Estimated glucose disposal rate predicts mortality in adults with type 1 diabetes

Metabolic dysfunction-associated steatotic liver disease, insulin sensitivity and continuous glucose monitoring metrics in patients with type 1 diabetes: A multi-centre cross-sectional study

BACKGROUND AND AIM

We assessed the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and significant liver fibrosis in adults with type 1 diabetes mellitus (T1DM) and the association of MASLD with insulin sensitivity and continuous glucose monitoring metrics.

METHODS

We consecutively enrolled 198 adults with T1DM undergoing vibration-controlled transient elastography with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). All participants had a continuous glucose monitoring (CGM) device. Insulin sensitivity was evaluated by estimated glucose disposal rate (eGDR). MASLD was defined as CAP ≥ 248 db/m and the presence of at least one cardiometabolic risk factor. Significant liver fibrosis was defined as LSM ≥ 7 kPa.

RESULTS

Patients had a mean age of 56 years, mean BMI of 26.0 ± 5.9 kg/m2, and mean eGDR of 7.1 ± 2.3 mg/kg/min. 73 (37%) patients had MASLD (using a CAP threshold of 274 dB/m), 16 (8.1%) of whom had significant liver fibrosis. MASLD was associated with a significantly lower eGDR (beta coefficient = -0.367, 95% confidence interval -0.472 to -0.261; p < 0.001). This association remained significant, even after adjustment for age, sex, body mass index, plasma triglycerides, diabetes duration, daily insulin dose, time above the range of glucose levels, LSM and chronic kidney disease. No association was observed between MASLD and CGM-derived metrics. These results were not different when we used a CAP threshold of 274 dB/m for diagnosing MASLD.

CONCLUSION

In T1DM, MASLD was inversely associated with eGDR and biomarkers of insulin resistance but not with CGM-derived metrics.

Association of the estimated glucose disposal rate with and mortality risk in patients with atherosclerotic cardiovascular disease: A cohort study from the NHANES 1999-2018

AIM

To investigate the association between estimated glucose disposal rate (eGDR) and mortality risk among patients with atherosclerotic cardiovascular disease (ASCVD).

METHODS

NHANES (1999-2018) data were analyzed using weighted Cox regression and restricted cubic splines (RCS) to assess the association between eGDR and mortality. Improvement in predictive performance was evaluated. Subgroup, mediation, and sensitivity analyses were conducted.

RESULTS

Among 4,425 ASCVD patients (67.40 % ≥60 years, 44.66 % female), 1,815 deaths (35.62 %) and 751 CVD deaths (18.48 %) occurred over 7.7 years. Compared to the highest quartile, the lowest eGDR quartile had HRs of 2.13 and 2.06 for CVD and all-cause mortality, respectively. RCS demonstrated linearity (P-nonlinear > 0.05). Addition of eGDR improved the predictive performance for both CVD and all-cause mortality (P < 0.001), whereas other insulin resistance indicators did not yield comparable improvements. Diabetes status modified its association with CVD mortality (P-interaction = 0.029). Neutrophil-to-lymphocyte ratio and estimated pulse wave velocity were key mediators.

CONCLUSIONS

Lower eGDR was associated with increased mortality risk in ASCVD, particularly among patients without diabetes. eGDR enhances mortality prediction, supporting its role as a prognostic marker in ASCVD.

The role of cardiovascular disease in the association between estimated glucose disposal rate and chronic kidney disease

Chronic kidney disease (CKD) is characterized as a progressive dysfunction of the kidney. The estimated glucose disposal rate (eGDR) is widely recognized as a dependable marker of insulin resistance (IR). Nonetheless, the potential link between eGDR and CKD incidence remains insufficiently clarified. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). The outcome of this study was CKD events. We performed adjusted Cox proportional hazards regression, restricted cubic splines (RCS), and mediation analyses. Among the 6,737 participants followed for a median of 108 months, 1,356 (20.13%) developed CKD. Relative to the lowest quartile (Q1) of eGDR, the adjusted HR for the highest quartile (Q4) was 0.85 (95% CI: 0.72-0.99). Each standard deviation increase in eGDR was linked to a 7% reduction in CKD risk (HR: 0.93, 95% CI: 0.88-0.99). The RCS curve indicated a linear relationship between eGDR and CKD risk (threshold = 8.21). The cardiovascular disease (CVD) significantly mediated 27.0% of the association between eGDR and CKD risk. This study demonstrates a significant inverse correlation between eGDR levels and CKD risk in middle-aged and elderly individuals within the Chinese population. Moreover, CVD emerges as a key intermediary linking eGDR and the heightened risk of CKD.

Association Between Estimated Glucose Disposal Rate and Stroke in Middle-Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study

BACKGROUND

The estimated glucose disposal rate (eGDR) is recognized as a reliable marker of insulin resistance. However, the association between eGDR and the risk of stroke remains unclear.

METHODS AND RESULTS

A total of 13 706 middle-aged and older participants were enrolled from CHARLS (China Health and Retirement Longitudinal Study). The primary end point was the occurrence of stroke events. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between eGDR and the risk of stroke according to sex, age, and glycemic status. A total of 1101 stroke events were recorded. Our findings revealed a significant nonlinear relationship between eGDR and the occurrence of stroke. The association was similar between men (hazard ratio [HR], 0.83 [95% CI, 0.80-0.87]) and women (HR, 0.86 [95% CI, 0.80-0.87]), as well as among participants with normal glucose tolerance (HR, 0.83 [95% CI, 0.79-0.87]), prediabetes (HR, 0.85 [95% CI, 0.82-0.89]), and diabetes (HR, 0.87 [95% CI, 0.82-0.92]). However, the association was stronger in middle-aged participants (HR, 0.82 [95% CI, 0.78-0.86]) compared with older individuals (HR, 0.87 [95% CI, 0.83-0.90]; P for interaction=0.019).

CONCLUSIONS

This study demonstrates that lower eGDR levels are significantly linked to increased stroke risk. The relationship between eGDR and stroke risk was similar across different sexes and glycemic statuses and was stronger in middle-aged participants compared with older participants.

Insulin resistance in type 1 diabetes is a key modulator of platelet hyperreactivity

AIMS/HYPOTHESIS

Individuals with type 1 diabetes are at increased cardiovascular risk, particularly in the presence of insulin resistance. A prothrombotic environment is believed to contribute to this risk but thrombotic pathways in type 1 diabetes are only partially understood and the role of platelets is incompletely studied. We hypothesised that platelets from individuals with type 1 diabetes exhibit platelet hyperactivity due to both increased propensity for activation and diminished sensitivity to inhibition, with an amplified maladaptive phenotype in those with insulin resistance.

METHODS

Blood samples were obtained from individuals with type 1 diabetes enrolled on the 'Double diabEtes and adVErse cLinical Outcome: identification of mechanistic Pathways' (DEVELOP) study with insulin resistance assessed as estimated glucose disposal rate (eGDR), whereby eGDR >8 or <6 mg kg-1 min-1 indicates normal insulin sensitivity or advanced insulin resistance, respectively. Platelet function was analysed using whole blood multiparameter flow cytometry to simultaneously measure three distinct markers of activation, including integrin αIIbβ3 (PAC-1 binding), P-selectin (CD62P) and phosphatidylserine (PS) (Annexin V). Both activation and inhibition responses of the platelets were investigated, which were subjected to the machine learning tool Full Annotation Shape-constrained Trees (FAUST) to characterise platelet subpopulations.

RESULTS

A total of 32 individuals with type 1 diabetes were studied (median age [range] of 24 [18-34] years, 59% male, diabetes duration [mean ± SD] of 14.0 ± 6.3 years and HbA1c of 65.3 ± 14.0 mmol/mol [8.1%]). An increased basal expression, measured as mean fluorescence intensity, of all three platelet activation markers was detected in the type 1 diabetes group compared with healthy control participants (CD62P expression 521 ± 246 vs 335 ± 67; p<0.001, PAC-1 370 ± 165 vs 231 ± 88; p=0.011 and PS 869 ± 762 vs 294 ± 109; p=0.001). Following platelet stimulation, an enhanced activation of these markers was found in the type 1 diabetes group. Within the type 1 diabetes group, those with advanced insulin resistance (eGDR<6 mg kg-1 min-1) showed increased platelet activation compared with individuals with normal insulin sensitivity (eGDR>8 mg kg-1 min-1) with single agonist stimulation CD62P expression (29,167 ± 2177 vs 22,829 ± 2535, p<0.001 and PAC-1 19,339 ± 11,749 and 5187 ± 2872, p=0.02). Moreover, individuals with type 1 diabetes showed reduced sensitivity to platelet inhibition by prostacyclin (PGI2) compared with control participants. Stratification of individuals with type 1 diabetes by insulin resistance demonstrated that in the presence of PGI2, suppression of stimulated CD62P was 17 ± 11% and 33 ± 12% (p=0.02) for advanced insulin resistance and normal insulin sensitivity groups, respectively, with even larger differences demonstrated for PAC-1 (48 ± 17% and 75 ± 7%; p=0.006) and PS exposure (33 ± 12% and 84 ± 10%; p=0.001). Furthermore, FAUST analysis showed that, under basal conditions, there was a different distribution of the eight platelet subpopulations comparing advanced insulin resistance and normal insulin sensitivity groups, with differences also detected following PGI2 inhibition.

CONCLUSIONS/INTERPRETATION

Our novel characterisation of platelets in type 1 diabetes shows a maladaptive phenotype with increased basal activity together with hyperactivation following stimulation and diminished responses to inhibition. Insulin resistance appears to further drive this adverse thrombotic phenotype, suggesting an enhanced platelet-driven cardiovascular risk in those with type 1 diabetes and reduced insulin sensitivity.

The role of estimated glucose disposal rate in predicting cardiovascular risk among general and diabetes mellitus population: a systematic review and meta-analysis

BACKGROUND

Estimated glucose disposal rate (eGDR) is a measure of insulin sensitivity. While recent evidence suggests its role in cardiovascular risk assessment in Type 1 diabetes, its associations with cardiovascular disease (CVD), diabetic microvascular complications (DMC), and mortality across different populations remain unclear.

METHODS

We systematically searched Medline, EMBASE, Web of Science, and the Cochrane Library up to September 1st, 2024, following PRISMA guidelines. We examined associations between eGDR and CVD, DMC (including diabetic retinopathy, nephropathy, and peripheral neuropathy), and all-cause mortality using random-effects models. Secondary analysis assessed mean eGDR levels in diabetes populations.

RESULTS

Nineteen observational studies (185,810 participants) examined clinical outcomes, while 50 studies reported mean eGDR values. In patients with Type 1 diabetes (T1DM), each 1-unit (mg/kg/min) increase in eGDR was associated with lower risks of CVD (HR 0.78; 95% CI 0.69-0.87; I2 = 68%) and all-cause mortality (HR 0.83; 95% CI 0.79-0.88; I2 = 0%). The association between eGDR and DMC in T1DM was not statistically significant (HR 0.86; 95% CI 0.72-1.03; I2 = 25%). In patients with Type 2 diabetes (T2DM), each 1-unit (mg/kg/min) increase in eGDR was associated with reduced all-cause mortality (HR 0.90; 95% CI 0.84-0.97; I2 = 62%). Similarly, in the general population, each 1-unit (mg/kg/min) increase in eGDR was associated with decreased mortality risk (HR 0.88; 95% CI 0.82-0.94; I2 = 48%). The pooled mean eGDR was higher in patients with T1DM (8.19 mg/kg/min; 95% CI 7.81-8.57; I2 = 99%) compared to those with T2DM (7.03 mg/kg/min; 95% CI 4.89-9.17; I2 = 100%).

CONCLUSIONS

Higher eGDR levels were consistently associated with lower risks of CVD and mortality in T1DM, with similar associations observed for mortality in T2DM. In the general population, higher eGDR levels were associated with reduced mortality risk. The relationship between eGDR and DMC requires further investigation, particularly in T2DM. These findings suggest eGDR's potential utility as a risk assessment tool, though its clinical application may vary across different populations.

Association between estimated glucose disposal rate and future cardiovascular disease risk across glucose metabolism status: a prospective cohort study

BACKGROUND

Cardiovascular disease (CVD) remains a major global health challenge, particularly affected by glucose metabolism status. However, the relationship between estimated glucose disposal rate (eGDR) and future CVD risk across different glucose metabolism status remains unclear.

METHODS

We analyzed data from the China Health and Retirement Longitudinal Study (2011-2020) of participants aged ≥ 45 years. The eGDR was calculated using waist circumference, hypertension status, and HbA1c levels. CVD events (stroke or cardiac events) were the outcome. Participants were categorized by glucose metabolism status (normoglycemia, prediabetes, diabetes). Cox proportional hazards models and restricted cubic splines were used to assess associations and potential non-linear relationships.

RESULTS

Among 7,828 participants (52.84% male, mean age 59.01 ± 9.21 years) followed for an average of 8.29 years, 1,944 participants (24.83%) developed CVD. Higher eGDR was inversely associated with CVD risk across all glucose metabolism states. Below the inflection points (11.77, 11.15, and 11.56 mg/kg/min for normoglycemia, prediabetes, and diabetes, respectively), each 1-unit increase in eGDR reduced CVD risk by 14% (HR = 0.86, 95%CI: 0.83-0.89), 10% (HR = 0.90, 95%CI: 0.86-0.93), and 14% (HR = 0.86, 95%CI: 0.81-0.91), respectively.

CONCLUSION

The eGDR demonstrates a potentially non-linear inverse association with future CVD risk across different glucose metabolism states.

Estimated Glucose Disposal Rate Predicts the Risk of Incident Metabolic Dysfunction-Associated Steatotic Liver Disease

OBJECTIVES

There is a relationship between insulin resistance and metabolic dysfunction-associated steatotic liver disease (MASLD) and the estimated glucose disposal rate (eGDR), which has been reported as a surrogate marker of insulin resistance. This study aimed to investigate the association between eGDR and the incident MASLD, and compare the ability to predict incident MASLD with other insulin resistance markers.

METHODS

Retrospective cohort data from a health check-up program were analyzed. Participants were categorized into 4 subgroups according to eGDR quartiles. To assess the association between eGDR quartiles and incident MASLD, logistic regression analyses were used. Additionally, to compare the predictive ability of eGDR, triglyceride/high-density lipoprotein (HDL) cholesterol (TG/HDL) ratio, and triglyceride glucose index with respect to incident MASLD, receiver operating characteristics analysis was used.

RESULTS

Of 16 689 participants were included, 3654 developed MASLD. After multivariate adjustment, compared with the lowest eGDR quartile, odds ratios (95% confidence interval [CI]) for incident MASLD in the second, third, and highest GDR quartiles, were 0.775 (0.692-0.868), 0.478 (0.408-0.560), and 0.147 (0.110-0194), respectively. The association between lower eGDR levels and MASLD risk remained consistent across stratification by sex and obesity status. Moreover, the area under the receiver operating characteristics curve (95% CI) for eGDR (0.8 [0.79-0.81]) was higher than for TG/HDL ratio 0.76 [0.79-0.81]) and triglyceride glucose index (0.75 [0.74-0.76]).

CONCLUSIONS

Lower eGDR levels were associated with an increased risk of incident MASLD. Our findings suggest that eGDR may be a more effective tool for predicting MASLD risk.

Association between the changes in the estimated glucose disposal rate and new-onset cardiovascular disease in middle-aged and elderly individuals: A nationwide prospective cohort study in China

AIMS

Previous studies have shown that eGDR and TyG, as indicators of insulin resistance (IR), were key risk factors for cardiovascular disease (CVD). Our study further explored the relationship between eGDR change and new-onset CVD, and compared the predictive value of eGDR change, eGDR and TyG.

MATERIALS AND METHODS

A total of 2895 participants without CVD at baseline from the China Health and Retirement Longitudinal Study (CHARLS) were included, using K-means clustering and cumulative eGDR to measure eGDR change between 2012 and 2015. Cox and restricted cubic splines (RCS) regression models assessed the relationship between eGDR change and new-onset CVD. The predictive value of TyG, eGDR and eGDR change for outcomes was evaluated using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

RESULTS

During a mean follow-up of 4.42 years, 581 CVD cases occurred, including 389 heart disease cases and 249 stroke cases. Participants with consistently low eGDR had a higher new-onset CVD risk (HR: 2.51, 95%CI: 2.04-3.09). A stepwise increase of outcomes was observed with the increased cumulative eGDR (p for trend <0.001). Further analysis showed the correlation between cumulative eGDR and outcomes was linear. Compared to eGDR and TyG, cumulative eGDR exerted greater predictive effect as evaluated by area under curve, IDI and NRI.

CONCLUSIONS

Sustained low eGDR was related to an increased risk of new-onset CVD in middle-aged and elderly population. Continuous monitoring of eGDR significantly enhances the accuracy of new-onset CVD risk stratification, which may reduce the incidence of new-onset CVD.

Associations between estimated glucose disposal rate and osteoarthritis risk in US adults: a cross-sectional study

BACKGROUND

Estimated glucose disposal rate (eGDR) is a novel insulin resistance (IR) assessment surrogate. Although it has shown promising potential in other metabolic disease studies, no research has yet explored its relationship with osteoarthritis (OA). Therefore, this study aims to investigate the association between eGDR and OA in a cross-sectional observational cohort.

METHOD

Data utilized in this cross-sectional study were drawn from the National Health and Nutrition Examination Survey (NHANES). Logistic regression models were used to evaluate the association between eGDR and OA, stratified analysis was applied to assess the stability of the results.

RESULT

A total of 19,040 participants were included in the study, including 2,001 OA patients and 17,039 non-OA participants with an age distribution ranging from 20 to 85 years. The fully adjusted logistic regression model shows that eGDR were less likely associated with OA compared to those with non-OA (OR = 0.879, 95% CI = 0.846-0.914, P < 0.001). By dispersing the eGDR into quartiles, the correlation between eGDR and OA remained significant (P for trend < 0.0001).

CONCLUSION

This study suggests that eGDR is independently associated with OA, with lower eGDR values being linked to a higher risk of OA.

CLINICAL TRIAL NUMBER

Not applicable.

Association between estimated glucose disposal rate and prediabetes reversion and progression: a nationwide cohort study of middle-aged and elderly people in China

Objective

Prediabetes is a chronic condition characterized by elevated blood glucose levels that are not yet high enough to be classified as diabetes. It is particularly prevalent among middle-aged and elderly populations. This study aims to investigate the association between a novel marker of insulin resistance-the estimated glucose disposal rate (eGDR)-and the reversion of prediabetes to normoglycaemia or progression to diabetes in a Chinese population.

Methods

This prospective cohort study utilized baseline data from the 2011 China Health and Retirement Longitudinal Study involving 2,600 prediabetic participants aged 45 years and older, along with follow-up data from 2015. The study's endpoints were defined according to the American Diabetes Association criteria, including maintenance of the prediabetic state, reversion to normoglycaemia, or progression to diabetes. Multivariable Cox regression models and restricted cubic spline regression were used to assess the association between eGDR and the reversion or progression of prediabetes in middle-aged and elderly populations, followed by stratified analyses to explore potential population-specific dependencies.

Results

Over a median follow-up period of 4 years, 1,615 (62.1%) participants remained in the prediabetic state, 586 (22.5%) reverted to normoglycaemia, and 399 (15.3%) progressed to diabetes. In multivariable Cox regression analyses, our results indicated that eGDR was positively associated with the reversion of prediabetes to normoglycaemia [Hazard Ratio = 1.14, 95% Confidence Interval: 1.05, 1.23], and negatively associated with the progression of prediabetes to diabetes (HR = 0.81, 95% CI: 0.70, 0.93). Restricted cubic spline analysis revealed a nonlinear, L-shaped association between eGDR and the reversion of prediabetes to normoglycaemia, with segmented Cox regression identifying an eGDR threshold of 6.81 as the point of significant change in the likelihood of prediabetes reversion.

Conclusion

This prospective cohort study among middle-aged and elderly Chinese populations suggested that higher eGDR promoted the reversion of prediabetes and provided a protective effect against its progression to diabetes.

Estimated glucose processing rates and the association of chronic kidney disease and proteinuria in non-diabetic adults

The study, which was based on NHANES data (1999-2018), included 21,234 nondiabetic individuals aged 20 years and older to investigate the associations between the estimated glucose disposal rate (eGDR) and the risk of chronic kidney disease (CKD) and proteinuria. CKD was defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2, and proteinuria was defined as a urinary albumin-to-creatinine ratio (UACR) exceeding 30 mg/g. The results demonstrated a significant inverse association between eGDR levels and the risks of CKD and proteinuria. After adjusting for potential confounders, the association between eGDR and CKD showed that, compared with those for Q1, the adjusted odds ratios (ORs) for Q2, Q3, and Q4 were 0.82 (95% CI: 0.61-1.11), 0.62 (95% CI: 0.39-0.98), and 0.55 (95% CI: 0.28-1.05), respectively. For the relationship between eGDR and proteinuria, the adjusted ORs for Q2, Q3, and Q4 were 0.54 (95% CI: 0.42-0.69), 0.41 (95% CI: 0.27-0.62), and 0.65 (95% CI: 0.43-0.98), respectively. Moreover, each standard deviation increase in eGDR was associated with a 9% reduction in CKD risk (OR: 0.91, 95% CI: 0.85-0.98) and a 13% reduction in proteinuria risk (OR: 0.87, 95% CI: 0.82-0.93). Further adjustments via restricted cubic spline (RCS) regression analysis revealed a significant nonlinear relationship between eGDR and CKD and a U-shaped relationship between eGDR and proteinuria. A lower risk of proteinuria was observed when eGDR levels were between 8.70 and 9.91. These findings, combined with those of previous studies, suggest that eGDR may serve as a potential alternative metric for insulin resistance (IR). In nondiabetic individuals, the eGDR was significantly associated with the risk of CKD and proteinuria, with a notable nonlinear pattern in these relationships.

The association between estimated glucose disposal rate and metabolic dysfunction-associated steatotic liver disease and liver fibrosis in US adults

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, also considered a metabolic syndrome, and is associated with poor prognosis. eGDR (estimated glucose disposal rate) is a new biomarker to assessment insulin resistance (IR). The association between eGDR and MASLD and liver fibrosis is currently unclear.

OBJECTIVE

The aim of this cross-sectional study is to appraise the association between eGDR and MASLD and liver fibrosis.

METHODS

This study have enrolled 3,100 participants from the 2017-2018 National Health and Nutrition Examination Surveys (NHANES). Binary logistic regression analysis was used to assess the association between eGDR and MASLD and liver fibrosis. Receiver operating characteristic (ROC) was applied to estimate the ability of eGDR to identify MASLD.

RESULTS

The mean age of the subjects was 54.59 (17.29) years, and 49.26% were female. The prevalence of MASLD and liver fibrosis was 62.19% and 11.15%, respectively. In the fully adjusted models, there were negative associations of eGDR with the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), with βs of -15.18 and - 0.74 (all p < 0.01), respectively. There were negative associations of eGDR with MASLD and liver fibrosis, with odds ratios (ORs) and 95% confidence intervals of 0.53 (95% CI: 0.48-0.74) and 0.40 (95% CI: 0.28-0.57) (all p < 0.01). The area under the curve (AUC) of the eGDR for identifying MASLD and liver fibrosis is 0.74 and 0.75, respectively.

CONCLUSION

The study findings suggest a significant association between eGDR and MASLD as well as liver fibrosis. eGDR may serve as a biomarker for identifying MASLD.

U-shaped relationship of estimated glucose disposal rate with cardiovascular disease risk in cardiovascular-kidney-metabolic syndrome stages 0-3: a population-based prospective study

BACKGROUND

Cardiovascular-Kidney-Metabolic (CKM) syndrome is characterized by the interrelatedness of chronic kidney disease (CKD), cardiovascular disease (CVD), and metabolic disorders. The relationship between estimated glucose disposal rate (eGDR) and CVD risk in CKM syndrome remains unclear.

METHODS

We analyzed data from 7,849 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). The eGDR was calculated using waist circumference, hypertension, and HbA1c. Cox regression and restricted cubic spline (RCS) regression analyses examined the association between eGDR and CVD (stroke or cardiac events).

RESULTS

During a mean follow-up of 8.29 ± 1.67 years, among 7,849 participants (mean age 62.4 ± 8.7 years; 52.82% male), 1,946 CVD events occurred, including 1,504 cardiac events and 663 strokes. CKM stages 0-3 comprised 492 (6.27%), 1,404 (17.89%), 5,462 (69.59%), and 491 (6.26%) of participants, respectively. A U-shaped relationship between eGDR and CVD risk was identified (turning point: 11.82 mg/kg/min). Below this turning point, each unit increase in eGDR decreased CVD risk by 12% (HR: 0.88, 95% CI: 0.86-0.90, P < 0.0001); above it, each unit increase raised the risk by 19% (HR: 1.19, 95% CI: 1.04-1.37, P = 0.0135).

CONCLUSION

Our findings reveal a U-shaped relationship between eGDR and CVD risk in CKM syndrome stages 0-3. A higher or lower eGDR was associated with an increased CVD risk.

Association between estimated glucose disposal rate with the all-cause and cause-specific mortality among the population with cardiometabolic syndrome

BACKGROUND

Estimated glucose disposal rate (eGDR) is considered as a reliable alternative indicator of insulin resistance. However, the relationship between eGDR levels and mortality among individuals with cardiometabolic syndrome (CMS), as well as within different glucose metabolic states in this population, remains unclear.

METHODS

We conducted a cohort study on 9928 CMS participants from the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018. The relationship between eGDR levels and mortality in the CMS population was evaluated using multivariable Cox proportional hazards regression models and restricted cubic splines (RCS). Finally, stratified analysis was performed to determine the relationship between eGDR levels and mortality in different subgroups.

RESULTS

Cox regression analysis showed a significant correlation between eGDR levels and both all-cause and cause-specific mortality in the entire CMS population (all p < 0.05). RCS analysis revealed a non-linear relationship between eGDR levels and both all-cause (p for overall < 0.001, p for non-linear < 0.001) and diabetes specific mortality (p for overall < 0.001, p for non-linear = 0.004) in CMS population, while a linear relationship with cardiovascular specific mortality (p for overall < 0.001, p for non-linear = 0.091). In participants with baseline diabetes mellitus (DM), eGDR levels were significantly correlated with all-cause mortality, cardiovascular specific mortality, and diabetes specific mortality (all p < 0.05). In CMS participants with baseline pre-diabetes mellitus (Pre-DM), eGDR levels were significantly correlated with cardiovascular-specific and diabetes-specific mortality (all p < 0.05). In CMS participants with baseline normal glucose regulation (NGR), eGDR levels were only significantly related to diabetes specific mortality (p < 0.05).

CONCLUSION

There is a significant correlation between eGDR levels and both all-cause and cause-specific mortality in the entire CMS population. Furthermore, the protective effect of high eGDR levels on mortality persists across various glucose metabolic states.

The relationship between estimated glucose disposal rate and cognitive function in older individuals

The estimated glucose disposal rate (eGDR) serves as a novel indicator of insulin resistance, which has been shown to correlate with cardiovascular disease risk; however, its relationship with cognitive function remains unclear.This article describes a cross-sectional study design based on data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). The Weighted logistic regression and the restricted cubic spline were employed to examine the relationship between eGDR and cognitive ability.The subjects were divided into two categories: the normal group and the cognitive function decline (CFD) group, based on their cognitive scores. There were significant differences in eGDR levels between the two groups(P = 0.001).After adjusting for relevant covariates, notable differences were found between eGDR and cognitive function when eGDR was expressed in both continuous and categorical data forms (P < 0.05). The stability of these findings was further confirmed through sensitivity analyses.This difference persisted in subgroups, including women, individuals with education beyond high school, moderate drinkers, and those who had not been diagnosed with stroke (P < 0.05). A restricted cubic spline revealed a non-linear relationship with an inflection point between the two (P-for-non-linear < 0.05, P-overall < 0.001). This study contributes to the understanding of the relationship between eGDR and cognitive performance by identifying a potential non-linear association.

Association between the cumulative estimated glucose disposal rate and incident cardiovascular disease in individuals over the age of 50 years and without diabetes: data from two large cohorts in China and the United States

BACKGROUND

The estimated glucose disposal rate (eGDR) has been linked to incident cardiovascular disease (CVD) in individuals without diabetes. However, few studies have accounted for long-term cumulative eGDR exposure.

OBJECTIVE

The aim of this study was to explore whether long-term cumulative eGDR was independently associated with incident CVD in individuals over the age of 50 years and without diabetes.

METHODS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The cumulative eGDR was calculated as the summation of the average eGDR for each pair of consecutive examinations multiplied by the time between these two consecutive visits, in years. The outcome was incident CVD. Cox proportional hazards regression models and restricted cubic spline (RCS) regression models were used to evaluate the association between cumulative eGDR and incident CVD.

RESULTS

A total of 2430 participants from CHARLS and 2008 participants from HRS were included in the analysis. The median age of the participants in CHARLS at baseline was 59 years [IQR: 55-65 years], and 1205 (49.59%) were men. The median age of the participants in HRS at baseline was 64 years [IQR: 57-70 years], and 705 (35.11%) were men. The RCS regression model showed a negative and linear association between the cumulative eGDR and incidence of CVD (CHARLS: P < 0.001, P for nonlinearity = 0.248; HRS: P = 0.013, P for nonlinearity = 0.121). After multivariate adjustment, the higher levels of cumulative eGDR were independently associated with a lower risk of CVD (per SD, CHARLS: HR: 0.802, 95% CI: 0.716-0.898, HRS: HR: 0.791, 95% CI: 0.665-0.940, pooled analysis: HR: 0.799, 95% CI: 0.726-0.878).

CONCLUSIONS

A lower level of cumulative eGDR was associated with an increased risk of incident CVD in individuals over the age of 50 years and without diabetes. Continuous monitoring of cumulative eGDR exposure over time, based on consideration of traditional risk factors, may prove beneficial for the early identification and intervention of individuals at high risk of CVD. In regions with limited healthcare resources, among individuals with limited ability to access, process, and understand health information and services, cumulative eGDR may offer improved clinical applicability.

Analyzing the impact of glycemic metabolic status on cardiovascular mortality and all-cause mortality related to the estimated glucose disposal rate: a nationwide cohort study

Objective

The Estimated Glucose Disposal Rate (eGDR) serves as a surrogate marker for insulin resistance, with numerous studies highlighting its significant prognostic value. This paper aims to analyze the impact of eGDR on cardiovascular and all-cause mortality across different glycemic metabolic statuses, including normal fasting glucose (NFG), prediabetes, and diabetes.

Methods

This study included 46,016 American adults who underwent health examinations as part of the National Health and Nutrition Examination Survey from 1999 to 2018. Multivariable Cox regression was employed to explore the relationships between eGDR and mortality rates under varying glycemic states. Additionally, Kaplan-Meier curves were used to compare the cumulative incidence of cardiovascular and all-cause mortality across different metabolic statuses. Finally, the predictive value of eGDR for mortality was assessed using receiver operating characteristic curves.

Results

During an average follow-up of 115 months, a total of 6,906 (15.01%) participants experienced all-cause mortality, with 1,798 (3.91%) deaths attributed to cardiovascular causes. Kaplan-Meier analysis revealed that higher eGDR levels were associated with gradually reduced mortality rates. After adjusting for confounders, elevated eGDR levels were protective against both cardiovascular and all-cause mortality; the protective effect was notably stronger for cardiovascular mortality [Cardiovascular mortality hazard ratio: 0.92; All-cause mortality hazard ratio: 0.94]. Further interaction tests indicated that glycemic status significantly modified the protective effect of eGDR (P-interaction<0.0001); specifically, high eGDR conferred stronger protection against cardiovascular and all-cause mortality in individuals with NFG and prediabetes compared to those with diabetes. Receiver operating characteristic analysis suggested that eGDR had superior predictive value for mortality in the NFG and prediabetic populations compared to the diabetic group.

Conclusion

eGDR is a straightforward surrogate for insulin resistance, acting as a protective factor against cardiovascular and all-cause mortality in American adults, with glycemic status modifying this protective effect. Specifically, high eGDR levels offer stronger protection in individuals with NFG and prediabetes compared to those with diabetes; moreover, eGDR appears to be more suitable for predicting mortality events in the NFG and prediabetic populations.

The 13C Glucose Breath Test Accurately Identifies Insulin Resistance in People With Type 1 Diabetes

OBJECTIVE

This study investigated whether the delta-over-baseline of exhaled 13CO2 (Δ13CO2), generated from a 13C glucose breath test (13C-GBT), measured insulin resistance (IR) in people with type 1 diabetes, using the hyperinsulinemic-euglycemic clamp (HEC) as a reference method. The secondary objective was to compare the 13C-GBT with the estimated glucose disposal rate (eGDR).

METHODS

A 40 mU/m2/min HEC and 2 separate 13C-GBTs (euglycemic with insulin bolus and hyperglycemic without bolus) were consecutively performed in 44 adults with type 1 diabetes with varying body compositions. eGDR was calculated based on hemoglobin A1c (HbA1c), presence of hypertension, and waist circumference.

RESULTS

The mean glucose disposal rate (M-value) was 5.9 ± 3.1 mg/kg/min and mean euglycemic Δ13CO2 was 6.4 ± 2.1 δ‰, while median eGDR was 5.9 [4.3-9.8] mg/kg/min. The hyperglycemic Δ13CO2 did not correlate with the M-value, while the euglycemic Δ13CO2 and the M-value correlated strongly (r = 0.74, P < .001). The correlation between M-value and eGDR was more moderate (Spearman's rho = 0.63, P < .001). Linear regression showed an association between Δ13CO2 and M-value, adjusted for age, sex, and HbA1c ]adjusted R² = 0.52, B = 1.16, 95% confidence interval (CI) .80-1.52, P < .001]. The area under the receiver-operator characteristics curve for Δ13CO2 to identify subjects with IR (M-value < 4.9 mg/kg/min) was 0.81 (95% CI .68-.94, P < .001). The optimal cut-off for Δ13CO2 to identify subjects with IR was ≤ 5.8 δ‰.

CONCLUSION

Under euglycemic conditions, the 13C-GBT accurately identified individuals with type 1 diabetes and concurrent IR, suggesting its potential as a valuable noninvasive index. Clinical Trial Identifier: NCT04623320.

Association between estimated glucose disposal rate and cardiovascular diseases in patients with diabetes or prediabetes: a cross-sectional study

BACKGROUND

Insulin resistance proxy indicators are significantly associated with cardiovascular disease (CVD) and diabetes. However, the correlations between the estimated glucose disposal rate (eGDR) index and CVD and its subtypes have yet to be thoroughly researched.

METHODS

10,690 respondents with diabetes and prediabetes from the NHANES 1999-2016 were enrolled in the study. Three machine learning methods (SVM-RFE, XGBoost, and Boruta algorithms) were employed to select the most critical variables. Logistic regression models were established to evaluate the association between eGDR and CVD. We applied ROC curves, C-statistics, NRI, IDI, calibration curves, and DCA curves to assess model performance. Subgroup analyses were conducted to investigate the association among different subgroups.

RESULTS

Participants in the higher quartile showed a decreased prevalence of CVD. Multivariate logistic regression models and RCS curves demonstrated that eGDR had an independently negative linear correlation with the likelihood of CVD[Q4 vs. Q1: OR 0.24(0.18,0.32)], CAD[OR 0.81(0.78,0.85)], CHF[OR 0.81(0.76,0.86)], and stroke[0.85(0.80,0.90)]. Model evaluation showed better performance in fully adjusted models than basic models[C-statistics(Model 3 vs. Model 1): CVD(0.683 vs. 0.814), CAD(0.672 vs. 0.807), CHF(0.714 vs. 0.839) and stroke(0.660 vs. 0.790)]. The AUCs of eGDR were significantly higher than the values of other IR surrogates in the unadjusted models, and slightly higher in the fully adjusted models. Subgroup analyses indicated that the results were robust.

CONCLUSION

A lower eGDR was significantly associated with a heightened likelihood of CVD and its subtypes in diabetic and prediabetic populations. And eGDR exhibited better performance in evaluating the associations compared to other IR proxies encompassing TyG, HOMA-IR, QCUIKI, METS-IR, etc.

Association between estimated glucose disposal rate and subclinical coronary atherosclerosis

BACKGROUND AND AIMS

The estimated glucose disposal rate (eGDR) is an easily accessible clinical parameter for assessing insulin resistance in patients with diabetes mellitus. In this study, we aimed to investigate the link between eGDR and subclinical coronary atherosclerosis in an asymptomatic middle-aged Korean population.

METHODS AND RESULTS

This study involved 4004 subjects who underwent routine health checkups with coronary multidetector computed tomography (MDCT) at Asan Medical Center from 2007 to 2011, among whom 913 had a follow-up analysis through 2014. The eGDR was calculated using: 21.16 - (0.09 ∗ waist circumference [cm]) - (3.41 ∗ hypertension) - (0.55 ∗ glycated hemoglobin [%]). Patients were categorized into three groups according to the tertiles of eGDR. Subclinical coronary atherosclerosis was defined by significant coronary stenosis (≥50%), presence of plaques, coronary artery calcification (CAC) score, and its progression. As a result, a lower eGDR level was associated with higher prevalence of significant coronary stenosis, plaques, moderate to severe CAC, and CAC progression. Compared to other markers or risk scores, eGDR was superior to other biomarkers of insulin resistance but did not provide additional information beyond classic cardiovascular risk models like the Framingham Risk Score and Pooled Cohort Equations.

CONCLUSION

Decreased eGDR values were significantly associated with higher subclinical coronary atherosclerosis burdens in an asymptomatic middle-aged Korean population. However, its clinical implications remain uncertain due to its weaker performance compared to established cardiovascular risk models.

The predictive value of estimated glucose disposal rate for all-cause and cardiovascular mortality in the US non-diabetic population aged ≥60 years: A population-based cohort study

AIMS

This study seeks to evaluate the prognostic significance of eGDR in predicting mortality outcomes within non-diabetic older adults.

METHODS

8131 non-diabetic participants aged ≥60 years from the National Health and Nutrition Examination Survey (2001-2018) was included in this study. eGDR was calculated as: eGDR (mg/kg/min) = 21.158 - [0.09 × waist circumference (cm)] - [3.407 × Hypertension (Yes = 1/No = 0)] - [0.551 × HbA1c (%)]. Weighted Cox proportional hazards models, cumulative hazard curves, restricted cubic spline (RCS), and threshold effects analyses were performed to explore the relationship between eGDR and mortality outcomes. Subgroup analyses and mediation effects analyses were conducted.

RESULTS

2566 all-cause deaths and 689 cardiovascular deaths were recorded. Lower eGDR was associated with higher all-cause (HR = 0.76, 95 % CI: 0.63-0.91) and cardiovascular mortality (HR = 0.56, 95 % CI: 0.40-0.80). Inflection points were identified through RCS curve analyses, and the threshold effect was significant. The eGDR-mortality association remained consistent across subgroups. Mediation analyses showed that neutrophil to high-density lipoprotein cholesterol ratio mediated the association.

CONCLUSIONS

Lower eGDR levels are linked to higher risk of both all-cause and cardiovascular mortality in non-diabetic older adults, suggesting its potential utility for risk assessment among this population.

Gender differences in the association between insulin resistance assessed by estimated glucose disposal rate and the risk of all-cause and cardiovascular deaths in adults without diabetes

AIM

We intended to examine the relationship between estimated glucose disposal rate (eGDR) and risks of all-cause and cardiovascular deaths in non-diabetic adults.

METHODS

38,175 participants from the National Health and Nutrition Examination Survey (1999-2018) were included, and deaths were identified through the National Death Index.

RESULTS

With a median follow-up of 9.8 years, we found that dose-response relationships between eGDR level and the risk of death differed between genders. In female participants, higher eGDR level was linearly correlated with lower risks of all-cause and cardiovascular deaths. In contrast, among male participants, there were L-shaped relationships between eGDR and risks of all-cause and cardiovascular deaths, with threshold points of 8.50 and 8.49 mg/kg/min, respectively. To the left of threshold points, eGDR was negatively linked with risks of all-cause (HR 0.91, 95 % CI 0.88-0.94, P < 0.001) and cardiovascular deaths (HR 0.87, 95 % CI 0.82-0.93, P < 0.001). After the inflection point, an increase in eGDR was not related to lower risks of all-cause and cardiovascular deaths (P > 0.05).

CONCLUSION

Higher eGDR level was associated with lower risks of all-cause and cardiovascular deaths in a linear dose-response manner among non-diabetic females, while L-shaped relationships were observed among non-diabetic males.

Metabolic health in people living with type 1 diabetes in Belgium: a repeated cross-sectional study

AIMS/HYPOTHESIS

Metabolic abnormalities such as central obesity, insulin resistance, dyslipidaemia and hypertension, often referred to as 'the metabolic syndrome' (or 'combined metabolic abnormalities'), are increasingly being identified in people living with type 1 diabetes, accelerating the risk for CVD. As a result, in recent years, treatment in people living with type 1 diabetes has shifted to improving overall metabolic health rather than glucose control alone. In Belgium, diabetes care for people living with type 1 diabetes is centrally organised. The Initiative for Quality Improvement and Epidemiology in Diabetes, imposed by the Belgian health insurance system, has systematically collected data from patients on intensive insulin therapy treated in all 101 diabetes clinics in Belgium since 2001. The aim of this real-world study is to describe the evolution of treatment and metabolic health, including the prevalence of obesity and combined metabolic abnormalities, in people living with type 1 diabetes over the past 20 years, and to compare the treatment and prevalence of complications between those with and without combined metabolic abnormalities.

METHODS

We analysed data on adults (≥16 years old) living with type 1 diabetes, who were diagnosed at age ≤45 years and who had a diabetes duration ≥1 year, collected between 2001 and 2022. The evolution of HbA1c, BMI, LDL-cholesterol, systolic BP, lipid-lowering therapy and antihypertensive therapy over time was analysed. The prevalence of individual and multiple metabolic abnormalities according to various definitions of the metabolic syndrome/combined metabolic abnormalities was analysed, and the association between combined metabolic abnormalities and metabolic health indicators, complications and treatment was investigated in the 2022 data.

RESULTS

The final dataset consisted of 26,791 registrations of adults living with type 1 diabetes collected between 2001 and 2022. Although glycaemic and lipid control generally improved over time, the prevalence of obesity strongly increased (12.1% in 2001 vs 21.7% in 2022, p<0.0001), as did the presence of combined metabolic abnormalities (WHO criteria: 26.9% in 2001 vs 42.9% in 2022 in women, p<0.0001; 30.4% in 2001 vs 52.1% in 2022 in men, p<0.0001; WHO criteria without albuminuria: 22.3% in 2001 vs 40.6% in 2022 in women, p<0.0001; 25.1% in 2001 vs 49.2% in 2022 in men, p<0.0001; NCEP-ATPIII criteria: 39.9% in 2005 vs 57.2% in 2022 in women, p<0.0001; 40.8% in 2005 vs 60.9% in 2022 in men, p<0.0001; IDF criteria: 43.9% in 2005 vs 59.3% in 2022 in women, p<0.001; 33.7% in 2005 vs 50.0% in 2022 in men, p<0.0001). People with combined metabolic abnormalities had higher glucose levels compared to those without combined metabolic abnormalities (HbA1c >58 mmol in men: 48.9% vs 36.9%; HbA1c >58 mmol in women: 53.3% vs 41.1%, p<0.0001). People with combined metabolic abnormalities were more often treated with adjunct therapies such as metformin, sodium-glucose transport protein 2 inhibitors and glucagon-like peptide-1 receptor agonists. In both men and women, the presence of combined metabolic abnormalities was strongly related to the presence of eye complications, peripheral neuropathy, chronic kidney disease and CVD, corrected for age, diabetes duration and HbA1c.

CONCLUSIONS/INTERPRETATION

Overweight, obesity and combined metabolic abnormalities are increasingly being identified in people living with type 1 diabetes, further accelerating the risk of microvascular and macrovascular complications. Early identification of the presence of combined metabolic abnormalities should enable therapeutic interventions to be modified towards multifactorial approaches, with attention to education on avoidance of overweight (e.g. dietary counselling) in addition to strict glycaemic control and intensification of use of antihypertensive agents and statins. Use of adjunct therapies in this population as a tool should be explored more thoroughly to reduce risk of complications.

Association of Insulin Resistance With Cardiovascular Disease and All-Cause Mortality in Type 1 Diabetes: Systematic Review and Meta-analysis

OBJECTIVE

The association of insulin resistance (IR) with cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes (T1D) remains unclear.

PURPOSE

To investigate whether IR is associated with CVD and all-cause mortality among individuals with T1D.

DATA SOURCES

PubMed, Embase, and the Cochrane Library databases were searched from inception to 31 October 2023.

STUDY SELECTION

Observational studies reporting the associations between IR, as calculated by the estimated glucose disposal rate (eGDR), and the risk of CVD and all-cause mortality in individuals with T1D were eligible for inclusion.

DATA EXTRACTION

Data from eight selected studies were extracted, pooled by random-effects models, and results are presented as hazard ratios (95% CIs).

DATA SYNTHESIS

Eight studies involving 21,930 individuals were included, of which five studies involving 19,960 individuals with T1D reported the risk of CVD. During a median follow-up of 10 years, there were 2,149 cases of incident CVD. The pooled hazard ratio for composite CVD outcome per 1-unit increase in the eGDR index was 0.83 (95% CI 0.78-0.90, I2 = 58.9%). Five studies involving 19,403 individuals reported the risk of all-cause mortality. During a median follow-up of 10 years, 1,279 deaths were observed. The pooled hazard ratio for all-cause mortality per 1-unit increase in the eGDR index was 0.84 (95% CI 0.81-0.87, I2 = 0%).

LIMITATIONS

The small number of available studies restricted our ability to perform meta-regression analyses or more detailed subgroup analyses.

CONCLUSIONS

IR, as calculated by the eGDR, may be an additional risk factor for CVD and all-cause mortality in T1D.

Association between estimated glucose disposal rate and cardiovascular mortality across the spectrum of glucose tolerance in the US population

AIMS

To determine if estimated glucose disposal rate (eGDR) can predict cardiovascular disease mortality risk at different levels of glycaemic tolerance.

MATERIALS AND METHODS

The eGDR levels of 11 656 individuals aged 45-79 years from the National Health and Nutrition Examination Survey cycles 1999 to 2010 were analysed. Associations between eGDR levels and all-cause and cardiovascular mortality were examined using Cox proportional hazards and Fine and Gray models, respectively.

RESULTS

After a median follow-up of 12.8 years, a total of 2852 participants died, with 777 of those deaths attributed to cardiovascular causes. When comparing participants with eGDR values of ≤4 mg/kg/min to those with eGDR values falling within the ranges of 4-6, 6-8 and >8 mg/kg/min, it was found that the latter groups exhibited lower hazard ratios for both all-cause mortality (0.61 [0.52-0.72], 0.61 [0.52-0.72] and 0.46 [0.39-0.55]) and cardiovascular mortality (0.44 [0.33-0.57], 0.45 [0.34-0.59] and 0.30 [0.23-0.40]). A U-shaped relationship between eGDR and all-cause mortality was observed, with an inflection point at an eGDR of 9.54 mg/kg/min.

CONCLUSIONS

In the general population, the association between reduced eGDR and all-cause and cardiovascular mortality was independently significant, contributing to the identification of individuals at high risk for different levels of glucose tolerances.

Relationship between stroke and estimated glucose disposal rate: results from two prospective cohort studies

BACKGROUND

Insulin resistance (IR) is a recognized contributor to stroke association, and the estimated glucose disposal rate (eGDR) is a dependable indicator of IR. However, the specific connections between eGDR, stroke prevalence, and overall mortality have not been thoroughly investigated. This study aimed to examine how eGDR correlates with stroke and overall death rate.

METHODS

The study leveraged information from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. To unravel the data, the team utilized logistic regression, cox proportional hazards models, and restricted cubic splines (RCS) Sensitivity analyses excluded participants with a stroke history within the previous two years. Results were validated through analysis of the China Health and Retirement Longitudinal Study (CHARLS).

RESULTS

A higher eGDR is like a protective shield against strokes, with those in the top eGDR quartile exhibited a 60% reduction in stroke association (OR = 0.40, 95% CI, 0.22-0.73, P = 0.003). Additionally, a higher eGDR correlates with a lower overall death rate (HR = 0.71, 95% CI, 0.52-0.98, P = 0.037), particularly in individuals without a history of stroke. RCS analysis demonstrated that eGDR's influence on stroke association follows a non-linear pattern. Subgroup analysis revealed that the protective effect of eGDR was stronger in non-diabetic and non-hypertensive individuals.

CONCLUSION

eGDR is inversely related to both stroke association and mortality, affirming its utility as a predictive marker of stroke.

Evaluation of Estimated Glucose Disposal Rate with Neutrophil-to-Lymphocyte Ratio Integrated for Prognosticating Adverse Cardiovascular and Cerebrovascular Events and Risk Stratification Among Acute Coronary Syndrome with Type 2 Diabetes Mellitus Following Percutaneous Coronary Intervention

Objective

This research aimed to address the critical need for effective prognostic tools in patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI) by exploring the potential significance of integrating estimated glucose disposal rate (eGDR) and neutrophil-to-lymphocyte ratio (NLR).

Methods

Major adverse cardiovascular and cerebrovascular events (MACCE) were the primary endpoint. Log rank test was conducted to compare the Kaplan-Meier curves across the overall follow-up period, and multivariate Cox regression was used to investigate the association between the eGDR/NLR and MACCE.

Results

One hundred fifty-four patients (9.5%) experienced MACCE including 15 cardiac deaths, 97 nonfatal MI, 120 TVR, and 10 strokes. Patients were distributed into low and high eGDR/NLR groups (lower eGDR [eGDR-L] group, higher eGDR [eGDR-H] group, lower NLR [NLR-L] group, and higher NLR [NLR-H] group) based on the median value of eGDR and NLR, further divided into four groups: eGDR-L + NLR-L, eGDR-H + NLR-L, eGDR-L + NLR-H, and eGDR-H + NLR-H. eGDR-L + NLR-H group exhibited significantly higher risks of MACCE (17.4%), compared to another three groups. An independent correlation between eGDR/NLR and MACCE was demonstrated by Cox regression analysis, establishing if the eGDR and NLR was treated as a continuous or categorical variable. Compared to eGDR-H + NLR-L group, patients in eGDR-L + NLR-H group had the uppermost MACCE risk (HR: 5.201; 95% CI 2.764-7.786; P < 0.001). A linear relationship between eGDR/ NLR and MACCE was showed by restricted cubic spline curves. Incorporating the eGDR and NLR toward the baseline risk model developed the precision of forecasting MACCE (baseline risk model-AUC: 0.611 vs baseline risk model + eGDR + NLR-AUC: 0.695, P < 0.001).

Conclusion

Combining eGDR with NLR can be utilized to forecast long-term MACCE and substantially improve the accuracy of risk stratification in ACS patients with T2DM following PCI.

Association between estimated glucose disposal rate and female infertility: a cross-sectional study

Background

Insulin resistance (IR) can lead to infertility in women. The primary objective of this research was to examine how estimated glucose disposal rate (eGDR) correlates with infertility in women, assessing its validity as an indicator of IR.

Methods

Data from the National Health and Nutrition Examination Survey spanning 2013 to 2018 were analyzed in this study. In order to investigate the correlation between eGDR and the prevalence of female infertility, this study used a combination of weighted multivariate regression analysis, restricted cubic spline (RCS) analysis, subgroup analyses, sensitive analysis, and receiver operating characteristic (ROC) curves.

Results

This study enrolled 2541 women, with an average age of (32.52 ± 0.23) years. The overall infertility rate was 14.27%. A negative relationship was observed between eGDR levels and female infertility. Each increment of one unit in eGDR was linked to a 14% reduction in infertility incidence (OR = 0.86, 95% CI 0.80-0.94). RCS analysis revealed a nonlinear, inverse correlation between eGDR and female infertility. Subgroup analyses indicated that age influenced the association between eGDR and female infertility. The ROC curve suggested that eGDR was significantly better than HOMA-IR in predicting infertility [eGDR: 0.632 (95% CI: 0.603, 0.660) vs. HOMA-IR: 0.543 (95% CI: 0.514, 0.572)].

Conclusion

There was an observed association where lower eGDR levels were linked with higher rates of female infertility. These results emphasize the significance of implementing measures to manage IR to protect women's reproductive health.

Estimated glucose disposal rate is correlated with increased depression: a population-based study

BACKGROUND

Recent studies have identified a correlation between insulin resistance (IR) and depression. This study aims to explore the correlation between estimated glucose disposal rate (eGDR), a practical and noninvasive measure for assessing IR, and depression in the general population.

METHODS

In this population-based cross-sectional study, data from 28,444 adults aged 18 years old or older in the NHANES during the period from 1999 to 2018 were analyzed. The correlation between eGDR and depression was examined through multivariate logistic regression analyses, subgroup analyses, restricted cubic spline, and interaction tests. Furthermore, a mediation analysis was conducted to elucidate the role of the atherogenic index of plasma (AIP) in mediating the effect of eGDR on depression.

RESULTS

Multivariate logistic regression analysis and restricted cubic splines analysis indicated that eGDR can exhibit a linearly correlation with depression (OR = 0.913; 95% CI: 0.875, 0.953). Subjects in eGDR6-8 and eGDR > 8 groups had a decrease risk of depression as 25.4% and 41.5% than those in the eGDR < 4 group. This negative correlation was more pronounced in those with obesity. Mediation analysis indicated that AIP mediated 9.6% of the correlation between eGDR and depression.

CONCLUSIONS

eGDR was linear negatively correlated with depression, with AIP playing a mediating role. This study provides a novel perspective on the mechanism connecting IR to depression. Managing IR and monitoring AIP may contribute to alleviating depression.

Changes in the estimated glucose disposal rate and incident cardiovascular disease: two large prospective cohorts in Europe and Asia

BACKGROUND AND AIMS

Previous study found that estimated glucose disposal rate (eGDR) was significantly associated with cardiovascular disease (CVD). However, little is known about the change in eGDR over time and its association with the development of CVD. The aim of this study was to investigate the association of change in eGDR with CVD risk.

METHODS

This study used data of two prospective cohorts: UK Biobank and China Health and Retirement Longitudinal Study (CHARLS) with two measurements of eGDR. Changes in the eGDR were classified using K‑means clustering analysis, and the cumulative eGDR was also calculated. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders.

RESULTS

A total of 11,682 individuals from the UK Biobank, and 4,974 individuals from the CHARLS were included. The median follow-up periods were 9.7 years in the UK Biobank and 3.0 years in the CHARLS. Compared with persistently high level of eGDR (class 1), individuals with low level increasing (class 3) and persistently low level of eGDR (class 4) showed elevated risks of incident CVD in both UK Biobank (HR = 2.79, 95% 2.15-3.62 for class 3; HR = 3.19, 95% 2.50-4.08 for class 4) and CHARLS (HR = 1.66, 95% 1.29-2.13 for class 3; HR = 1.69, 95% 1.34-2.14 for class 4). In addition, lower level of cumulative eGDR were associated with elevated risks of incident CVD. The dose-response curve between cumulative eGDR and CVD risk showed a negative linear relationship.

CONCLUSION

Different changes in eGDR level are associated with different risks of incident CVD. Dynamic monitoring of eGDR level is of significant importance for the CVD prevention and treatment.

Estimated glucose disposal rate, high sensitivity C-reactive protein and cardiometabolic multimorbidity in middle-aged and older Chinese adults: A nationwide prospective cohort study

AIM

To explore the separate and joint association of estimated glucose disposal rate (eGDR) and high-sensitivity C-reactive protein (hsCRP) with cardiometabolic multimorbidity (CMM).

METHODS

A total of 6900 participants aged 45 years or older with available data on eGDR and hsCRP and without cardiometabolic diseases at baseline from the China Health and Retirement Longitudinal Study were included. CMM was defined as the coexistence of two or more cardiometabolic diseases, including heart diseases, stroke, and diabetes.

RESULTS

During a median follow-up of 9.0 years, 464 (6.7 %) participants developed CMM. Low eGDR and high hsCRP separately and jointly increased the risk of CMM. The adjusted hazard ratio (HR) was 1.67 (95 % confidence interval [CI] 1.33-2.09) for low eGDR versus high eGDR, 1.43 (95 % CI 1.12-1.82) for high hsCRP versus low hsCRP) and 2.40 (95 % CI 1.77-3.27) for low eGDR plus high hsCRP versus high eGDR plus low hsCRP. The C-statistic, discriminatory power and risk reclassification significantly improved with the addition of combined eGDR and hsCRP for CMM (P < 0.001).

CONCLUSIONS

Low eGDR and high hsCRP were individually and jointly associated with increased risk of incident CMM. The findings highlighted the importance of joint evaluation of eGDR and hsCRP for primary prevention of CMM.

Physical activity and sedentary behaviour in relation to body composition, estimated insulin sensitivity and arterial stiffness in adults with type 1 diabetes

AIMS

To examine the association of daily PA levels and sedentary behaviour with body composition, estimated insulin sensitivity, and arterial stiffness in adults with type 1 diabetes (T1D).

METHODS

Cross-sectional study in adults with T1D (n = 54). PA levels (daily steps, and time in moderate-to-vigorous intensity PA (MVPA)) and sedentary behaviour were measured using accelerometry for 7 days (McRoberts® DynaPort MoveMonitor). Cardiopulmonary exercise test for VO2max. Anthropometrics were collected, and body composition (total and % of fat mass (FMtot, FM%), total and % of lean mass (LMtot, LM%), and estimated visceral adipose tissue (VAT)) volume was assessed with dual energy X-ray-absorptiometry (DXA). Estimates of insulin sensitivity were determined (estimated glucose disposal rate (eGDR) and total daily insulin dose). Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV (m/s); SphygmoCor®).

RESULTS

Lower 10-years HbA1c associated moderately with all PA measures. Favourable moderate associations were also found between PA measures and BMI, waist, VAT but not FM and LM. PA measures were favourably associated with a lower total daily insulin dose and higher eGDR. All PA parameters associated moderately with cf-PWV however not independent from traditional risk factors. VO2max was inversely associated with cf-PWV independent of age, T1D duration and 24-hour mean blood pressure.

CONCLUSIONS

Higher levels of PA, lower sedentary behaviour and greater exercise capacity are favourably associated with long-term glycaemic control, body composition, insulin dosage, estimated insulin sensitivity and arterial stiffness in adults with T1D. Therefore, regular PA and limiting sedentary time should be encouraged to improve metabolic and cardiovascular health in this population. Future longitudinal studies should explore mutual interactions and synergistic effects of PA on these outcomes.

Estimated glucose disposal rate and risk of cardiovascular disease and mortality in U.S. adults with prediabetes: a nationwide cross-sectional and prospective cohort study

AIMS

Estimated glucose disposal rate (eGDR), a noninvasive and convenient measure of insulin resistance, has been demonstrated to be associated with mortality in both type 1 and type 2 diabetes. We aimed to explore whether eGDR is associated with cardiovascular disease (CVD) risk and mortality in prediabetic adults.

METHODS

A nationwide population-based cohort of prediabetic individuals from the National Health and Nutrition Examination Survey 1999-2018 with available data on eGDR was included and categorized into eGDR ≥ 8 (reference), 6-7.99, 4-5.99, and < 4 mg/kg/min groups. Cox proportional hazards model was used to estimate the associations of eGDR with mortality.

RESULTS

A total of 4725 prediabetic adults, 60.12% men, mean age 48 years were included. The odds ratio and 95% confidence interval (CI) for CVD risk were 1.74 (1.08-2.78), 2.90 (1.79-4.67), and 4.58 (2.15-9.76) for the eGDR 6-7.99, 4-5.99, and < 4 mg/kg/min groups, respectively, compared with the reference group. There were 410 deaths (116 CVD-related) during a median follow-up of 107 months in 4,332 participants without baseline CVD. The hazard ratios and 95%CI for the eGDR 6-7.99, 4-5.99, and < 4 mg/kg/min groups were 1.70 (1.23-2.35), 2.01 (1.45-2.77), and 1.84 (1.11-3.04), respectively, for all-cause mortality (P for trend < 0.0001), and 3.84 (2.04-7.21), 4.01 (2.01-8.00), and 2.88 (1.03-8.06), respectively, for CVD mortality (P for trend = 0.01). Smoking status significantly modified the associations between eGDR and all-cause or CVD mortality.

CONCLUSIONS

Increased insulin resistance, as indicated by a lower eGDR, is associated with increased risks of all-cause and CVD mortality in U.S. prediabetic adults.

Insulin Resistance and CGM-Derived Parameters in People With Type 1 Diabetes: Are They Associated?

BACKGROUND

Insulin resistance (IR) is increasingly more prevalent in people with type 1 diabetes (T1D).

OBJECTIVE

We investigated whether IR is associated with continuous glucose monitor (CGM)-derived parameters (glucometrics), such as time in range (TIR), time above range (TAR), time below range (TBR), and glycemic variability (CV).

METHODS

This is a retrospective analysis of 2 databases: IR was quantified according to the estimated glucose disposal rate (eGDR) (NCT04664036) and by performing a hyperinsulinemic-euglycemic clamp (HEC) (NCT04623320). All glucometrics were calculated over 28 days.

RESULTS

A total of 287 subjects were included. Mean age was 46 ± 17 years, 55% were male, TIR was 57% ± 14%, and eGDR was 7.6 (5.6-9.3) mg/kg/min. The tertile of people with the lowest eGDR (highest level of IR) had a higher TAR compared to the tertile with the highest eGDR (39% ± 15% vs 33% ± 14%, P = .043). Using logistic regression, a higher eGDR was associated with a higher chance to fall in a higher TIR-tertile (odds ratio [OR] 1.251, P < .001), a lower TAR-tertile (OR 1.281, P < .001), and a higher TBR-tertile (OR 0.893, P = .039), adjusted for age, sex, diabetes duration, smoking status, and alcohol intake. In the 48 people undergoing a HEC, no significant association between glucometrics and the HEC-determined glucose disposal rate (M-value) was observed.

CONCLUSION

In people with T1D, an association between IR, measured by eGDR, and worse CGM profiles was observed.

The potential of glucose management indicator for the estimation of glucose disposal rate in people with type 1 diabetes

BACKGROUND AND AIMS

Insulin resistance is a growing feature in type 1 diabetes (T1D). It can be quantified by calculating the estimated glucose disposal rate (eGDR) with the Epstein's formula, which includes laboratory-measured glycated hemoglobin (HbA1c). We aimed the current research to assess the agreement between the conventional eGDR formula and an alternative one (eGDR-GMI) incorporating the glucose management indicator (GMI) derived from continuous glucose monitoring (CGM). We also explored the relationship between eGDR-GMI, cardiovascular risk factors, and the prevalence of diabetes-related complications.

METHODS AND RESULTS

We designed a cross-sectional study that included adults with T1D. eGDR-GMI and eGDR (mg/kg/min) were calculated using GMI or HbA1c, waist circumference, and hypertensive state. Clinical data were collected from electronic medical records. The analyses encompassed 158 participants with a mean age of 39 ± 13 years. The Bland-Altman analysis showed a good agreement between eGDR-GMI and eGDR. When we divided participants in eGDR-GMI tertiles we found a higher prevalence of diabetes-related complications and a less favorable metabolic profile in the lowest eGDR-GMI tertile. The relative risk of retinopathy, nephropathy, and neuropathy significantly increased by approximately 1 unit with each decrease in eGDR-GMI, regardless of age, sex, disease duration, lipids, and smoking habit.

CONCLUSIONS

eGDR-GMI represents a valid and robust alternative to the eGDR to assess insulin resistance in T1D. Low eGDR-GMI is associated with diabetes complications and a less favorable metabolic profile. Incorporating the eGDR-GMI into clinical practice can enhance the characterization of T1D people and allow for a more personalized treatment approach.

Insulin resistance assessed by estimated glucose disposal rate and risk of atherosclerotic cardiovascular diseases incidence: the multi-ethnic study of atherosclerosis

BACKGROUND

To investigate the relationship between estimated glucose disposal rate (eGDR), a surrogate indicator of insulin resistance, and atherosclerotic cardiovascular diseases (ASCVD) incidence risk.

METHODS

This prospective cohort study utilized data from the 6026 participants from the Multi-Ethnic Study of Atherosclerosis. The eGDR (mg/kg/min) was computed as 21.158 - (0.09 × waist circumference [cm]) - (3.407 × hypertension [yes/no]) - (0.551 × HbA1c [%]). The population was categorized into four subgroups according to the quartiles (Q) of eGDR. Cox proportional hazard models were applied to assess the associations between eGDR and ASCVD incidence, and restricted cubic spine (RCS) was employed to examine the dose-response relationship.

RESULTS

The mean age of participants was 63.6 ± 10.1 years, comprising 3163 (52.5%) women. Over a median follow-up duration of 14.1 years, 565 (9.4%) developed ASCVD, including 256 (4.2%) myocardial infarctions, 234 (3.9%) strokes, and 358 (5.9%) fatal coronary heart disease. Compared to the lowest quartile, the adjusted hazard ratios (95% confidence intervals) for incident ASCVD for Q2-Q4 were 0.87 (0.68-1.10), 0.63 (0.47-0.84), and 0.43 (0.30-0.64), respectively. Per 1 standard deviation increase in eGDR was associated with a 30% (HR: 0.70, 95% CI 0.60-0.80) risk reduction of ASCVD, with the subgroup analyses indicating that age and hypertension modified the association (P for interaction < 0.05). RCS analysis indicated a significant and linear relationship between eGDR and ASCVD incidence risk.

CONCLUSION

eGDR level was negatively associated with incident ASCVD risk in a linear fashion among the general population. Our findings may contribute to preventive measures by improving ASCVD risk assessment.

Estimated glucose disposal rate for predicting cardiovascular events and mortality in patients with non-diabetic chronic kidney disease: a prospective cohort study

BACKGROUND

Evidence suggests that insulin resistance (IR) is an autonomous risk factor for cardiovascular disease (CVD). Nevertheless, the association between estimated glucose disposal rate (eGDR), a novel indicator of IR, and incident CVD and mortality in chronic kidney disease (CKD) patients without diabetes remains uncertain.

METHODS

The study included 19,906 participants from the UK Biobank who had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 or a urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g and no history of CVD and diabetes. Individuals were divided into three categories based on tertiles of eGDR. The outcome was a composite CVD (coronary heart disease (CHD) and stroke) and mortality (all-cause, non-accidental, and cardiovascular mortality). Furthermore, a cohort of 1,600 individuals from the US National Health and Nutrition Examination Survey (NHANES) was applied to validate the association between eGDR and mortality. The Cox proportional hazards regression models were used to examine the association between eGDR and event outcomes.

RESULTS

During a follow-up of around 12 years, 2,860 CVD, 2,249 CHD, 783 stroke, 2,431 all-cause, 2,326 non-accidental and 492 cardiovascular deaths were recorded from UK Biobank. Higher eGDR level was not only associated with lower risk of CVD (hazard ratio [HR] 0.641, 95% confidence interval [CI] 0.559-0.734), CHD (HR 0.607, 95% CI 0.520-0.709), stroke (HR 0.748, 95% CI 0.579-0.966), but also related to reduced risk of all-cause (HR 0.803, 95% CI 0.698-0.923), non-accidental (HR 0.787, 95% CI 0.682-0.908), and cardiovascular mortality (HR 0.592, 95% CI 0.423-0.829). Validation analyses from NHANES yielded consistent relationship on mortality.

CONCLUSIONS

In these two large cohorts of CKD patients without DM, a higher eGDR level was associated with a decreased risk of CVD and mortality.

Glucose Variability in People with Type 1 Diabetes: Associations with Body Weight, Body Composition, and Insulin Sensitivity

The prevalence of overweight and obesity increases in people with type 1 diabetes (T1D). However, the impact of fat accumulation on glucose dynamics in T1D is poorly understood. We assessed continuous glucose monitoring (CGM) parameters in patients with T1D depending on their body weight, body composition, and insulin sensitivity. In 547 patients, including 238 overweight/obese individuals, CGM-derived time in range (TIR) and glucose variability (GV) were estimated. Body composition was assessed by DXA. Estimated glucose disposal rate (eGDR) was used as an indicator of insulin sensitivity. Overweight/obese patients, when compared to normal-weight ones, have a lower time below range (TBR) (<3 mmol/L), GV, and experienced fewer episodes of low glucose. In men, lower TIR, higher time above range (TAR), and GV reduction were associated with central adiposity assessed by total, trunk, and android fat mass. In women, gynoid fat mass only was associated with a lower TIR and higher TAR. The eGDR was a positive predictor of TIR and a negative predictor of TAR, TBR, and GV in men and women. In conclusion, adiposity in people with T1D is associated with a lower risk of CGM-confirmed hypoglycemia, higher TAR, and reduced GV. These features of daily glucose dynamics may be mediated by insulin resistance.

Heterogeneous response of estimated insulin sensitivity indices to metformin in young individuals with type 1 diabetes and different phenotypes

AIMS

This study aimed to investigate whether the response to adding metformin to insulin in young adults with type 1 diabetes (T1D) differs according to weight phenotype and insulin sensitivity index.

METHODS

A prospective pilot study was conducted over 26 weeks in which insulin plus metformin (2 g/day) was administered to 35 individuals, ranging from normal weight (NW) to overweight (OW) to obese (OB) T1D individuals, to correlate insulin sensitivity indices and other clinical variables.

RESULTS

At the end of the follow-up period, all groups showed an increase in the eGDR (NW: 7.37 vs 8.16, p = 0.002; OW: 7.28 vs 8.24, p < 0.001; OB: 6.33 vs 7.52 p < 0.001). KITT and SEARCH SCORE improved only in the OB group (2.15 vs 3.14, p < 0.001 and 5.26 vs 5.72, p = 0.007, respectively). Furthermore, HbA1c and BMI were significantly greater in the OB group (- 0.62%, p < 0.001; - 1.12 kg/m2, p = 0.031, respectively). Regression analysis revealed that the serum levels of triglycerides and uric acid were significantly (0.059, p = 0.013; 0.076, p = 0.001) associated with insulin sensitivity indices.

CONCLUSIONS

The study showed that eGDR improved independently of basal weight after metformin treatment. However, the KITT and SEARCH indices improved only in the obese group. Triglycerides and uric acid are associated with insulin sensitivity indices. These results highlight the heterogeneity of the mechanisms underlying insulin resistance and its response to metformin in individuals with T1D.

Overweight and Obesity in People Living With Type 1 Diabetes: A Cross-Sectional Analysis of the BETTER Registry

AIMS

The prevalence and associations of overweight and obesity in Canadian adult people living with type 1 diabetes (PWT1D) are poorly documented. In a cohort of PWT1D patients, this study assesses (i) overweight and obesity frequencies and associated PWT1D clinicodemographic characteristics, (ii) diabetes characteristics, and (iii) the use of noninsulin adjunctive agents.

MATERIALS AND METHODS

Cross-sectional analysis of self-reported data from the BETTER registry: 1091 adult PWT1D (aged 44.4 ± 15.0 years; 32% HbA1c<7% [53 mmol/mol]) classified by BMI classes: underweight combined with normal weight, overweight, or obesity. Bivariate analyses were used to identify associations between BMI classes, diabetes characteristics, complications, and treatments.

RESULTS

Overweight and obesity affected 34.6% and 19.8% of participants. Compared to underweight + normal weight, PWT1D with overweight/obesity was associated with male sex, higher age, lower education level, longer diabetes duration, and higher total insulin doses and use of cardiorenal therapies (all p < 0.001). Compared to other PWT1D, those living with obesity reported higher HbA1c (p < 0.05), less frequent hypoglycemia (p < 0.05), more cardiovascular diseases (p < 0.003), retinopathy, neuropathy, depression treatment as well as noninsulin adjunctive agent use (all p < 0.001). Logistic regression showed that living with overweight/obesity was associated with male sex, being treated for cardiorenal therapies, depression, diabetes duration, and total daily insulin doses.

CONCLUSIONS

Overweight or obesity affects over half of adult PWT1D in the Canadian BETTER registry and is associated with higher HbA1c levels, higher total daily insulin doses, more chronic diabetes complications and noninsulin adjunctive agent use, a worse cardiometabolic profile, and lower hypoglycemia frequency.

The additive effect of the triglyceride-glucose index and estimated glucose disposal rate on long-term mortality among individuals with and without diabetes: a population-based study

BACKGROUND

The triglyceride-glucose (TyG) index and estimated glucose disposal rate (eGDR), which are calculated using different parameters, are widely used as markers of insulin resistance and are associated with cardiovascular diseases and prognosis. However, whether they have an additive effect on the risk of mortality remains unclear. This study aimed to explore whether the combined assessment of the TyG index and eGDR improved the prediction of long-term mortality in individuals with and without diabetes.

METHODS

In this cross-sectional and cohort study, data were derived from the National Health and Nutrition Examination Survey (NHANES) 2001-2018, and death record information was obtained from the National Death Index. The associations of the TyG index and eGDR with all-cause and cardiovascular mortality were determined by multivariate Cox regression analysis and restricted cubic splines.

RESULTS

Among the 17,787 individuals included in the analysis, there were 1946 (10.9%) all-cause deaths and 649 (3.6%) cardiovascular deaths during a median follow-up of 8.92 years. In individuals with diabetes, the restricted cubic spline curves for the associations of the TyG index and eGDR with mortality followed a J-shape and an L-shape, respectively. The risk of mortality significantly increased after the TyG index was > 9.04 (all-cause mortality) or > 9.30 (cardiovascular mortality), and after eGDR was < 4 mg/kg/min (both all-cause and cardiovascular mortality). In individuals without diabetes, the association between eGDR and mortality followed a negative linear relationship. However, there was no association between the TyG index and mortality. Compared with individuals in the low TyG and high eGDR group, those in the high TyG and low eGDR group (TyG > 9.04 and eGDR < 4) showed the highest risk for all-cause mortality (hazard ratio [HR] = 1.592, 95% confidence interval [CI] 1.284-1.975) and cardiovascular mortality (HR = 1.683, 95% CI 1.179-2.400) in the overall population. Similar results were observed in individuals with and without diabetes.

CONCLUSIONS

There was a potential additive effect of the TyG index and eGDR on the risk of long-term mortality in individuals with and without diabetes, which provided additional information for prognostic prediction and contributed to improving risk stratification.

Usefulness of estimated glucose disposal rate in detecting heart failure: results from national health and nutrition examination survey 1999-2018

BACKGROUND

Estimated glucose disposal rate (eGDR) is a novel, clinically available, and cost-effective surrogate of insulin resistance. The current study aimed to assess the association between eGDR and prevalent heart failure (HF), and further evaluate the value of eGDR in detecting prevalent HF in a general population.

METHODS

25,450 subjects from the National Health and Nutrition Examination Survey 1999-2018 were included. HF was recorded according to the subjects' reports. Logistic regression was employed to analyze the association between eGDR and HF, the results were summarized as Per standard deviation (SD) change. Then, subgroup analysis tested whether the main result from logistic regression was robust in several conventional subpopulations. Finally, receiver-operating characteristic curve (ROC) and reclassification analysis were utilized to evaluate the potential value of eGDR in improving the detection of prevalent HF.

RESULTS

The prevalence of reported HF was 2.96% (753 subjects). After adjusting demographic, laboratory, anthropometric, and medical history data, each SD increment of eGDR could result in a 43.3% (P < 0.001) risk reduction for prevalent HF. In the quartile analysis, the top quartile had a 31.1% (P < 0.001) risk of prevalent HF compared to the bottom quartile in the full model. Smooth curve fitting demonstrated that the association was linear in the whole range of eGDR (P for non-linearity = 0.313). Subgroup analysis revealed that the association was robust in age, sex, race, diabetes, and hypertension subgroups (All P for interaction > 0.05). Additionally, ROC analysis displayed a significant improvement in the detection of prevalent HF (0.869 vs. 0.873, P = 0.008); reclassification analysis also confirmed the improvement from eGDR (All P < 0.001).

CONCLUSION

Our study indicates that eGDR, a costless surrogate of insulin resistance, may have a linear and robust association with the prevalent HF. Furthermore, our findings implicate the potential value of eGDR in refining the detection of prevalent HF in the general population.

Evaluation of Cardiovascular Risk in People with Type 1 Diabetes: A Comprehensive and Specific Proposed Practical Approach

People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended from those for type 2 diabetes (T2D) even though the physiopathology and underlying mechanisms of atherosclerosis in T1D are poorly understood and differ from those in T2D. Unlike the assessment of microvascular complications, which is well established in T1D, this is far from being the case for the comorbidities and risk associated with CVD. Aside from classical cardiovascular comorbidities, carotid ultrasound can be useful to stratify CVD risk. The utilization of specific risk scales such as the Steno Type 1 Risk Engine can help to more accurately classify cardiovascular risk in these individuals. The cornerstones of the management of cardiovascular risk in T1D are the promotion of the Mediterranean diet, tight glycaemic control (glycated haemoglobin (HbA1c) < 7%), blood pressure < 130/80 mmHg in most patients, and low-density lipoprotein (LDL) cholesterol < 100 mg/dL in moderate-risk individuals, < 70 mg/dL in high-risk individuals, and < 55 mg/dL in very high-risk individuals. Conventional medical follow-up of patients with T1D should be individualized (approximately 2-3 visits per year), and a carotid ultrasound evaluation is recommended every 5 years in the absence of significant preclinical atherosclerosis or more often in those with severe preclinical atherosclerosis. Antithrombotic therapy is recommended in those receiving secondary prevention, those with stenosis > 50% in any arterial bed, and those with an impaired ankle-brachial index. This document is a proposal of a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D.

Frequency of prediabetes in individuals with increased adiposity and metabolically healthy or unhealthy phenotypes

AIMS

To utilize the estimated glucose disposal rate (eGDR) index of insulin sensitivity, which is based on readily available clinical variables, namely, waist circumference, hypertension and glycated haemoglobin, to discriminate between metabolically healthy and unhealthy phenotypes, and to determine the prevalence of prediabetic conditions.

METHODS

Non-diabetic individuals (n = 2201) were stratified into quartiles of insulin sensitivity based on eGDR index. Individuals in the upper quartiles of eGDR were defined as having metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW) or metabolically healthy obesity (MHO) according to their body mass index, while those in the lower quartiles were classified as having metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW) and metabolically unhealthy obesity (MUO), respectively.

RESULTS

The frequency of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and IFG + IGT status was comparable among the MHNW, MHOW and MHO groups, while it increased from those with MUNW status towards those with MUOW and MUO status. As compared with participants with MHNW, the odds ratio of having IFG, IGT, or IFG + IGT was significantly higher in participants with MUOW and MUO but not in those with MUNW, MHOW and MHO, respectively.

CONCLUSIONS

A metabolically healthy phenotype is associated with lower frequency of IFG, IGT, and IFG + IGT status across all body weight categories.

Association between estimated glucose disposal rate control level and stroke incidence in middle-aged and elderly adults

BACKGROUND

To estimate glucose disposal rate (eGDR) as a newly validated surrogate marker of insulin resistance. Few studies have explored the association between changes in eGDR levels and stroke incidence. This study aims to explore the effect of the level of eGDR control on stroke and events.

METHODS

Data were obtained from the China Longitudinal Study on Health and Retirement (CHARLS). The eGDR control level was classified using K-means cluster analysis. Logistic regression analysis was used to explore the association between different eGDR control levels and incident stroke. Restrictive cubic spline regression was used to test the potential nonlinear association between cumulative eGDR and stroke incidence.

RESULTS

Of the 4790 participants, 304 (6.3%) had a stroke within 3 years. The odds ratio (OR) was 2.34 (95% confidence interval [CI], 1.42-3.86) for the poorly controlled class 4 and 2.56 (95% CI, 1.53-4.30) for the worst controlled class 5 compared with class 1 with the best controlled eGDR. The OR for well-controlled class 2 was 1.28 (95% CI, 0.79-2.05), and the OR for moderately controlled class 3 was 1.95 (95% CI, 1.14-3.32). In restrictive cubic spline regression analysis, eGDR changes are linearly correlated with stroke occurrence. Weighted quartile and regression analysis identified waist circumference and hypertension as key variables of eGDR for predicting incident stroke.

CONCLUSIONS

Poorly controlled eGDR level is associated with an increased risk of stroke in middle-aged and elderly people. Monitoring changes in eGDR may help identify individuals at high risk of stroke early.

Insulin resistance and its relationship with long-term exposure to ozone: Data based on a national population cohort

The relationship of ozone (O3), particularly the long-term exposure, with impacting metabolic homeostasis in population was understudied and under-recognised. Here, we used data from ChinaHEART, a nationwide, population-based cohort study, combined with O3 and PM2.5 concentration data with high spatiotemporal resolution, to explore the independent association of exposure to O3 with the prevalence of insulin resistance (IR). Among the 271 540 participants included, the crude prevalence of IR was 39.1%, while the age and sex standardized prevalence stood at 33.0%. Higher IR prevalence was observed with each increase of 10.0 μg/m3 in long-term O3 exposure, yielding adjusted odds ratios (OR) of 1.084 (95% CI: 1.079-1.089) in the one-pollutant model and 1.073 (95% CI: 1.067-1.079) in the two-pollutant model. Notably, a significant additive interaction between O3 and PM2.5 on the prevalence of IR was observed (P for additive interaction < 0.001). Our main findings remained consistent and robust in the sensitivity analyses. Our study suggests long-term exposure to O3 was independently and positively associated with prevalence of IR. It emphasized the benefits of policy interventions to reduce O3 and PM2.5 exposure jointly, which could ultimately alleviate the health and economic burden related to DM.

Insulin resistance assessed by estimated glucose disposal rate and risk of incident cardiovascular diseases among individuals without diabetes: findings from a nationwide, population based, prospective cohort study

BACKGROUND

Recent studies have suggested that insulin resistance (IR) contributes to the development of cardiovascular diseases (CVD), and the estimated glucose disposal rate (eGDR) is considered to be a reliable surrogate marker of IR. However, most existing evidence stems from studies involving diabetic patients, potentially overstating the effects of eGDR on CVD. Therefore, the primary objective of this study is to examine the relationship of eGDR with incidence of CVD in non-diabetic participants.

METHOD

The current analysis included individuals from the China Health and Retirement Longitudinal Study (CHARLS) who were free of CVD and diabetes mellitus but had complete data on eGDR at baseline. The formula for calculating eGDR was as follows: eGDR (mg/kg/min) = 21.158 - (0.09 × WC) - (3.407 × hypertension) - (0.551 × HbA1c) [WC (cm), hypertension (yes = 1/no = 0), and HbA1c (%)]. The individuals were categorized into four subgroups according to the quartiles (Q) of eGDR. Crude incidence rate and hazard ratios (HRs) with 95% confidence intervals (CIs) were computed to investigate the association between eGDR and incident CVD, with the lowest quartile of eGDR (indicating the highest grade of insulin resistance) serving as the reference. Additionally, the multivariate adjusted restricted cubic spine (RCS) was employed to examine the dose-response relationship.

RESULTS

We included 5512 participants in this study, with a mean age of 58.2 ± 8.8 years, and 54.1% were female. Over a median follow-up duration of 79.4 months, 1213 incident CVD cases, including 927 heart disease and 391 stroke, were recorded. The RCS curves demonstrated a significant and linear relationship between eGDR and all outcomes (all P for non-linearity > 0.05). After multivariate adjustment, the lower eGDR levels were founded to be significantly associated with a higher risk of CVD. Compared with participants with Q1 of eGDR, the HRs (95% CIs) for those with Q2 - 4 were 0.88 (0.76 - 1.02), 0.69 (0.58 - 0.82), and 0.66 (0.56 - 0.79). When assessed as a continuous variable, per 1.0-SD increase in eGDR was associated a 17% (HR: 0.83, 95% CI: 0.78 - 0.89) lower risk of CVD, with the subgroup analyses indicating that smoking status modified the association (P for interaction = 0.012). Moreover, the mediation analysis revealed that obesity partly mediated the association. Additionally, incorporating eGDR into the basic model considerably improve the predictive ability for CVD.

CONCLUSION

A lower level of eGDR was found to be associated with increased risk of incident CVD among non-diabetic participants. This suggests that eGDR may serve as a promising and preferable predictor and intervention target for CVD.

Short, frequent, light-intensity walking activity improves postprandial vascular-inflammatory biomarkers in people with type 1 diabetes: The SIT-LESS randomized controlled trial

AIM

To examine the effect of interrupting prolonged sitting with short, frequent, light-intensity activity on postprandial cardiovascular markers in people with type 1 diabetes (T1D).

MATERIALS AND METHODS

In a randomized crossover trial, 32 adults with T1D (mean ± SD age 28 ± 5 years, glycated haemoglobin 67.9 ± 12.6 mmol/mol, 17 women) completed two 7-h laboratory visits separated by >7 days. Participants either remained seated for 7 h (SIT) or interrupted sitting with 3-min bouts of self-paced walking at 30-min intervals commencing 1 h after each meal (SIT-LESS). Physical activity, insulin regimen, experimental start times, and meal consumption were standardized during each arm. Plasma levels of interleukin (IL)-1β, tumour necrosis factor (TNF)-α, plasminogen activator inhibitor (PAI)-1 and fibrinogen were sampled at baseline, 3.5 and 7 h, and assessed for within- and between-group effects using a repeated measures ANOVA. The estimated glucose disposal rate was used to determine the insulin resistance status.

RESULTS

Vascular-inflammatory parameters were comparable between SIT and SIT-LESS at baseline (p > .05). TNF-α, IL-1β, PAI-1 and fibrinogen increased over time under SIT, whereas these rises were attenuated under SIT-LESS (p < .001). Specifically, over the 7 h under SIT, postprandial increases were detected in TNF-α, IL-1β, PAI-1 and fibrinogen (+67%, +49%, +49% and +62%, respectively; p < .001 for all). Conversely, the SIT-LESS group showed no change in IL-1β (-9%; p > .50), whereas reductions were observed in TNF-α, PAI-1 and fibrinogen (-22%, -42% and -44%, respectively; p < .001 for all). The intervention showed enhanced effects in insulin-resistant individuals with T1D.

CONCLUSIONS

Interrupting prolonged sitting with light-intensity activity ameliorates postprandial increases in vascular-inflammatory markers in T1D.

TRIAL REGISTRATION

The trial was prospectively registered (ISRCTN13641847).