Bahrami Hezaveh Ehsan, Hashemi Rana, Noorafrooz Mohammadamin, Mohammadi Fatemeh, Yadegar Amirhossein, Karimpour Reyhan Sahar, Nakhjavani Manouchehr, Esteghamati Alireza, Rabizadeh Soghra
Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran.
Endocrinol Diabetes Metab. 2025 Mar;8(2):e70037. doi: 10.1002/edm2.70037.
This study investigates the association between estimated glucose disposal rate (eGDR), a measurement of insulin resistance, and microvascular and macrovascular complications in patients with type 2 diabetes (T2D).
This cross-sectional study enrolled 7471 patients with T2D from 2010 to 2023. The eGDR was calculated using waist circumference, HbA1C levels, and hypertension status. Logistic regression analysis and restricted cubic splines were utilised to examine the relationship between eGDR and vascular complications, including nephropathy, retinopathy, and coronary artery disease (CAD). The robustness of the results and between-group interactions were examined by sensitivity and subgroup analysis. Furthermore, receiver operating characteristic (ROC) curve analysis was employed to assess the discriminatory value of the adjusted model for T2D vascular complications.
Among participants, 56.5% were female, with a mean age of 57.04 ± 11.05 years and a median of 8 years of diabetes duration. In the final adjusted model, each unit increase in the standard deviation of eGDR was significantly associated with a 23.6%, 24.8% and 29.6% decrease in the odds of nephropathy, retinopathy, and CAD, respectively. There was a significant association between higher eGDR quartiles compared to Q1 for all complications (p < 0.05). The Q4 group had the lowest adjusted odds ratios (ORs) compared to the Q1 group for all complications; the OR of Q4 was 0.549 for nephropathy, 0.360 for retinopathy, and 0.396 for CAD (p < 0.001). The restricted cubic spline for nephropathy followed a negative nonlinear association with eGDR, whereas for retinopathy and CAD, it followed a negative linear pattern. The effect of eGDR was consistent among different subgroups. The ROC curve analysis of the adjusted model showed good discriminatory power for all complications.
In patients with type 2 diabetes, a higher eGDR was significantly associated with a lower risk of microvascular and macrovascular complications, regardless of well-known confounders.
本研究调查了2型糖尿病（T2D）患者中胰岛素抵抗指标估计葡萄糖处置率（eGDR）与微血管和大血管并发症之间的关联。
这项横断面研究纳入了2010年至2023年的7471例T2D患者。使用腰围、糖化血红蛋白（HbA1C）水平和高血压状态计算eGDR。采用逻辑回归分析和受限立方样条来研究eGDR与包括肾病、视网膜病变和冠状动脉疾病（CAD）在内的血管并发症之间的关系。通过敏感性分析和亚组分析检验结果的稳健性以及组间相互作用。此外，采用受试者工作特征（ROC）曲线分析来评估调整模型对T2D血管并发症的判别价值。
参与者中，56.5%为女性，平均年龄为57.04±11.05岁，糖尿病病程中位数为8年。在最终调整模型中，eGDR标准差每增加一个单位，肾病、视网膜病变和CAD的发病几率分别显著降低23.6%、24.8%和29.6%。与第一四分位数（Q1）相比，所有并发症在较高的eGDR四分位数之间存在显著关联（p<0.05）。与Q1组相比，所有并发症的Q4组调整后的优势比（OR）最低；肾病的Q4组OR为0.549，视网膜病变为0.360，CAD为0.396（p<0.001）。肾病的受限立方样条与eGDR呈负非线性关联，而视网膜病变和CAD则呈负线性模式。eGDR的作用在不同亚组中一致。调整模型的ROC曲线分析显示对所有并发症均具有良好的判别能力。
在2型糖尿病患者中，无论已知的混杂因素如何，较高的eGDR与较低的微血管和大血管并发症风险显著相关。
