Association of different insulin resistance surrogates with risk of incident type 2 diabetes mellitus, major adverse cardiovascular events and mortality: evidence from UK Biobank cohort study

Background We investigated the relationship of triglyceride-glucose (TyG), C-reactive protein-triglyceride glucose index (CTI), atherogenic index of plasma (AIP), metabolic score of insulin resistance (METS-IR), and estimated glucose discharge rate (eGDR), with cardio-metabolic risk and mortality.Methods A cohort of 312,380 participants was selected from the UK Biobank to investigate the associations between various surrogates and the incidence of major adverse cardiovascular events (MACE) and mortality.Results The study identified 12,223 cases of new-onset type 2 diabetes mellitus (T2DM), 42,504 cases of MACE. Compared to those with CTI ≤8.24, there was a significantly higher risk of developing new-onset T2DM and experiencing MACE as well as all-cause or cardiovascular mortality in the highest eGDR quartiles. Compared to those with eGDR ≤6.41, there was a significantly lower risk of developing new-onset T2DM and experiencing MACE as well as all-cause or cardiovascular mortality in the highest eGDR quartiles.Conclusions TyG index, CTI, AIP, and METS-IR have an increased risk of developing new-onset T2DM and MACE. Conversely, a higher eGDR was significantly associated with a reduced risk of both new-onset T2DM and MACE. The CTI and eGDR exhibited a more pronounced association with all-cause and cardiovascular mortality compared to other surrogate indexes.