Use of the Estimated Glucose Disposal Rate as a Measure of Insulin Resistance in an Urban Multiethnic Population With Type 1 Diabetes

Abstract

OBJECTIVEInsulin resistance has been described in type 1 diabetes mellitus, is related to risk of vascular complications, and may be more common in certain ethnic groups. Estimated glucose disposal rate (eGDR) is a validated clinical tool for estimating insulin sensitivity in type 1 diabetes. Because previous reports of eGDR in adults with type 1 diabetes have included few ethnic minorities, this study explored interethnic differences in eGDR and the relationship of eGDR with diabetic vascular complications.RESEARCH DESIGN AND METHODSWe conducted a cross-sectional study using a sample that included 207 white, black, or Hispanic adults with prior clinical diagnosis of type 1 diabetes who were receiving care at an urban academic medical center. eGDR (milligrams per kilogram per minute) was calculated using HbA1c, waist circumference, and hypertensive status. Race/ethnicity was self-reported. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CIs of association of eGDR with diabetes complications (cardiovascular disease, retinopathy, albuminuria, and chronic kidney disease above stage 3).RESULTSForty-two percent of the participants were women, and mean age was 45 ± 15 years; 34% were white, 32% were Hispanic, and 34% were black. Ethnicity was significantly associated with eGDR; blacks had significantly lower eGDR (5.66 ± 2.34) than Hispanics (6.70 ± 2.29) and whites (7.20 ± 2.03) (P < 0.001). Patients with the lowest eGDR compared with the highest had a significantly greater risk of any diabetes complication (OR 3.1 [95% CI 1.2–8.1]) compared with the least insulin-resistant patients.CONCLUSIONSIn an urban clinic population of patients with type 1 diabetes, blacks were significantly less insulin sensitive than whites or Hispanics, and lower eGDR was associated with diabetes complications. Further study is needed to determine whether using eGDR to target interventions can improve outcomes.

The dose–response effect of insulin sensitivity on albuminuria in children according to diabetes type

“…Similarly, higher levels of IS in older type 1 diabetic populations predicted regression of microalbuminuria [40]. These studies were conducted in populations with type 1 diabetes with a duration of 10 – 20 years, mean BMI of 25 – 30 and a prevalence of microalbuminuria of 18 – 44 %; all characteristics very distinct from our population [23, 31, 32]. …”

“…The association of albuminuria and low IS, or a surrogate abdominal adiposity, has been recognized in type 2 diabetes [24–30], in type 1 diabetes [21, 23, 31–35] and in populations without diabetes [7, 36, 37]. The few negative studies have been from populations with distinct characteristics such as hypertensive individuals or those without significant representation of overweight [25, 29].…”

“…The Epidemiology of Diabetes Interventions and Complications Study documented weight gain and increased abdominal adiposity in type 1 patients over time, as well as its association with increased vascular disease [39]. Studies of adult type 1 diabetic populations have clearly shown low IS to be predictive of subsequent micro- and macroalbuminuria [21, 23, 31–35]. Similarly, higher levels of IS in older type 1 diabetic populations predicted regression of microalbuminuria [40].…”

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

“…The eGDR (mg/kg/min) was calculated as previously described, according to the following formula: …”

Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social jetlag

“…To estimate insulin sensitivity, eGDR was calculated as follows: eGDR (mg/kg/min) = 21.158 + (−0.09 × waist circumference) + (−3.407 × hypertension) + (−0.551 × HbA1c) as validated (25,26).…”