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

Nyström, Thomas; Holzmann, Martin J.; Eliasson, Björn; Svensson, Ann‐Marie; Sartipy, Ulrik

doi:10.1111/dom.13110

Cited by 84 publications

(103 citation statements)

References 40 publications

(73 reference statements)

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“…An eGDR <8 was associated with increased cardiovascular risk or death compared to those with eGDR ≥8. The risk further increased with lower eGDR values (Figure ) . Interestingly, the survival rate of individuals with eGDR ≥8 was identical to a matched reference population.…”

Section: Definition Of Ddmentioning

confidence: 75%

“…The eGDR score was originally developed and validated with the euglycaemic‐hyperinsulinemic clamp in a subset of 24 participants with T1D from the Pittsburgh EDC study . The authors of that study initially calculated eGDR using clinical factors including waist–hip ratio (WHR), presence of hypertension and HbA1c; however, they also stated that replacing WHR with either BMI or waist circumference provided a similar association with insulin resistance . Formulae used for eGDR calculation are shown below:

{eGDR}_{WHR} = 24.31 - ((), 12.22 \times WHR) - ((), 3.29 \times HTN) - ((), 0.57 \times HbA 1 normalc ([] %))

{eGDR}_{WC} = 21.16 - ((), 0.09 \times WC) - ((), 3.41 \times HTN) - ((), 0.55 \times HbA 1 normalc ([] %))

{eGDR}_{BMI} = 19.02 - ((), 0.22 \times BMI ([], kg / m^{2})) - ((), 3.26 \times HTN) - ((), 0.61 \times HbA 1 normalc ([] %))

where, WC is waist circumference (cm) and HTN is hypertension (1 = yes, 0 = no).…”

Section: Definition Of Ddmentioning

confidence: 99%

“…While eGDR appears to be a promising marker to identify DD, the cut off value requires careful consideration. Nyström et al performed a nationwide cohort study in 17 050 individuals with T1D, using data from healthcare registers in Sweden. Individuals were categorized into four eGDR groups: <4; 4 to 5.99; 6 to 7.99; and ≥8.…”

Section: Definition Of Ddmentioning

confidence: 99%

“…All‐cause mortality was related to eGDR, calculated using waist circumference, in 17 050 individuals with T1D diabetes. Data were adapted from Nyström et al…”

Section: Definition Of Ddmentioning

confidence: 99%

“…The role of different metabolic syndrome definitions in predicting double diabetes is shown. Data were obtained from references . AHA/NHLBI, American Heart Association/National Heart, Lung, and Blood Institute; eGDR, estimated glucose disposal rate; IDF, International Diabetes Federation; NCEP/ATPIII, Third National Cholesterol Education Program Adult Treatment Panel; WHO, World Health Organization…”

Section: Prevalence Of Dd According To Each Definitionmentioning

confidence: 99%

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Double diabetes: A distinct high‐risk group?

Kietsiriroje

Pearson

Campbell

et al. 2019

Diabetes Obesity Metabolism

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The term double diabetes (DD) has been used to refer to individuals with type 1 diabetes (T1D) who are overweight, have a family history of type 2 diabetes and/or clinical features of insulin resistance. Several pieces of evidence indicate that individuals who display features of DD are at higher risk of developing future diabetes complications, independently of average glucose control, measured as glycated haemoglobin (HbA1c) concentration. Given the increased prevalence of individuals with features of DD, pragmatic criteria are urgently required to identify and stratify this group, which will help with subsequent implementation of more effective personalized interventions. In this review, we discuss the potential criteria for the clinical identification of individuals with DD, highlighting the strengths and weaknesses of each definition. We also cover potential mechanisms of DD and how these contribute to increased risk of diabetes complications. Special emphasis is placed on the role of estimated glucose disposal rate (eGDR) in the diagnosis of DD, which can be easily incorporated into clinical practice and is predictive of adverse clinical outcome. In addition to the identification of individuals with DD, eGDR has potential utility in monitoring response to different interventions. T1D is a more heterogeneous condition than initially envisaged, and those with features of DD represent a subgroup at higher risk of complications. Pragmatic criteria for the diagnosis of individuals with DD will help with risk stratification, allowing a more personalized and targeted management strategy to improve outcome and quality of life in this population.

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Section: Definition Of Ddmentioning

confidence: 75%

{eGDR}_{WHR} = 24.31 - ((), 12.22 \times WHR) - ((), 3.29 \times HTN) - ((), 0.57 \times HbA 1 normalc ([] %))

{eGDR}_{WC} = 21.16 - ((), 0.09 \times WC) - ((), 3.41 \times HTN) - ((), 0.55 \times HbA 1 normalc ([] %))

{eGDR}_{BMI} = 19.02 - ((), 0.22 \times BMI ([], kg / m^{2})) - ((), 3.26 \times HTN) - ((), 0.61 \times HbA 1 normalc ([] %))

where, WC is waist circumference (cm) and HTN is hypertension (1 = yes, 0 = no).…”

Section: Definition Of Ddmentioning

confidence: 99%

Section: Definition Of Ddmentioning

confidence: 99%

“…All‐cause mortality was related to eGDR, calculated using waist circumference, in 17 050 individuals with T1D diabetes. Data were adapted from Nyström et al…”

Section: Definition Of Ddmentioning

confidence: 99%

Section: Prevalence Of Dd According To Each Definitionmentioning

confidence: 99%

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Double diabetes: A distinct high‐risk group?

Kietsiriroje

Pearson

Campbell

et al. 2019

Diabetes Obesity Metabolism

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Insulin resistance is associated with preclinical carotid atherosclerosis in patients with type 1 diabetes

Pané

Conget

Boswell

et al. 2020

Diabetes Metabolism Res

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Aim: Although insulin resistance (IR) is a growing trait among type 1 diabetes (T1D) population, its relationship with atherosclerosis has been scarcely studied. We assessed the association between IR indexes and carotid atherosclerosis in T1D, a population at high cardiovascular disease (CVD) risk. Materials and Methods: We evaluated 191 participants with T1D and no prior CVD with at least one of the following criteria: ≥40 years old; diabetic nephropathy; or T1D duration ≥10 years harbouring ≥1 additional CVD risk factor. IR was assessed with the metabolic syndrome (MetS) harmonized definition proposed in 2009 and the estimated glucose disposal rate (eGDR), a T1D-specific IR surrogate marker (lower values indicating higher IR). Standardized carotid ultrasonography was performed, recording intima-media thickness (IMT), plaque presence and maximum height of plaque. Comparisons between patients according to their MetS status as well as concerning eGDR values were performed. Results: The participants' median age was 47.4 (41.1-53.3) years and diabetes duration 25.7 (21.6-32.5) years. Plaque prevalence was higher in patients with greater IR (49.1%, 29.1% and 20%, P = .001, for any plaque according to decreasing eGDR tertiles). Conversely, no statistically significant higher plaque prevalence was found in participants with MetS. In multivariate analyses (adjusted for general-and T1Dspecific risk factors, and statin treatment), MetS was associated with neither IMT nor plaque. On the contrary, eGDR was independently related to ≥2 plaques (P = .018) and maximum plaque height (P < .01). Conclusions: In T1D, IR assessed through eGDR but not by MetS definition was independently associated with plaque burden, a predictor of CVD.

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Cardiovascular disease in patients with type 1 diabetes: Early evaluation, risk factors and possible relation with cardiac autoimmunity

Shi

Tang

Huang

et al. 2020

Diabetes Metabolism Res

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Cardiovascular disease now is the leading cause of mortality among patients with type 1 diabetes (T1D). The risk of death from cardiovascular events in subjects with T1D is 2–10 times higher than the general population, depending on blood glucose control. Although complications of cardiovascular disease occur in middle and old age, pathological processes begin in childhood. Some methods used to evaluate subclinical cardiovascular disease, such as carotid intima‐media thickness and pulse wave velocity, can detect early cardiovascular abnormalities in adolescence. The effect of risk factors including hypertension, dyslipidemia and diabetic nephropathy on cardiovascular disease has been well studied. According to the current clinical practice recommendations from the American Diabetes Association, cardiovascular risk factors should be systematically assessed at least annually and treated as recommended. And yet, the effects of intensive insulin therapy on cardiovascular risk, as well as the mechanisms of cardiac autoimmunity require further studying. This review concentrates on the cardiovascular risk in type 1 diabetes in order to provide a comprehensive outlook of its epidemiology, early assessment, risk factors and possible relations with cardiac autoimmunity, aiming to propose promising therapeutic strategies.

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

Abstract: There is a strong association between eGDR and all-cause mortality, as well as cardiovascular mortality, in individuals with T1D. Our findings may guide preventive measures by improving risk assessment in individuals with T1D.

Cited by 84 publications

References 40 publications

Double diabetes: A distinct high‐risk group?

Double diabetes: A distinct high‐risk group?

Insulin resistance is associated with preclinical carotid atherosclerosis in patients with type 1 diabetes

Cardiovascular disease in patients with type 1 diabetes: Early evaluation, risk factors and possible relation with cardiac autoimmunity

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