TyG index and related measures show distinct, time-varying mortality links in older adults with type 2 diabetes

A large community-based cohort study of older adults with type 2 diabetes has found that the triglyceride-glucose (TyG) index and the anthropometric indices derived from it behave very differently when it comes to predicting death. Rather than functioning as interchangeable markers of metabolic risk, the indices showed distinct, non-linear and time-varying associations with both all-cause and cardiovascular mortality, and no single measure dominated across every prognostic test.

The study, published in Cardiovascular Diabetology, drew on 56,182 older adults with type 2 diabetes who took part in the Wuhan Elderly Health Management Program in 2018. Mortality outcomes were then ascertained through linkage with the Wuhan Mortality Surveillance System through January 26, 2024.

Over a median follow-up of 5.56 years, 9,236 deaths from any cause occurred, including 4,126 cardiovascular deaths. The team used multivariable Cox regression models to estimate associations with both outcomes, restricted cubic spline and threshold analyses to characterise non-linear dose-response relationships, and time-stratified analyses to assess how the associations changed over the course of follow-up.

One index stood out for the consistency of its signal. TyG-ABSI, which couples the TyG score to a body shape index, showed the most consistent positive association with mortality among the evaluated indices. In fully adjusted models, each 1-SD increase in TyG-ABSI was associated with a hazard ratio of 1.104 (95% CI 1.082–1.127) for all-cause mortality and 1.096 (95% CI 1.064–1.130) for cardiovascular mortality. The TyG index itself was also positively associated with both outcomes.

The anthropometric derivatives told a more complicated story. TyG-BMI showed inverse associations with mortality in conventional Cox models, meaning higher values of this combined marker were linked to lower death risk in this population. TyG-WC and TyG-WHtR showed weaker or less consistent associations. This divergence matters because the five indices are often discussed as if they capture the same underlying metabolic risk; the findings suggest they do not.

The relationships were also not straightforwardly linear. Restricted cubic spline and threshold analyses revealed non-linear dose-response patterns across all five indices, with mortality risk generally decreasing toward an intermediate minimum and increasing again beyond data-derived turning points. In other words, both very low and very high values of these markers were associated with elevated risk, a pattern that simple linear models would obscure.

Time added another layer of complexity. The associations varied over the follow-up period: the positive associations of TyG and TyG-ABSI became more evident after two years, while the inverse associations of several of the anthropometric derivatives attenuated as follow-up lengthened.

To test whether the indices added anything beyond existing risk assessment, the researchers evaluated incremental prognostic performance using the C-index, time-dependent area under the curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI) and decision-curve analysis. At five years, TyG-ABSI yielded the largest improvements in AUC and NRI, while TyG-BMI yielded the largest IDI. However, the authors emphasise that the absolute gains in overall discrimination were small, and decision curves showed limited separation between models.

The overall conclusion is a caution against enthusiasm for any single marker. In this large community-based cohort of older adults with type 2 diabetes, TyG and TyG-related anthropometric indices showed distinct, non-linear and time-varying associations with mortality, but no single index consistently dominated across prognostic metrics. The authors argue that these findings speak against treating TyG-related indices as interchangeable or ranking them solely by the strength of their associations, and they note that the potential roles of these indices in community-based risk stratification require external validation before any broader application.

For clinicians and researchers following the growing literature on TyG-based markers, the study offers a sobering benchmark: even in a cohort of more than 56,000 people with long-term mortality linkage, the incremental predictive value of these easily calculated indices over existing assessment was modest. The work was published as open access, with the article shared early as peer-reviewed, accepted research carrying a permanent DOI, subject to further editorial edits before the final Version of Record.

Subject of Research: Comparative associations of the triglyceride-glucose index and TyG-related anthropometric indices with all-cause and cardiovascular mortality in older adults with type 2 diabetes

Article Title: Comparative mortality associations of the triglyceride glucose index (TyG) and TyG-related anthropometric indices in older adults with type 2 diabetes

Article References: Hu, W., Huang, C., Dai, J., Zhao, Y., Wang, L., Yan, Y., & Liu, Q. (2026). Comparative mortality associations of the triglyceride glucose index (TyG) and TyG-related anthropometric indices in older adults with type 2 diabetes. Cardiovascular Diabetology. https://doi.org/10.1186/s12933-026-03389-5

Image Credits: AI Generated

DOI: 10.1186/s12933-026-03389-5

Keywords: TyG index, TyG-ABSI, type 2 diabetes, older adults, all-cause mortality, cardiovascular mortality, cohort study, risk stratification, non-linear dose-response, Wuhan, anthropometric indices, C-index