Ratio-Based Assessments

The TyG index is presented as the most accurate currently available clinical proxy for insulin resistance. TG:HDL is more stable than HOMA-IR because triglycerides and HDL are less moment-to-moment volatile than fasting insulin. HOMA-IR remains used in research, especially PCOS studies, but has been superseded by more stable ratios for primary clinical use. A TG:HDL ratio below 2.0 is presented as the current recommended target, replacing the older 3.0 threshold as too permissive. Ratio-based assessments combine volatile markers to partially cancel noise. TyG is described as mechanistically grounded because triglycerides and glucose are downstream products of insulin resistance pathophysiology. HOMA-IR combines fasting insulin and fasting glucose to reduce the volatility of each input. A TyG concern threshold of 8.1-8.4 is associated with higher likelihood of diabetes transition, diabetic complications, and major adverse cardiovascular events.