5 years ago

Estimated glucose disposal rate predicts mortality in adults with type 1 diabetes

Ann-Marie Svensson, Björn Eliasson, Martin J. Holzmann, Ulrik Sartipy, Thomas Nyström
Aims This study aimed to investigate the association between insulin resistance as determined by the estimated glucose disposal rate (eGDR), and survival in adults with type 1 diabetes (T1D) in Sweden. Material and Methods Using the Swedish National Diabetes Register, people with T1D were included from January 1, 2005 to December 31, 2012. Outcomes were retrieved from National healthcare registers. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for the associations between eGDR (mg/kg/min) categorized into <4, 4–5.99, 6–7.99, and ≥8 (reference) and outcomes. Relative survival methods were used to compare survival to a matched Swedish reference population. Results Among 17,050 included people with T1D, 10.5%, 20.2%, 20.5%, and 48.9% had an eGDR of <4, 4–5.99, 6–7.99, and ≥8, respectively. People with an eGDR <8 were older and had more comorbidities. During a median follow-up of 7.1 years, there were 946 (6%) deaths; 264 (15%), 367 (11%), 195 (6%), and 120 (1%) deaths occurred in people with an eGDRof <4, 4–5.99, 6–7.99, and ≥8, respectively. After adjustment for a wealth of different covariates; including diabetes duration, age, sex and renal function, people with an eGDR <4, 4–5.99, and 6–7.99 had an increased risk of death compared with people with an eGDR ≥8 (adjusted HRs, 95% CIs, p-values: 2.78, 2.04–3.77, <0.001; 1.92, 1.49–2.46, <0.001; 1.73, 1.34–2.21, <0.001). Survival in people with an eGDR ≥8 was equal to a matched general population. Conclusions/interpretation There is a strong association between eGDR and all-cause mortality, and also cardiovascular mortality, in people with T1D. Our findings may guide preventive measures by improving risk assessment in people with T1D.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/dom.13110

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