Estimated glucose disposal rate may predict stroke, mortality risk in type 2 diabetes
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Low insulin resistance, as measured by estimated glucose disposal rate, is associated with an increased risk for stroke and mortality for adults with type 2 diabetes, according to a speaker.
“In this Swedish nationwide study, individuals with type 2 diabetes with a low estimated glucose disposal rate (eGDR) were associated with an increased risk for stroke and mortality,” Alexander Zabala, MD, a resident doctor in internal medicine and neurology at Södersjukhuset Stockholm in Sweden and a clinical PhD student at the Karolinska Institutet, said during a presentation at the European Association for the Study of Diabetes virtual meeting. “EGDR, which may reflect insulin resistance, may be a useful risk marker for stroke and death in people with type 2 diabetes.”
Zabala and colleagues calculated eGDR using a formula including waist circumference, the presence of hypertension and HbA1c. A nationwide population-based observational cohort study was conducted of 104,697 people with type 2 diabetes in Sweden’s national diabetes registry (mean age, 63 years; 44.5% women). The study cohort was placed into one of four eGDR categories. Adults with an eGDR of less than 4 mg/kg/min were considered the reference group for the study (n = 24,706). The other groups consisted of participants with an eGDR between 4 mg/kg/min and 6 mg/kg/min (n = 40,187), between 6 mg/kg/min and 8 mg/kg/min (n = 21,402) and greater than 8 mg/kg/min (n = 18,762). Risks for stroke and death were calculated for the three highest eGDR categories and compared with the reference group.
There were 4,201 stroke events in the study cohort during a median follow-up time of 5.6 years. After adjusting for covariates, a lower risk for stroke was observed for adults with an eGDR between 4 mg/kg/min and 6 mg/kg/min (HR = 0.77; 95% CI, 0.69-0.87), between 6 mg/kg/min and 8 mg/kg/min (HR = 0.68; 95% CI, 0.58-0.8) and greater than 8 mg/kg/min (HR = 0.6; 95% CI, 0.48-0.76) compared with the lowest eGDR category. Similarly, a reduced risk for mortality was observed for those with an eGDR between 4 mg/kg/min and 6 mg/kg/min (HR = 0.83; 95% CI, 0.76-0.89), between 6 mg/kg/min and 8 mg/kg/min (HR = 0.77; 95% CI, 0.69-0.77) and greater than 8 mg/kg/min (HR = 0.72; 95% CI, 0.59-0.88) compared with the reference group.
Within the eGDR formula, hypertension was the most important predictor for stroke and mortality risk (R2 = 0.045) followed by HbA1c (R2 = 0.013) and waist circumference (R2 = 0.006).
Zabala said eGDR could be used as a tool both in patient education and clinical trials. However, more studies are needed to further investigate the formula, especially as pertains to cardiovascular risk.
“The eGDR formula needs further validation in type 2 diabetic patients,” Zabala told Healio. “Further preclinical studies are needed to investigate the actual mechanism.”
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Zabala A, et al. Oral presentation 4. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 27-Oct. 1, 2021 (virtual meeting).
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