ESTIMATED glucose disposal rate (eGDR), a surrogate measure of insulin sensitivity, is increasingly being recognised as a valuable marker for assessing cardiovascular risk in people with diabetes. While its role in individuals with Type 1 diabetes (T1D) has gained interest, less is known about its predictive value for cardiovascular disease (CVD), diabetic microvascular complications (DMC), and mortality across broader populations. A comprehensive new meta-analysis sheds light on these associations. Crucially, it found that each 1-unit increase in eGDR was associated with a 22% lower risk of CVD in people with T1D.
To evaluate the clinical relevance of eGDR across various populations, researchers conducted a systematic review and meta-analysis in line with PRISMA guidelines. Data were extracted up to September 2024, encompassing 69 studies. 19 of these studies (involving 185,810 participants) explored the associations between eGDR and clinical outcomes, while 50 studies reported average eGDR levels. Random-effects models were used to estimate pooled hazard ratios (HRs), with additional subgroup analyses performed by diabetes type and population group.
The analysis showed that in T1D, every 1 mg/kg/min increase in eGDR was linked with reduced risk of both CVD (hazard ratio [HR] 0.78; 95% CI: 0.69–0.87; I²=68%) and all-cause mortality (HR 0.83; 95% CI: 0.79–0.88; I²=0%). Although there was a trend toward reduced DMC risk in T1D, this did not reach statistical significance (HR 0.86; 95% CI: 0.72–1.03; I²=25%). In Type 2 diabetes (T2D), increased eGDR was associated with lower all-cause mortality (HR 0.90; 95% CI: 0.84–0.97; I²=62%), and similar findings emerged for the general population (HR 0.88; 95% CI: 0.82–0.94; I²=48%). Mean eGDR values were higher in T1D (8.19 mg/kg/min; 95% CI: 7,81–8.57; I²=99%) than in T2D (7.03 mg/kg/min; 95% CI: 4.89–9.17; I²=100%), though substantial heterogeneity was observed.
These findings highlight eGDR as a potentially valuable tool for mortality and cardiovascular risk stratification, particularly in T1D. However, its predictive power for microvascular outcomes and its role in T2D remain less certain. The use of observational data introduced limitations in the study, including potential confounding, and high heterogeneity. Nonetheless, eGDR may offer clinicians a pragmatic, non-invasive means of identifying high-risk patients and tailoring preventative strategies accordingly.
Reference
Guo L et al. The role of estimated glucose disposal rate in predicting cardiovascular risk among general and diabetes mellitus population: a systematic review and meta-analysis. BMC Med. 2025;23(1):234
