Estimated Glucose Disposal Rate Predicts Renal Progression in Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Abstract

Aim Insulin resistance is a feature of type 2 diabetes mellitus (T2DM). The estimated glucose disposal rate (eGDR), a validated marker for insulin resistance, is associated with complications of diabetes, but few studies have explored the relationship between eGDR and renal outcomes in T2DM. This study investigated the value of eGDR in predicting renal progression in T2DM. Methods A total of 956 T2DM patients with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73m2and a 5-year follow-up were enrolled. Primary outcomes were rapid eGFR decline, eGFR <60 mL/min/1.73m2, and composite renal endpoint consisting of 50% eGFR decline, doubling of serum creatinine, or end-stage renal disease. A continuous scale with restricted cubic spline curves and a generalized linear model were applied to evaluate the associations between eGDR and primary outcomes. Results 23.95% of patients experienced rapid eGFR decline, 21.97% with eGFR <60 mL/min/1.73m2, and 12.13% with the composite renal endpoint. eGDR showed a relationship with follow-up eGFR and percent change in eGFR (P<0.001). eGDR <6.34 mg/kg/min was an independent risk factor for rapid eGFR decline, eGFR<60 mL/min/1.73m2or the composite renal endpoint(P<0.05). Compared with eGDR of 5.65∼6.91 mg/kg/min, eGDR levels >8.33 mg/kg/min decreased the risk of rapid eGFR decline by 75%, eGFR<60 mL/min/1.73m2 by 60%, and the composite renal endpoint by 61%. Subgroup analysis was performed by sex, age, and diabetes duration, which showed that eGDR was associated with primary outcomes. Conclusions Lower eGDR is a predictive factor for renal deterioration in T2DM patients.