Key result
Lower estimated glucose disposal rate (lowest vs highest quartile) was associated with a higher risk of lower extremity arterial disease in type 2 diabetes (OR 2.23; 95% CI 1.47-3.37).
Why the study?
Lower extremity arterial disease is closely linked to insulin resistance, but the clinical utility of estimated glucose disposal rate for early risk stratification remains underexplored.
Does lower estimated glucose disposal rate (eGDR) associate with an increased risk of lower extremity arterial disease (LEAD) in adults aged ≥50 years with T2DM?
Cross-Sectional (n=7,482)
Yes
Does lower estimated glucose disposal rate (eGDR) associate with an increased risk of lower extremity arterial disease (LEAD) in adults aged ≥50 years with T2DM?
Lower estimated glucose disposal rate (eGDR) is significantly associated with a higher prevalence of lower extremity arterial disease in older adults with type 2 diabetes, suggesting its utility as a practical risk stratification tool.
eGDR may aid LEAD risk stratification in older T2DM; cross-sectional data leaves open clinical utility and need for prospective validation.
AIMS: Lower extremity arterial disease (LEAD), a prevalent but under-recognised macrovascular complication of type 2 diabetes mellitus (T2DM), is closely linked to insulin resistance (IR). The estimated glucose disposal rate (eGDR), a surrogate marker of IR, may facilitate early LEAD risk stratification; however, its clinical utility remains underexplored. MATERIALS AND METHODS: This cross-sectional analysis of 7482 adults aged ≥50 years with T2DM, from the China DIA-LEAD study evaluated the association between eGDR (quartiles: Q1-Q4) and LEAD, defined by the ankle-brachial index (ABI <0.9 or >1.3). Multivariate logistic regression and restricted cubic spline (RCS) models were used to assess the nonlinear relationships, adjusted for demographics, metabolic factors and comorbidities. RESULTS: Participants in the lower eGDR quartiles showed a progressively higher LEAD prevalence (Q1: 31.4% vs. Q4: 12.8%), worse glycaemic control (HbA1c Q1: 9.8% vs. Q4: 7.3%) and a greater comorbidity burden (all p < 0.001). In fully adjusted models, Q1 had a 2.23-fold higher LEAD risk versus Q4 (95% CI 1.47-3.37). Each 1-unit eGDR increase conferred a 24% lower LEAD risk (adjusted OR 0.76, 95% CI 0.70-0.84). RCS analysis revealed an L-shaped relationship, with sharp risk escalation at eGDR < 8 mg/kg/min (p for nonlinearity = 0.003). Subgroup analyses confirmed consistency across populations (all p for interaction >0.05). CONCLUSIONS: eGDR demonstrated a significant inverse L-shaped association with LEAD in patients with T2DM. These findings support the clinical utility of eGDR as a practical indicator of LEAD risk screening and management. Patients with lower eGDR may benefit from insulin-sensitising therapies, which could reduce both glucose levels and the risk of LEAD.
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Wei et al. (2025) conducted a cross-sectional in Type 2 diabetes mellitus (n=7,482). Lower estimated glucose disposal rate (eGDR) vs. Higher eGDR was evaluated on Lower extremity arterial disease (LEAD) (OR 2.23, 95% CI 1.47-3.37). Lower estimated glucose disposal rate (lowest vs highest quartile) was associated with a higher risk of lower extremity arterial disease in type 2 diabetes (OR 2.23; 95% CI 1.47-3.37).
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