The role of estimated glucose disposal rate in predicting cardiovascular risk among general and diabetes mellitus population: a systematic review and meta-analysis.

BACKGROUND

Estimated glucose disposal rate (eGDR) is a measure of insulin sensitivity. While recent evidence suggests its role in cardiovascular risk assessment in Type 1 diabetes, its associations with cardiovascular disease (CVD), diabetic microvascular complications (DMC), and mortality across different populations remain unclear.

METHODS

We systematically searched Medline, EMBASE, Web of Science, and the Cochrane Library up to September 1st, 2024, following PRISMA guidelines. We examined associations between eGDR and CVD, DMC (including diabetic retinopathy, nephropathy, and peripheral neuropathy), and all-cause mortality using random-effects models. Secondary analysis assessed mean eGDR levels in diabetes populations.

RESULTS

Nineteen observational studies (185,810 participants) examined clinical outcomes, while 50 studies reported mean eGDR values. In patients with Type 1 diabetes (T1DM), each 1-unit (mg/kg/min) increase in eGDR was associated with lower risks of CVD (HR 0.78; 95% CI 0.69-0.87; I = 68%) and all-cause mortality (HR 0.83; 95% CI 0.79-0.88; I = 0%). The association between eGDR and DMC in T1DM was not statistically significant (HR 0.86; 95% CI 0.72-1.03; I = 25%). In patients with Type 2 diabetes (T2DM), each 1-unit (mg/kg/min) increase in eGDR was associated with reduced all-cause mortality (HR 0.90; 95% CI 0.84-0.97; I = 62%). Similarly, in the general population, each 1-unit (mg/kg/min) increase in eGDR was associated with decreased mortality risk (HR 0.88; 95% CI 0.82-0.94; I = 48%). The pooled mean eGDR was higher in patients with T1DM (8.19 mg/kg/min; 95% CI 7.81-8.57; I = 99%) compared to those with T2DM (7.03 mg/kg/min; 95% CI 4.89-9.17; I = 100%).

CONCLUSIONS

Higher eGDR levels were consistently associated with lower risks of CVD and mortality in T1DM, with similar associations observed for mortality in T2DM. In the general population, higher eGDR levels were associated with reduced mortality risk. The relationship between eGDR and DMC requires further investigation, particularly in T2DM. These findings suggest eGDR's potential utility as a risk assessment tool, though its clinical application may vary across different populations.