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As obesity continues to be a growing problem in our societyAmerica, the prevalence of type 2 diabetes also continues to progress.  Obesity is becoming more common because our society provides an environment that promotes unhealthy eating and lack of physical activity.  Obesity also presents a problem because it has a close tie with insulin resistance.  In obese patients, insulin signaling becomes impaired.¹ Impairment of insulin signaling leads to impaired glucose transport, decreased metabolism of adipocytes and skeletal muscle, and increased glucose release by the liver.¹ Measuring insulin resistance, a major cause of type 2 diabetes, is a great tool for early detection in order to prevent or delay a person’s progression to developingof diabetes.

            A new method of measuring tool for gauging insulin resistance is the triglyceride:high--density -lipoprotein ,( TG:HDL)  ratioratio.  Triglycerides are lipids, or fats, producedused by our the body as way tofor store energy. and  HDL is a beneficial cholesterol molecule that transports fats cholesterol from the body to the liver for excretion or re-utilization.  In individuals with insulin resistance, triglyceride levels increase while HDL levels If you think about the TG:HDL ratio, it compares a “bad” marker to a “good” one. decrease.² A higher ratio would represent a poorer health status because there is a large amount of circulating fats in the blood stream and/or a low amount of healthy cholesterol.  So aA TG:HDL ratio ≥ greater than 3 has a close correlation to insulin resistance.²  According to authors Karen Olson, Bryan Hendricks, and David K. Murdock in 2012, the ratio produces similar results to other methods such as the QUICKI and HOMA-IR.²  The HOMA-IR and QUICKI are methods used to calculate an insulin resistance value.  The HOMA-IR equation is insulin x [glucose/22.5] and a value ≥ 2.6 represents an insulin resistant individual.³  The QUICKI equation is 1/(log insulin + log glycemia in mg/dL) and a value ≤ 0.33 represents an insulin resistant individual.³ 

Authors Cosimo Giannini, Nicola Santoro, and et al in 2011 discovered the TG:HDL ratio was significantly associated with insulin resistance in whites but insignificantly associated with other ethnicities, suggesting a cutoff point to be determined for each ethnicTriglyceride and HDL values are obtained through a blood draw and processed by a laboratory for a relatively small fee.  Physicians will often routinely obtain these values to evaluate the patient’s health and risk for cardiovascular disease.  The TG:HDL ratio is an easy and inexpensive tool calculation that physicians can use perform in their officesfrom readily available patient data as opposed to requesting separate, instead of sending the patient to a special center to perform  expensive, clinical test.s to evaluate insulin resistance.  In order to obtain the TG and HDL values, blood has to be drawn and then sent to a lab for a fee charged to the doctor’s office and patient.  However, a physician would obtain these values regularly to evaluate their patient’s health. The TG:HDL ratio has a similar ability to predict insulin resistance as the QUICKI and HOMA-IR, other methods commonly used to calculate insulin resistance which require obtaining a fasting glucose and fasting insulin level.³   

There are some things to note before using the TG:HDL ratio to predict a person’s risk for having or developing insulin resistance.  There is conflicting evidence of the validity of this tool depending on the patient’s race.  Authors Cosimo Giannini, Nicola Santoro, and et al in 2011 discovered the TG:HDL ratio was significantly associated with insulin resistance in whites but insignificantly associated with other ethnicities, suggesting a cutoff point to be determined for each ethnicity.⁴

A small study of 125 African American participants found triglyceride and HDL values were not appropriate markers of insulin resistance in this population.⁴ A larger analysis of non-diabetic men and women in the United States described the TG:HDL ratio as a useful marker of insulin resistance in whites, blacks and Mexican Americans.⁵  Conversely, in 2011 Cosimo Giannini, and Santoro reported the TG:HDL ratio was significantly associated with insulin resistance in whites, however this ratio was not as accurate in other ethnicities.⁶   

The TG:HDL ratio is easily obtained and calculated and can be a useful tool in determining a person’s risk for developing insulin resistance.  If a person’s TG:HDL ratio is greater than 3, a healthcare provider  Lastly, the TG:HDL ratio was proven to only be significant in determining insulin resistance for white individuals and no other ethnicity unless further studies provide other evidence.

The healthcare team could use this value to express to athe patient’s risk for developing diabetes.  These numbers could encourage a patient to make healthy lifestyle changes such as losing weight, making healthy food choices, and engaging in physical activity in order to improve their TG:HDL ratio and decrease their risk of developing insulin resistance and possibly diabetes that if they do not make lifestyle changes such as weight loss, healthy eating, and performing physical activity, they are at a high risk of developing diabetes.  .

Megan Sumner

PharmD Candidate 2014

Presbyterian College School of Pharmacy

References:

1. Kahn B, Flier J.  Obesity and Iinsulin Rresistance.  J Clin Invest.  2000; 106(4):473-481.  http://www.jci.org/articles/view/10842.  Accessed July 16, 2013.
2. McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven GM. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003;139:802-809.
3. Olson K, Hendricks B, Murdock D.  The Triglyceride to HDL Rratio and Iits Rrelationship to Iinsulin Rresistance in Ppre- and Ppostpubertal Cchildren: Oobservation from the Wausau SCHOOL Project.  Cholesterol.  2012; 2012(2012), Article ID 794252.  http://www.hindawi.com/journals/chol/2012/794252/.  Accessed July 10, 2013.
4. Hettihewa L, Palangasinghe S, Jayasinghe S, et al.  Comparison of Insulin resistance by indirect methods – HOMA, QUICKI and McAuley – with fasting insulin in patients with type 2 diabetes in Galle, Sri Lanka: A pilot study.  JHAS.  2006; 5:1-8.  http://cogprints.org/5000/1/2006-1-2.pdf.  Accessed July 17, 2013.
5. Giannini C, Santoro N, Caprio S, et al.  The Triglyceride-to-HDL Cholesterol Ratio: Association with insulin resistance in obese youths of different ethnic backgrounds.  Diabetes Care.  2011; 34(8):1869-1874. http://care.diabetesjournals.org/content/34/8/1869.full.  Accessed July 10, 2013. Sumner AE. 
6. Fasting triglyceride and the triglyceride-HDL cholesterol ratio are not markers of insulin resistance in African Americans. Arch Intern Med. 2005;165:1395-1400. 
7. Li C, Ford ES, Meng YX, Mokdad AH, Reaven GM. Does the association of the triglyceride to high-density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity? Cardiovasc Diabetol. 2008 Feb 28;7:4.
8. Giannini C, Santoro N, Caprio S, et al.  The Triglyceride-to-HDL Cholesterol Ratio: Association with insulin resistance in obese youths of different ethnic backgrounds.  Diabetes Care.  2011; 34(8):1869-1874. http://care.diabetesjournals.org/content/34/8/1869.full.  Accessed July 10, 2013.