Association between the insulin resistance indices and incident type 2 diabetes across different body mass index states: a cohort study and external validation from two East Asian populations
Authors' conclusion
IR indices, particularly TyG and TyG-BMI, are powerful predictors of T2DM across all BMI categories. Their predictive ability is most pronounced in non-overweight individuals, challenging the obesity-centric diabetes screening paradigm and underscoring the need for early metabolic risk assessment in lean adults.
Study context
- Population
- Chinese adults without diabetes; replication in 15,453 Japanese adults (NAGALA cohort)2,435 developed T2D
- Participants
- 114,293 adults
- Exposure
- Insulin resistance (IR) indices and incident T2D across BMI categories
- Outcome
- Incident T2D
- Follow-up
- mean 3.10-year follow-up
Methodological detailsexternal validation, stratified by BMI
- External validation
- Stratified by BMI
Main finding
As reported in the abstract
Association of TyG with incident T2D, by BMI category
| Group | Value | Fully adjusted HR |
|---|---|---|
| Non-overweight | 4.60 | 4.60 |
| Overweight | 3.10 | 3.10 |
| Obese | 2.62 | 2.62 |
Value
Non-overweight4.60
Overweight3.10
Obese2.62
Fully adjusted HR
Non-overweight4.60
Overweight3.10
Obese2.62
Observational data: associations, not effects.
Further findings
| Outcome | Non-overweight |
|---|---|
| Predictive performance | |
| TyG AUC | 76.74% |
Dose-response shape
- Non-linear relationships with clear inflection points
Predictive performance
- Predictive performance highest in the non-overweight group
External replication (NAGALA, Japanese adults)
- External replication confirmed these findings
Original publication
Association between the insulin resistance indices and incident type 2 diabetes across different body mass index states: a cohort study and external validation from two East Asian populations. Diabetes Res Clin Pract. Published 8 January 2026. doi:10.
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