All Title Author
Keywords Abstract

PLOS ONE  2013 

Triglyceride/HDL Ratio as a Screening Tool for Predicting Success at Reducing Anti-Diabetic Medications Following Weight Loss

DOI: 10.1371/journal.pone.0069285

Full-Text   Cite this paper   Add to My Lib


Background and Objectives Intentional weight loss, by reducing insulin resistance, results in both better glycemic control and decreased need for anti-diabetic medications. However, not everyone who is successful with weight loss is able to reduce anti-diabetic medication use. In this retrospective cohort study, we assessed the predictive accuracy of baseline triglyceride (TGL)/HDL ratio, a marker of insulin resistance, to screen patients for success in reducing anti-diabetic medication use with weight loss. Methods Case records of 121 overweight and obese attendees at two outpatient weight management centers were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1000Kcal/day deficit), a behavior modification plan, and a plan for increasing physical activity. Results Mean period of follow-up was 12.5 ± 3.5 months. By study exit, mean weight loss and mean HbA1c% reduction were 15.4 ± 5.5 kgs and 0.5 ± 0.2% respectively. 81 (67%) in the study cohort achieved at least 1 dose reduction of any anti-diabetic medication. Tests for predictive accuracy of baseline TGL/HDL ratio ≤ 3 to determine success with dose reductions of anti-diabetic medications showed a sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, likelihood ratio (LR) + and LR-of 81, 83, 90, 70, 78, 4.8 and 0.2, respectively. Reproducibility of TGL/HDL ratio was acceptable. Conclusion TGL/HDL ratio shows promise as an effective screening tool to determine success with dose reductions of anti-diabetic medications. The results of our study may inform the conduct of a systematic review using data from prior weight loss trials.


[1]  Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 307(5): 491-497. doi:10.1001/jama.2012.39. PubMed: 22253363.
[2]  Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F et al. (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289(1): 76–79. doi:10.1001/jama.289.1.76. PubMed: 12503980.
[3]  Colditz GA (1999) Economic costs of obesity and inactivity. Med Sci Sports Exerc 31(suppl): S663–S667. doi:10.1097/00005768-199911001-00026. PubMed: 10593542.
[4]  Sunyer XP, Blackburn G, Brancati FL, Bray GA, Bright R et al. (2007) Look AHEAD Research Group. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 30(6): 1374–1383. doi:10.2337/dc07-0048. PubMed: 17363746.
[5]  Shantha GP, Kumar AA, Kahan S, Cheskin LJ (2012) Association between glycosylated hemoglobin and intentional weight loss in overweight and obese patients with type 2 diabetes mellitus: a retrospective cohort study. Diabetes Educ 38(3): 417-426. doi:10.1177/0145721712443293. PubMed: 22508341.
[6]  Kumar AA, Shantha GP, Kahan S, Samson RJ, Boddu ND et al. (2012) Intentional weight loss and dose reductions of anti-diabetic medications: a retrospective cohort study. PLOS ONE 7(2): e32395. doi:10.1371/journal.pone.0032395. PubMed: 22384240.
[7]  Chávez AG, Mendía LES, Argueta SE (2011) Elevated triglycerides/HDL-cholesterol ratio associated with insulin resistance. Cir Cir 79(2): 126-131. PubMed: 21631973.
[8]  Jeffrey SF, Eleftheria MF (2005) Obesity. In: DL KasperE. BraunwaldAS FauciSL HauserDL Longo. Harrison’s Principles of Internal Medicine. New York: McGraw Hill Inc. pp. 422-423.
[9]  Greenberg RS, Daniels SR, Dana Flanders W, Sanders FH, Robert RB et al. (2005) Diagnostic testing. In: RS Greenberg. Medical Epidemiology. New York: McGraw-Hill Inc. pp. 112-117.
[10]  StataCorp (2009) Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.
[11]  Rondanelli M, Opizzi A, Perna S, Faliva M, Solerte SB et al. (2012) Improvement in insulin resistance and favourable changes in plasma inflammatory adipokines after weight loss associated with two months’ consumption of a combination of bioactive food ingredients in overweight subjects. Endocrine.
[12]  Hatmi ZN, Mazdeh MM, Nazari SSH, Hajighasemi E, Nozari B et al. (2011) Relationship between the pattern of coronary artery disease risk factors and lipid ratios with five groups of body mass index in 28566 healthy adults. Acta Med Iran 49(11): 730-736. PubMed: 22131243.
[13]  Tovar JR, Oller I, Tomas A, Llavero C, Arroyo A et al. (2012) Midterm impact of sleeve gastrectomy, calibrated with a 50-Fr bougie, on weight loss, glucose homeostasis, lipid profiles, and comorbidities in morbidly obese patients. Am Surg 78(9): 969-974. PubMed: 22964206.
[14]  Greenberg RS, Daniels SR, Dana Flanders W, Sanders FH, Robert RB et al. (2005) Diagnostic testing. In: RS Greenberg. Medical Epidemiology. New York: McGraw-Hill. pp. 227-233.
[15]  Weiss ICS, Réa RR, Picheth CMF, rego FG, Fde OP et al. (2012) The plasma logarithm of the triglyceride/HDL-cholesterol ratio is a predictor of low risk gestational diabetes in early pregnancy. Clin Chim Acta Pii: S0009-S8981 (12)00574-8.
[16]  So?ka V, Jarkovsky J, Rav?uková B, Tichy L, Fajkusová L et al. (2012) The logarithm of the triglyceride/HDL-cholesterol ratio is related to the history of cardiovascular disease in patients with familial hypercholesterolemia. Clin Biochem 45(1-2): 96-100. doi:10.1016/j.clinbiochem.2011.11.001. PubMed: 22119890.
[17]  Grundy SM, Vega GL, Tomassini JE, Tershakovec AM (2011) Comparisons of apolipoprotein B levels estimated by immunoassay, nuclear magnetic resonance, vertical auto profile, and non-high-density lipoprotein cholesterol in subjects with hypertriglyceridemia (SAFARI Trial). Am J Cardiol 108(1): 40-46. doi:10.1016/j.amjcard.2011.03.003. PubMed: 21565322.
[18]  Nicholls SJ, Tuzcu EM, Wolski K, Bayturan O, Lavoie A et al. (2011) Lowering the triglyceride/high-density lipoprotein cholesterol ratio is associated with the beneficial impact of pioglitazone on progression of coronary atherosclerosis in diabetic patients: insights from the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study. J Am Coll Cardiol 57(2): 153-159. doi:10.1016/j.jacc.2010.06.055. PubMed: 21211686.
[19]  Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW et al. (2011) Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 365(21): 1959-1968. doi:10.1056/NEJMoa1108660. PubMed: 22085317.
[20]  the Trials of Hypertension Prevention Collaborative Research Group (1997) Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. Arch Intern Med; 157(6): 657-667. doi:10.1001/archinte.1997.00440270105009. PubMed: 9080920.


comments powered by Disqus