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Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study
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 strok...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495918/ https://www.ncbi.nlm.nih.gov/pubmed/34615525 http://dx.doi.org/10.1186/s12933-021-01394-4 |
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author | Zabala, Alexander Darsalia, Vladimer Lind, Marcus Svensson, Ann-Marie Franzén, Stefan Eliasson, Björn Patrone, Cesare Jonsson, Magnus Nyström, Thomas |
author_facet | Zabala, Alexander Darsalia, Vladimer Lind, Marcus Svensson, Ann-Marie Franzén, Stefan Eliasson, Björn Patrone, Cesare Jonsson, Magnus Nyström, Thomas |
author_sort | Zabala, Alexander |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8495918 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-84959182021-10-07 Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study Zabala, Alexander Darsalia, Vladimer Lind, Marcus Svensson, Ann-Marie Franzén, Stefan Eliasson, Björn Patrone, Cesare Jonsson, Magnus Nyström, Thomas Cardiovasc Diabetol Original Investigation 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. BioMed Central 2021-10-06 /pmc/articles/PMC8495918/ /pubmed/34615525 http://dx.doi.org/10.1186/s12933-021-01394-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/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/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://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. |
spellingShingle | Original Investigation Zabala, Alexander Darsalia, Vladimer Lind, Marcus Svensson, Ann-Marie Franzén, Stefan Eliasson, Björn Patrone, Cesare Jonsson, Magnus Nyström, Thomas Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study |
title | Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study |
title_full | Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study |
title_fullStr | Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study |
title_full_unstemmed | Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study |
title_short | Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study |
title_sort | estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495918/ https://www.ncbi.nlm.nih.gov/pubmed/34615525 http://dx.doi.org/10.1186/s12933-021-01394-4 |
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