Summary: In a post-hoc analysis of the ACCORD/ACCORDION trials, a composite index combining triglycerides, glucose, weight, and waist (TyG-WWI) independently predicted cardiovascular events and mortality in type 2 diabetes, outperforming the triglyceride-glucose index alone, with a U-shaped relationship to total mortality.
PICO Summary
| Element | Detail |
|---|---|
| Population | 10,092 patients with type 2 diabetes from the ACCORD/ACCORDION trials. |
| Exposure | Triglyceride-glucose-weight-adjusted waist index (TyG-WWI), combining triglycerides, glucose, weight, and waist circumference. |
| Comparison | Lower TyG-WWI values; and TyG index alone for predictive comparison. |
| Outcome | Per 1-SD higher TyG-WWI, risk rose 11% for MACE, 8% for major CHD, 28% for congestive heart failure, and 12% for total mortality. A non-linear (U-shaped) relationship with mortality was seen (turning point 96.574). TyG-WWI outperformed TyG alone on AUC, NRI, and IDI. |
Expert Commentary
This is a competent prognostic-marker analysis on a large, well-characterised trial population, and the direction is sensible: a composite that folds insulin-resistance surrogates (triglycerides and glucose) together with central adiposity (weight-adjusted waist) should track cardiometabolic risk better than any single component, and it modestly did, with the heart-failure association standing out. The U-shaped relationship with total mortality is biologically plausible too, since very low values may capture frailty or weight loss from illness rather than metabolic health. My reservations are the usual ones for these indices. The hazard ratios per standard deviation are real but modest, the incremental gains over TyG on reclassification metrics tend to be small, and a derived index validated within one trial dataset needs external confirmation and a demonstration that it actually changes decisions before it earns a place in practice. Can I use this with my patients? Not as a new test to order. It reinforces a principle I already apply, that the combination of dyslipidaemia, dysglycaemia, and central obesity compounds cardiovascular and heart-failure risk, and that such patients warrant aggressive risk-factor management. I would not adopt TyG-WWI as a routine calculation on this evidence.
References
Liu M, Pei J, Zeng C, Xin Y, Tang P, Hu X. Association and predictive value of the triglyceride glucose-weight adjusted waist index for cardiovascular outcomes in patients with type 2 diabetes. Sci Rep. 2025;15(1):24573. doi:10.1038/s41598-025-08580-4