Response to Comment on Garofolo et al. Insulin Resistance and Risk of Major Vascular Events and All-Cause Mortality in Type 1 Diabetes: A 10-Year Follow-up Study. Diabetes Care 2020;43:e139–e141

González-Clemente et al.(1) claim that a simpler though efficient assessment of cardiovascular risk in people with type 1 diabetes (T1D) is much needed.Since we showed that the estimated glucose disposal rate (eGDR) was an independent predictor of cardiovascular (CVD) and coronary artery disease (CAD) in people with T1D, they evaluated whether cutoff eGDRvaluescouldbecalculatedtobeusedin clinical practice to stratify CVD risk.They used the Steno Type 1 Risk Engine (ST1RE) (2) in 179 T1D subjects without CVD to identify 10-year risk level for a first CVD event: low (,10%), moderate (10-20%), and high ($20%) risk.An eGDR ,8.52 mg/kg/min was associated with moderate/high risk and an eGDR ,8.08 mg/kg/min predicted for high risk, both with high C-statistics.To gain further validation, as suggested by González-Clemente etal.(1),we assessed the 10-year CVD risk by ST1RE (2) in our population as well (3).After exclusion of 41 subjects with prior CVD events (5.3%), 453 (61.7%) were defined as low risk, 179 (24.5%) as moderate risk, and 101 as high risk (13.8%).Such distribution was similar(x 2 2.205, P50.332)tothatreported by González-Clemente et al. (1).We then calculated cutoff levels of eGDR associated with ST1RE categories based on the Youden index calculation.The value associated with moderate/high risk (,7.65 mg/kg/min; C-statistic 0.75, 95% CI 0.71-0.79)was similar to that associated with high risk