic regression, adjusted for confounders, assessed the relationship of TyG index, TG/HDL-C, and METS-IR with SLVD. Receiver operating characteristic (ROC) curves were plotted to compare their predictive performance. Univariate analysis revealed that smoking, hypertension, BMI, creatinine, triglycerides, HbA1c, fasting blood glucose, TyG index, TG/HDL-C, and METS-IR were positively associated with SLVD, while gender and HDL-C were negatively correlated (all P < 0.05). In multivariate analysis, TyG index, TG/HDL-C, and METS-IR remained significantly and positively associated with SLVD (all P < 0.001). ROC analysis showed AUCs of 0.785, 0.798, and 0.819 for TyG index, TG/HDL-C, and METS-IR, respectively, with no significant differences in predictive value according to Delong’s test (P > 0.05). TyG index, TG/HDL-C, and METS-IR are significantly associated with SLVD in T2DM patients and demonstrate good predictive performance. These indices are valuable for clinical application, especially in primary care settings, though no significant difference in predictive efficacy was observed among them.