Association of Triglyceride‑Glucose Index with Heart Failure among Patients with Type 2 Diabetes

Abstract

Background and Purpose: The triglyceride–glucose (TyG) or “Tri-Glu” index is an accessible surrogate of insulin resistance linked to cardiovascular disease in several populations. However, its association with heart failure (HF) among patients with type 2 diabetes in Middle Eastern populations remains unclear. This study examined the relationship between the Tri-Glu index and prevalent HF in patients with type 2 diabetes.

Methods: We retrospectively analyzed records of adults with type 2 diabetes attending a tertiary center between January 2022 and June 2025. Clinical, anthropometric, and laboratory data, including fasting glucose and triglycerides, were extracted. The Tri-Glu index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. HF status was determined from clinician documentation and echocardiography. Mean Tri-Glu values were compared between patients with and without HF using t-tests. Multivariable logistic regression assessed the association between the Tri-Glu index and HF, adjusting for age, sex, body mass index (BMI), and diabetes duration. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported.

Results: Among 1,373 patients (mean age 59 ± 10 years; 49% women), 134 (9.8%) had HF. The mean Tri-Glu index was higher in patients with HF than those without (9.58 ± 0.76 vs 9.32 ± 0.70; p < 0.001). In multivariable analysis, each 1-unit increase in Tri-Glu index was associated with higher odds of HF (aOR 1.75; 95% CI 1.34–2.28; p < 0.001). Older age and higher BMI were also independent predictors of HF.

Conclusions: A higher triglyceride–glucose index was independently associated with heart failure in type 2 diabetes, even after adjusting for major risk factors. The Tri-Glu index may serve as a simple, low-cost biomarker to identify diabetic patients at elevated HF risk in Middle Eastern populations.