Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study

Abstract

Background and aims Insulin resistance contributes to the development of type 2 diabetes (T2D) and is also a cardiovascular risk factor. The aim of this study was to investigate the potential association between insulin resistance measured by estimated glucose disposal rate (eGDR) and risk of stroke and mortality thereof in people with T2D. Materials and methods Nationwide population based observational cohort study that included all T2D patients from the Swedish national diabetes registry between 2004 and 2016 with full data on eGDR and categorised as following: < 4, 4–6, 6–8, and ≥ 8 mg/kg/min. We calculated crude incidence rates and 95% confidence intervals (CIs) and used multiple Cox regression to estimate hazard ratios (HRs) to assess the association between the risk of stroke and death, according to the eGDR categories in which the lowest category < 4 (i.e., highest grade of insulin resistance), served as a reference. The relative importance attributed of each factor in the eGDR formula was measured by the R2 (± SE) values calculating the explainable log-likelihoods in the Cox regression. Results A total of 104 697 T2D individuals, 44.5% women, mean age of 63 years, were included. During a median follow up-time of 5.6 years, 4201 strokes occurred (4.0%). After multivariate adjustment the HRs (95% CI) for stroke in patients with eGDR categories between 4–6, 6–8 and > 8 were: 0.77 (0.69–0.87), 0.68 (0.58–0.80) and 0.60 (0.48–0.76), compared to the reference < 4. Corresponding numbers for the risk of death were: 0.82 (0.70–0.94), 0.75 (0.64–0.88) and 0.68 (0.53–0.89). The attributed relative risk R2 (± SE) for each variable in the eGDR formula and stroke was for: hypertension (0.045 ± 0.0024), HbA1c (0.013 ± 0.0014), and waist (0.006 ± 0.0009), respectively. Conclusion A low eGDR (a measure of insulin resistance) is associated with an increased risk of stroke and death in individuals with T2D. The relative attributed risk was most important for hypertension.

Impact of estimated glucose disposal rate for identifying prevalent ischemic heart disease: findings from a cross-sectional study

“…In Penno et al’s study, subjects with eGDR < 4.14 had a hypertension prevalence of 99.5%, subjects with eGDR value between 4.15 and 5.34 also had a hypertension prevalence of 98.7%, and subjects with eGDR ≥ 5.34 had a hypertension prevalence of 52.8% [ 11 ]; In their work, they also used euglycemic hyperinsulinemic clamp test to exam the correlation between eGDR and the level of measured glucose disposal rate, the results demonstrated that the correlation of eGDR with measured glucose disposal rate was highly significant (r = 0.624, P < 0.001). In another study assessing the value of eGDR, the prevalence of anti-hypertensive therapy reached 97.9% in subjects with eGDR < 4; On the contrary, the prevalence of anti-hypertensive therapy was only 41.0% and 1.1% in subjects with eGDR 6–8 and > 8, respectively [ 13 ]. In this research, the researcher also observed a close correlation between eGDR and the results of euglycemic hyperinsulinaemic clamp (r = 0.73).…”

“…eGDR has been demonstrated to have high precision in estimating IR compared to the euglycemic hyperinsulinemic clamp approach [12]. Additionally, published data have revealed the usefulness of eGDR in predicting cardiovascular events in diabetic patients [13][14][15][16]. However, evidence about the association between eGDR and the prevalent IHD in the general population is still limited.…”

The Correlation Between Estimated Glucose Disposal Rate and Coagulation Indexes in Type 2 Diabetes Mellitus

“…Several studies have found that low eGDR levels are an independent predictor of increased risk of death in patients with T2DM. 6 , 7 Patients were considered to have IR when the level of eGDR value was <7.5. 8 eGDR is a continuous index, and it is simple and easy to obtain.…”

“…2,[4][5] Lately, Alexander Zabala et al revealed that eGDR also can reflect IR in patients with type 2 diabetes. 6 Moreover, eGDR also has a predictive value. Several studies have found that low eGDR levels are an independent predictor of increased risk of death in patients with T2DM.…”

The pre-stroke induction and normalization of insulin resistance respectively worsens and improves functional recovery

“…However, the results of these studies showed no clinical bene t (12) suggesting that other underlying pathophysiological mechanisms of diabetes may be responsible of poor stroke recovery. IR is another main T2D-hallmark, which is also an independent risk factor for cardiovascular disease (13,14), including stroke (15). Similar to hyperglycaemia, IR has been associated with poor stroke outcome (14).…”