Keywords
Type 2 diabetic kidney disease
Surrogate indicators
Review
Submitted : 2026-02-13
Accepted : 2026-02-28
Published : 2026-03-15
Abstract
Diabetic kidney disease (DKD)is one of the most common and severe microvascular complications of type 2 diabetes mellitus (T2DM). It is also a major cause of end-stage renal disease (ESRD), making early identification and intervention crucial. Insulin resistance (IR)is a key pathophysiological mechanism of T2DM and plays a central role in the progression of DKD. In recent years, a series of novel surrogate indicators of IR, such as the triglyceride-glucose (TyG)index, TyG-body mass index (TyG-BMI), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), have attracted widespread attention due to their simplicity and cost-effectiveness. This article reviews the research progress of novel surrogate indicators of insulin resistance (IR) in type 2 diabetic kidney disease (DKD), aiming to provide references for the early prevention and improved prognosis of DKD.
References
Genitsaridi I, Salpea P, Salim A, et al., 2026, 11th Edition of the IDF Diabetes Atlas: Global, Regional, and National Diabetes Prevalence Estimates for 2024 and Projections for 2050. The Lancet Diabetes & Endocrinology, 14(2): 149–156.
Chinese Society of Nephrology, 2021, Chinese Clinical Practice Guideline for Diabetic Kidney Disease. Chinese Journal of Nephrology, 37(3): 255–304.
International Diabetes Federation, 2023, Diabetes and Kidney Disease. International Diabetes Federation.
Zhang X, Chen L, Li Y, et al., 2025, Relationship Between Surrogate Indicators of Insulin Resistance and Early Diabetic Kidney Injury. Chinese Journal of Endocrinology and Metabolism, 41(1): 40–45.
Adeva-Andany M, Adeva-Contreras L, Fernandez-Fernandez C, et al., 2023, Histological Manifestations of Diabetic Kidney Disease and Its Relationship with Insulin Resistance. Current Diabetes Reviews, 19(1): e280322202705.
Nabipoorashrafi S, Adeli A, Seyedi S, et al., 2023, Comparison of Insulin Resistance Indices in Predicting Albuminuria Among Patients with Type 2 Diabetes. European Journal of Medical Research, 28(1): 166.
Staten M, Stern M, Miller W, et al., 2010, Insulin Assay Standardization: Leading to Measures of Insulin Sensitivity and Secretion for Practical Clinical Care. Diabetes Care, 33: 205–206.
Placzkowska S, Pawlik L, Kokot I, et al., 2019, Indirect Insulin Resistance Detection: Current Clinical Trends and Laboratory Limitations. Biomedical Papers of the Medical Faculty of Palacky University in Olomouc, 163(3): 187–199.
Muniyappa R, Lee S, Chen H, et al., 2008, Current Approaches for Assessing Insulin Sensitivity and Resistance in vivo: Advantages, Limitations, and Appropriate Usage. American Journal of Physiology-Endocrinology and Metabolism, 294(1): E15–E26.
Chinese Diabetes Society, 2022, Expert Consensus on Clinical Issues Related to Insulin Resistance (2022 Edition). Chinese Journal of Diabetes, 14(12): 1368–1379.
Jin Y, 2024, Study on the Correlation Between Triglyceride Glucose-Body Mass Index (TyG-BMI) and Diabetic Kidney Disease in Type 2 Diabetes Mellitus, thesis, Hebei Medical University.
Simental-Mendia L, Rodriguez-Moran M, Guerrero-Romero F, 2008, The Product of Fasting Glucose and Triglycerides as Surrogate for Identifying Insulin Resistance in Apparently Healthy Subjects. Metabolic Syndrome and Related Disorders, 6(4): 299–304.
Guerrero-Romero F, Simental-Mendia L, Gonzalez-Ortiz M, et al., 2010, The Product of Triglycerides and Glucose, A Simple Measure of Insulin Sensitivity: Comparison with the Euglycemic-Hyperinsulinemic Clamp. The Journal of Clinical Endocrinology & Metabolism, 95(7): 3347–3351.
Lv L, Zhou Y, Chen X, et al., 2021, Relationship Between the TyG Index and Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus. Diabetes Metabolic Syndrome and Obesity-Target & Therapy, 14: 3299–3306.
Zhang H, Wang L, Zhang Q, et al., 2024, Non-Linear Association of Triglyceride-Glucose Index with Cardiovascular and All-Cause Mortality in T2DM Patients with Diabetic Kidney Disease: NHANES 2001–2018 Retrospective Cohort Study. Lipids in Health and Disease, 23(1): 253.
Er L, Wu S, Chou H, et al., 2016, Triglyceride Glucose-Body Mass Index is a Simple and Clinically Useful Surrogate Marker for Insulin Resistance in Nondiabetic Individuals. PLoS ONE, 11(3): e0149731.
Deng W, Han Y, Deng Z, et al., 2025, The Relationship Between Longitudinal Changes in Triglyceride-Glucose-Body Mass Index and New-Onset Diabetes in Middle-Aged and Elderly Adults: Evidence from a Nationwide Chinese Cohort Study. Diabetes Research and Clinical Practice, 223: 112127.
Jiang Y, Lai X, 2024, Association Between the Triglyceride Glucose Index, Triglyceride-Glucose Body Mass Index and Diabetic Kidney Disease in Adults with Newly Diagnosed Type 2 Diabetes. Frontiers in Medicine, 11: 1328601.
Liu S, Sun H, Liu J, et al., 2024, Assessing the Relationship Between Six Surrogate Insulin Resistance Indexes and the Incidence of Rapid Kidney Function Decline and the Progression to Chronic Kidney Disease Among Middle-Aged and Older Adults in China: Results from the China Health and Retirement Longitudinal Study. Diabetes Research and Clinical Practice, 212: 111705.
McLaughlin T, Abbasi F, Cheal K, et al., 2003, Use of Metabolic Markers to Identify Overweight Individuals Who are Insulin Resistant. Annals of Internal Medicine, 139(10): 802–809.
Mitrofanova A, Merscher S, Fornoni A, et al., 2023, Kidney Lipid Dysmetabolism and Lipid Droplet Accumulation in Chronic Kidney Disease. Nature Reviews Nephrology, 19(10): 629–645.
Nakada K, Tanaka K, Kimura H, et al., 2025, High-Density Lipoprotein Cholesterol and Kidney Disease Progression in Patients with Type 2 Diabetes Mellitus: The Fukushima Cohort Study. BMJ Open Diabetes Research & Care, 13(6): e005581.
Li M, Zheng L, Hu B, et al., 2024, Correlation Study of TG/HDL-C, TyG and Its Derived Indices with Abnormal Albuminuria. Journal of Chongqing Medical University, 49(6): 775–783.
Bello-Chavolla O, Almeda-Valdes P, Gomez-Velasco D, et al., 2018, METS-IR, A Novel Score to Evaluate Insulin Sensitivity, is Predictive of Visceral Adiposity and Incident Type 2 Diabetes. European Journal of Endocrinology, 178(5): 533–544.
Cai X, Zhu Q, Liu S, et al., 2021, Associations Between the Metabolic Score for Insulin Resistance Index and the Risk of Type 2 Diabetes Mellitus Among Non-Obese Adults: Insights from a Population-Based Cohort Study. International Journal of General Medicine, 14: 7729–7740.
Liu G, Tao L, Zhu Q, et al., 2022, Association Between the Metabolic Score for Insulin Resistance (METS-IR) and Estimated Glomerular Filtration Rate (eGFR) Among Health Check-Up Population in Japan: A Retrospective Cross-Sectional Study. Frontiers in Endocrinology, 13: 1027262.
Zhang F, Han Y, Mao Y, et al., 2024, Associations Between Non-Insulin-Based Insulin Resistance Indices and Diabetic Nephropathy in Patients with Diabetes Mellitus in US Adults: A Cross-Sectional Study of NHANES 1999–2018. Frontiers in Endocrinology, 15: 1458521.