Insulin resistance estimated using the estimated glucose disposal rate (eGDR) may help identify individuals with type 2 diabetes mellitus (T2DM) who are at increased risk of vascular complications. An analysis published in Diabetes, Obesity and Metabolism evaluated the relationship between eGDR and adverse clinical outcomes and examined whether insulin resistance modified the effects of glucose- and blood pressure (BP)-lowering therapies.

The analysis used data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial, which enrolled 11,140 participants with T2DM across 20 countries. eGDR was calculated for 11,081 participants using waist circumference, hypertension status, and glycated hemoglobin (HbA1c). Multivariable Cox proportional hazards models were applied to estimate hazard ratios (HRs) for the association between eGDR levels and clinical outcomes.

Over a median follow-up of 5 years, 2,117 participants experienced a major macrovascular or microvascular event. Participants in the highest eGDR quartile had significantly lower risks of composite vascular events (HR 0.72, 95% CI 0.62-0.84) compared with those in the lowest quartile. Similar associations were observed for major macrovascular events (HR 0.68, 95% CI 0.55-0.85), major microvascular events (HR 0.78, 95% CI 0.63-0.96), all-cause mortality (HR 0.69, 95% CI 0.55-0.86), and cardiovascular mortality (HR 0.62, 95% CI 0.45-0.85).

No significant differences were observed across eGDR quartiles in the efficacy or safety of intensive glucose control compared with standard therapy or BP-lowering treatment compared with placebo. These findings suggest that eGDR may serve as a prognostic marker in T2DM, while the benefits of intensive glucose and BP management appear consistent regardless of insulin resistance status.