The potential of glucose management indicator for the estimation of glucose disposal rate in people with type 1 diabetes

Jul 28, 2024Nutrition, metabolism, and cardiovascular diseases : NMCD

Using Glucose Management Indicator to Estimate How People with Type 1 Diabetes Process Sugar

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Abstract

A total of 158 adults with type 1 diabetes were analyzed, showing good agreement between eGDR-GMI and eGDR.

The eGDR-GMI formula incorporates the glucose management indicator derived from continuous glucose monitoring.
Participants in the lowest eGDR-GMI tertile exhibited a higher prevalence of diabetes-related complications.
There was a less favorable metabolic profile in individuals with lower eGDR-GMI values.
The relative risk of retinopathy, nephropathy, and neuropathy increased significantly with each unit decrease in eGDR-GMI.
The findings suggest that low eGDR-GMI may be indicative of greater cardiovascular risk factors in type 1 diabetes.

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BACKGROUND AND AIMS: Insulin resistance is a growing feature in type 1 diabetes (T1D). It can be quantified by calculating the estimated glucose disposal rate (eGDR) with the Epstein's formula, which includes laboratory-measured glycated hemoglobin (HbA1c). We aimed the current research to assess the agreement between the conventional eGDR formula and an alternative one (eGDR-GMI) incorporating the glucose management indicator (GMI) derived from continuous glucose monitoring (CGM). We also explored the relationship between eGDR-GMI, cardiovascular risk factors, and the prevalence of diabetes-related complications.

METHODS AND RESULTS: We designed a cross-sectional study that included adults with T1D. eGDR-GMI and eGDR (mg/kg/min) were calculated using GMI or HbA1c, waist circumference, and hypertensive state. Clinical data were collected from electronic medical records. The analyses encompassed 158 participants with a mean age of 39 ± 13 years. The Bland-Altman analysis showed a good agreement between eGDR-GMI and eGDR. When we divided participants in eGDR-GMI tertiles we found a higher prevalence of diabetes-related complications and a less favorable metabolic profile in the lowest eGDR-GMI tertile. The relative risk of retinopathy, nephropathy, and neuropathy significantly increased by approximately 1 unit with each decrease in eGDR-GMI, regardless of age, sex, disease duration, lipids, and smoking habit.

CONCLUSIONS: eGDR-GMI represents a valid and robust alternative to the eGDR to assess insulin resistance in T1D. Low eGDR-GMI is associated with diabetes complications and a less favorable metabolic profile. Incorporating the eGDR-GMI into clinical practice can enhance the characterization of T1D people and allow for a more personalized treatment approach.

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The potential of glucose management indicator for the estimation of glucose disposal rate in people with type 1 diabetes

Abstract

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