Estimated Glucose Disposal Rate and Risk of Cardiovascular Events in Type 1 Diabetes: A Systematic Review and Meta-Analysis Publisher



P Dastjerdi PARHAM ; Ns Hosseini Mohammadi Negin SADAT ; Nat Anaraki Nazanin Alsadat TABATABAEI ; S Rahmati SOHEIL ; R Nikfar REZA ; S Momeni SAGHAR ; S Zafarmandi SAHAR ; S Saeidi SAHAR ; Mk Askari Mani KHORSAND ; S Hosseini SAJJAD
Source: Diabetology and Metabolic Syndrome Published:2025

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in individuals with type 1 diabetes mellitus (T1DM), with insulin resistance (IR) increasingly recognized as a key contributor. The estimated glucose disposal rate (eGDR), a surrogate marker of insulin sensitivity, has been proposed as a predictor of adverse cardiovascular outcomes in T1DM. This systematic review and meta-analysis aimed to assess the association between eGDR and adverse cardiovascular outcomes. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library was conducted through March 6, 2025, to identify studies reporting multivariable-adjusted risk estimates linking eGDR with cardiovascular outcomes in individuals with T1DM. Pooled hazard ratios (HRs) were estimated using random-effects models with the Paule–Mandel method and Knapp–Hartung adjustment. Subgroup and meta-regression analyses were conducted to explore potential effect modifiers, and leave-one-out (LOO) sensitivity analyses were performed to assess the robustness of findings. Results: Sixteen studies comprising 29,075 individuals with T1DM were included. Higher eGDR was significantly associated with lower risk of MACE and all-cause mortality, with hazard ratios per unit increase of 0.79 (95% CI: 0.72–0.87; I² = 63%) and 0.84 (95% CI: 0.82–0.86; I² = 0%), respectively. Lower eGDR was also associated with increased risk of CAD (low vs. high eGDR: HR 3.61; 95% CI: 2.83–4.62; I² = 0%). Subgroup analyses suggested a stronger protective association between eGDR and MACE among older individuals (≥ 40 years), those with BMI < 25 kg/m², and those with longer diabetes duration (≥ 20 years). LOO sensitivity analyses showed that CAD was the only outcome influenced by exclusion of the largest study. Conclusions: Lower eGDR is consistently associated with increased risk of MACE, CAD, and all-cause mortality in individuals with T1DM. These findings support the utility of eGDR as a practical, non-invasive marker for cardiovascular risk stratification in this high-risk population. © 2025 Elsevier B.V., All rights reserved.