Risk of type 2 diabetes mellitus associated with lipid-related metabolic indicators: a diabetes family cohort study in China

Objective To evaluate the associations between lipid-related metabolic indicators and incident type 2 diabetes mellitus (T2DM). Methods A diabetes family cohort study of 3,726 participants was conducted in Taizhou from May to October 2021 to track incident T2DM cases. Lipid metabolism indicators included triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride-glucose (TyG) and its related indices, Chinese Visceral Adiposity Index (CVAI), and homeostasis model assessment of insulin resistance (HOMA-IR). Mixed-effects Cox proportional hazards models, within-family Cox models, and quartile analyses were performed to examine the associations between these indicators and incident T2DM. Results Among 1,257 participants without diabetes at baseline, 68 developed incident T2DM during the average follow-up of 3.92 years. Higher levels of TyG (HR = 1.758, 95% CI: 1.182–2.616), TyG-BMI (HR = 1.007, 95% CI: 1.002–1.013), TyG-WHtR (HR = 2.108, 95% CI: 1.468–3.027), TyG-WC (HR = 1.005, 95% CI: 1.003–1.007), CVAI (HR = 1.013, 95% CI: 1.006–1.020), and HOMA-IR (HR = 1.195, 95% CI: 1.038–1.376) were significantly associated with an increased risk of incident T2DM, whereas traditional lipid indicators showed no significant associations. These findings were consistent in within-family analyses. Furthermore, dose-response relationships were observed between TyG, TyG-WHtR, TyG-WC, CVAI and incident T2DM. Conclusions In conclusion, TyG-related indices, CVAI, and HOMA-IR were significantly associated with incident T2DM in this diabetes family-based cohort. These composite indicators may be useful for the early identification of high-risk individuals and for informing targeted prevention strategies. Clinical trial number Not applicable.