Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background and aims

Insulin resistance contributes to the development of type 2 diabetes (T2D) and is also a cardiovascular risk factor. The aim of this study was to investigate the potential association between insulin resistance measured by estimated glucose disposal rate (eGDR) and risk of stroke and mortality thereof in people with T2D.

Materials and methods

Nationwide population based observational cohort study that included all T2D patients from the Swedish national diabetes registry between 2004 and 2016 with full data on eGDR and categorised as following: < 4, 4–6, 6–8, and ≥ 8 mg/kg/min. We calculated crude incidence rates and 95% confidence intervals (CIs) and used multiple Cox regression to estimate hazard ratios (HRs) to assess the association between the risk of stroke and death, according to the eGDR categories in which the lowest category < 4 (i.e., highest grade of insulin resistance), served as a reference. The relative importance attributed of each factor in the eGDR formula was measured by the R ² (± SE) values calculating the explainable log-likelihoods in the Cox regression.

Results

A total of 104 697 T2D individuals, 44.5% women, mean age of 63 years, were included. During a median follow up-time of 5.6 years, 4201 strokes occurred (4.0%). After multivariate adjustment the HRs (95% CI) for stroke in patients with eGDR categories between 4–6, 6–8 and > 8 were: 0.77 (0.69–0.87), 0.68 (0.58–0.80) and 0.60 (0.48–0.76), compared to the reference < 4. Corresponding numbers for the risk of death were: 0.82 (0.70–0.94), 0.75 (0.64–0.88) and 0.68 (0.53–0.89). The attributed relative risk R ² (± SE) for each variable in the eGDR formula and stroke was for: hypertension (0.045 ± 0.0024), HbA1c (0.013 ± 0.0014), and waist (0.006 ± 0.0009), respectively.

Conclusion

A low eGDR (a measure of insulin resistance) is associated with an increased risk of stroke and death in individuals with T2D. The relative attributed risk was most important for hypertension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-021-01394-4.

Related collections

Most cited references 30

Record: found
Abstract: not found
Article: not found

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

(1998)

0 comments Cited 889 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Global estimates of the prevalence of diabetes for 2010 and 2030.

J E Shaw, R. A. Sicree, P Zimmet (2010)

We estimated the number of people worldwide with diabetes for the years 2010 and 2030. Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

0 comments Cited 633 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Glucose clamp technique: a method for quantifying insulin secretion and resistance.

Christian R. Andres, Stephanie J. Tobin, R. DeFronzo (1979)

Methods for the quantification of beta-cell sensitivity to glucose (hyperglycemic clamp technique) and of tissue sensitivity to insulin (euglycemic insulin clamp technique) are described. Hyperglycemic clamp technique. The plasma glucose concentration is acutely raised to 125 mg/dl above basal levels by a priming infusion of glucose. The desired hyperglycemic plateau is subsequently maintained by adjustment of a variable glucose infusion, based on the negative feedback principle. Because the plasma glucose concentration is held constant, the glucose infusion rate is an index of glucose metabolism. Under these conditions of constant hyperglycemia, the plasma insulin response is biphasic with an early burst of insulin release during the first 6 min followed by a gradually progressive increase in plasma insulin concentration. Euglycemic insulin clamp technique. The plasma insulin concentration is acutely raised and maintained at approximately 100 muU/ml by a prime-continuous infusion of insulin. The plasma glucose concentration is held constant at basal levels by a variable glucose infusion using the negative feedback principle. Under these steady-state conditions of euglycemia, the glucose infusion rate equals glucose uptake by all the tissues in the body and is therefore a measure of tissue sensitivity to exogenous insulin.

0 comments Cited 581 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Alexander Zabala:

ORCID: http://orcid.org/0000-0001-5389-1271

alexander.zabala@sll.se

Journal

Journal ID (nlm-ta): Cardiovasc Diabetol

Journal ID (iso-abbrev): Cardiovasc Diabetol

Title: Cardiovascular Diabetology

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2840

Publication date (Electronic): 6 October 2021

Publication date PMC-release: 6 October 2021

Publication date Collection: 2021

Volume: 20

Electronic Location Identifier: 202

Affiliations

[1 ]Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 11883 Stockholm, Sweden

[2 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Institute of Medicine, , University of Gothenburg, ; Gothenburg, Sweden

[3 ]GRID grid.459843.7, ISNI 0000 0004 0624 0259, Department of Medicine, , NU Hospital Group, ; Uddevalla, Sweden

[4 ]Centre of Registers in Region Västra Götaland, Gothenburg, Sweden

[5 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Molecular Medicine and Surgery, , Karolinska Institutet, ; Stockholm, Sweden

[6 ]GRID grid.24381.3c, ISNI 0000 0000 9241 5705, Department of Vascular Surgery, , Karolinska University Hospital, ; Stockholm, Sweden

Author information

Alexander Zabala http://orcid.org/0000-0001-5389-1271

Article

Publisher ID: 1394

DOI: 10.1186/s12933-021-01394-4

PMC ID: 8495918

PubMed ID: 34615525

SO-VID: 54c81af0-4557-42cd-b1cc-e0eca599fe01

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 June 2021

Date accepted : 29 September 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003793, hjärt-lungfonden;

Award ID: 20190298

Award Recipient : Thomas Nyström

Funded by: alf stockholms läns landsting and karolinska institutet (grant 20170120).

Award ID: 20170120

Award Recipient : Thomas Nyström

Funded by: Karolinska Institute

Open Access :

Open access funding provided by Karolinska Institute.

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: type 2 diabetes,estimated glucose disposal rate,insulin resistance,stroke,all-cause mortality

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: type 2 diabetes, estimated glucose disposal rate, insulin resistance, stroke, all-cause mortality

Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study

Read this article at

Abstract

Background and aims

Materials and methods

Results

Conclusion

Supplementary Information

Related collections

Stroke MRI

Most cited references 30

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

Global estimates of the prevalence of diabetes for 2010 and 2030.

Glucose clamp technique: a method for quantifying insulin secretion and resistance.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 102

Cited by 15

Most referenced authors 719