Bingqi Fu1 · Yu Yu1 · Sijing Cheng1 · Hao Huang1 · Tianxin Long1 · Juweig Yang1 · Min Gu1 · Chi Cai1 · Xuhua Chen1 · Hongxia Niu1 · Wei Hua
Received: 23 February 2024 / Accepted: 11 June 2024 / Published online: 19 June 2024 © The Author(s) 2024
Abstract
Background The prognostic value of triglyceride-glucose (TyG) index is not yet known for older diabetic patients received right ventricular pacing (RVP). We aimed to investigate the association between TyG index and the risk of heart failure hospitalization (HFH) in older diabetic patients received RVP.
Methods This study was conducted between January 2017 and January 2018 at Fuwai Hospital, Beijing, China, and included older (age≥65 years) diabetic patients that received RVP for the first time. TyG index were obtained before implantation. The primary endpoint was HFH.
Results A total of 231 patients were divided into three groups according to the tertiles of TyG index:<8.5 (T1, N=77), 8.5–9.1 (T2, N=77), and>9.1 (T3, N=77). T3 group had higher rate of HFH (Log-rank=11.7, P=0.003). Multivariate analyses showed that, TyG index served as an independent predictor for HFH, both as numerical variable (HR=1.94, 95% CI 1.21–3.11, P=0.006), and as categorical variable (HR=2.31, 95% CI 1.09–4.89, P=0.03). RCS demonstrated that the risk of HFH was relatively low until TyG index exceeded 8.8, beyond which the risk began to increase rapidly (P-non-linear=0.006).
Conclusion Preimplantation TyG index emerges as a robust, independent predictor for HFH in older diabetic patients received RVP, and TyG index>8.8 might be the optimal cut-off value.
Keywords Triglyceride-glucose index · Older · Diabetes · Right ventricular pacing
Abbreviations
AF Atrial fibrillation
CABG Coronary artery bypass grafting
CKD Chronic kidney disease
CVD Cardiovascular disease
eGFR Estimated glomerular filtration rate
FBG Fasting blood glucose
HbA1C Hemoglobin A1C
HDL-C High-density lipoprotein cholesterol
HEC Hyperinsulinemic euglycemic clamp
HF Heart failure
HFH Heart failure hospitalization
HOMA-IR Homeostasis model assessment of insulin
resistance
IR Insulin resistance
LDL-C Low-density lipoprotein cholesterol
LVEF Left ventricular ejection fraction
NT-proBNP N-terminal pro-brain natriuretic peptide
PCI Percutaneous coronary intervention
PPMI Permanent pacemaker implantation
RCS Restricted cubic splines
RVP Right ventricular pacing
T2DM Type 2 diabetes mellitus
TC Total cholesterol
TyG index Triglyceride-glucose index
Dirk Lund Christensen1 · Cathrine Olesen Emborg1,2 · Kaushik Laxmidas Ramaiya3 · Venance Philip Maro4 · Ib Christian Bygbjerg1 · Joseph Sironga4,5 · Jens Juul Holst6 · Kajiru Kilonzo4 · Bolette Hartmann6 · Flemming Dela6,7 · Steen Larsen6,8 · Jørn Wulff Helge6
Received: 13 September 2025 / Accepted: 26 April 2026 © The Author(s) 2026
Aims Rural, agro-pastoralist Maasai in East Africa exhibit low prevalence of diabetes, yet little is known about their physi-ological response to glucose loads and whether sex has an impact on glucose metabolism, including incretin hormones.
Methods We included 58 (29 men, 29 women) adult Maasai without diabetes living in rural Tanzania. Clinical background characteristics were measured, and they were exposed to an oral glucose tolerance test (OGTT) after an overnight fast. Plasma glucose, insulin/C-peptide, glucagon, glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like pep-tide-1 (GLP-1) were analysed.
Results Mean age was 34.8 (range 17–65) years, and mean body mass index (BMI) was 20.3 (range 14.0-30.9) kg/m2 with two individuals being overweight and 14 being underweight. Men had a higher mean fasting glucose concentration (5.2 vs. 4.9 mmol/L, p=0.031), while women exhibited a higher OGTT-derived mean GLP-1 concentration at 2-h (8.5 vs. 5.1 pmol/L, p=0.005). Total area-under-the-curve (tAUC) for GLP-1 was higher in women compared to men (1336 vs. 870 pmol x min, p=0.011). Sex- and BMI-adjusted regression analyses for tAUC showed higher values of insulin, C-peptide and GLP-1 in women (p<0.10).
Conclusions Sex differences were found in fasting glucose and OGTT-derived insulin/C-peptide and GLP-1 concentrations. Research using more sophisticated methodology is needed to further explain the glucose metabolism phenotype in Maasai
Keywords Oral glucose tolerance test · Incretin hormones · Sex differences · Maasai · Sub-Saharan Africa
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