VALIDITAS DIAGNOSTIK INDEKS TERKAIT LIPID DAN OBESITAS UNTUK DETEKSI RESISTENSI INSULIN PADA TENAGA KESEHATAN

Auliya Nisa, Pembimbing I: dr. Windarwati, M.Sc., Sp.PK, Subsp. E.M. (K). Pembimbing II: Dr. dr.Tri Ratnaningsih, M.Kes, Sp.PK. Subsp.B.D.K.T.(K), Subsp.H.K.(K)

2026 | Tesis-Spesialis | S2 Ilmu Patologi Klinik

Latar Belakang:

Resistensi insulin merupakan kondisi yang berperan penting dalam perkembangan diabetes melitus tipe 2 dan penyakit kardiometabolik. Metode baku emas penilaian resistensi insulin, yaitu hyperinsulinemic-euglycemic clamp, sulit diterapkan pada penelitian populasi besar, sedangkan HOMA-IR memerlukan pemeriksaan insulin puasa yang tidak selalu tersedia. Indeks berbasis lipid dan adipositas, seperti Triglyceride-Glucose index (TyG), TyG-BMI, TyG-WC, TyG-WHtR, dan Lipid Accumulation Product (LAP), berpotensi digunakan sebagai penanda pengganti resistensi insulin. Namun, kemampuan diagnostik indeks-indeks tersebut pada populasi dokter di Indonesia masih terbatas dilaporkan.

Tujuan:
Mengetahui validitas diagnostik indeks TyG, TyG-BMI, TyG-WC, TyG-WHtR, dan LAP dalam mendeteksi resistensi insulin pada tenaga kesehatan.

Metode:
Penelitian ini merupakan studi observasional analitik potong lintang dengan pendekatan uji diagnostik. Sebanyak 176 dokter berusia ?30 tahun yang menjalani pemeriksaan kesehatan diikutsertakan dalam penelitian. Data yang dikumpulkan meliputi pengukuran antropometri, glukosa puasa, trigliserida puasa, dan insulin puasa. HOMA-IR dengan cut-off ?2,5 digunakan sebagai standar rujukan resistensi insulin. Analisis diagnostik dilakukan menggunakan kurva receiver operating characteristic (ROC) untuk menentukan area under the curve (AUC), sensitivitas, spesifisitas, dan titik potong optimal berdasarkan indeks Youden.

Hasil:
Sebanyak 74 subjek (42,0%) mengalami resistensi insulin. Seluruh indeks menunjukkan kemampuan diagnostik yang baik dengan nilai AUC >0,80. Nilai AUC TyG, TyG-BMI, TyG-WC, TyG-WHtR, dan LAP berturut-turut adalah 0,824; 0,887; 0,865; 0,853; dan 0,864. TyG-BMI dan LAP menunjukkan sensitivitas tertinggi (89,19%), sedangkan TyG-WHtR menunjukkan spesifisitas tertinggi (86,27%). TyG-BMI memiliki nilai AUC, akurasi (81,25%), dan indeks Youden (0,65) tertinggi secara numerik.

Kesimpulan:
TyG, TyG-BMI, TyG-WC, TyG-WHtR, dan LAP memiliki kemampuan diagnostik yang baik untuk mendeteksi resistensi insulin pada populasi dokter dan berpotensi digunakan sebagai metode skrining sederhana.

Background:

Insulin resistance is a key pathophysiological condition involved in the development of type 2 diabetes mellitus and cardiometabolic diseases. The gold standard method for assessing insulin resistance, the hyperinsulinemic-euglycemic clamp, is difficult to apply in large population studies, whereas HOMA-IR requires fasting insulin measurements that are not always available. Lipid- and adiposity-based indices, including the Triglyceride-Glucose index (TyG), TyG-BMI, TyG-WC, TyG-WHtR, and Lipid Accumulation Product (LAP), have been proposed as surrogate markers of insulin resistance. However, evidence regarding the diagnostic performance of these indices among Indonesian physicians remains limited.

Objective:
To evaluate the diagnostic performance of TyG, TyG-BMI, TyG-WC, TyG-WHtR, and LAP in detecting insulin resistance among physicians.

Methods:
This was a cross-sectional analytical study with a diagnostic test design. A total of 176 physicians aged ?30 years who underwent health examinations were included in the study. Data collected included anthropometric measurements, fasting plasma glucose, fasting triglycerides, and fasting insulin levels. HOMA-IR with a cut-off value of ?2.5 was used as the reference standard for insulin resistance. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC), sensitivity, specificity, and optimal cut-off values based on the Youden index.

Results:
A total of 74 subjects (42.0%) had insulin resistance. All indices demonstrated good diagnostic performance with AUC values greater than 0.80. The AUC values for TyG, TyG-BMI, TyG-WC, TyG-WHtR, and LAP were 0.824, 0.887, 0.865, 0.853, and 0.864, respectively. TyG-BMI and LAP showed the highest sensitivity (89.19%), whereas TyG-WHtR showed the highest specificity (86.27%). TyG-BMI had the highest AUC, accuracy (81.25%), and Youden index (0.65) numerically.

Conclusion:
TyG, TyG-BMI, TyG-WC, TyG-WHtR, and LAP demonstrated good diagnostic performance for detecting insulin resistance among physicians and may serve as simple screening tools for identifying insulin resistance.

Kata Kunci : Resistensi insulin, TyG, TyG-BMI, TyG-WC, TyG-WHtR, LAP