Estimated glucose disposal rate (eGDR) may be a valuable prognostic factor for identifying diabetic kidney disease (DKD) progression among patients with type 2 diabetes mellitus (T2DM), according to study results published in Journal of Endocrine Society.
Diabetic kidney disease is a major cause of end-stage renal disease (ESRD), which increases the risk for all-cause mortality. With its gradual disease onset, many laboratory indicators have been put forth to assess renal function, namely eGDR and estimated glomerular filtration rate (eGFR). However, data on their long-term utility are lacking. Investigators assessed the predictive value of eGDR on renal outcomes among patients with T2DM, as well as the relationship between eGDR and eGFR.
A retrospective cohort study was conducted from January 2011 to September 2021 using subjects from the Third Xiangya Hospital of Central South University. Adults diagnosed with T2DM according to the World Health Organization 1999 diabetes classification and diagnostic criteria were included in the analysis.
Primary outcomes included the sudden onset of eGFR decline, eGFR of less than 60 mL/min/1.73 m2, as well as a composite renal endpoint of 50% decline in eGFR function, doubling of creatinine levels, or onset of ESRD.
A total of 956 patients were included in the study. Study participants were divided into 2 groups: those with an eGFR of at least 60 mL/min/1.73 m2 and those with an eGFR less than 60 mL/min/ 1.73 m2.
At baseline, compared against those with an eGFR of at least 60 mL/min/1.73 m2,patients with an eGFR less than 60 mL/min/1.73 m2 had a longer duration of diabetes, higher blood pressure, higher hemoglobin A1c (HbA1c), and lower eGDR levels, on average (all P <.05).
Overall, 747 (78.14%) patients were observed to have a decrease in eGFR, while 229 (23.95%) patients exhibited rapid eGFR decline; 116 (12.13%) patients satisfied the composite renal endpoint.
Linear regression analysis revealed a significant correlation between eGDR and eGFR (F = 13.4; P <.001). After adjusting for low-density lipoprotein, triglycerides, body mass index, and blood urea nitrogen, this association remained statistically significant (F = 10.3; P <.001).
According to logistic regression analysis, rapid eGFR decline was found to be associated with an eGDR threshold level below 6.34 (95% CI, 6.20-6.48) mg/kg/min.
Additionally, eGDR levels greater than 8.33 mg/kg/min were shown to decrease the risk for rapid eGFR decline by 75%, and for the composite renal endpoint by 61%.
When comparing eGDR to other renal outcome components (HbA1c, waist circumference [WC], and hypertension), the predictive value of eGDR in relationship to an eGFR less than 60 mL/min/1.73 m2 was superior to WC and HbA1c, and similar to hypertension.
When stratifying risk by age, sex, and diabetes duration, investigators found eGDR was significantly associated with rapid eGFR decline in patients with T2DM aged less than 65 years who have had diabetes for less than 10 years (P <.05).
This study was limited by exclusion of follow-up eGDR levels, potential confounders, use of a single-center patient cohort , and the post hoc nature of subgroup analyses.
The study authors concluded, “[L]ower eGDR was a predictive factor for renal function progression in patients with T2DM. More attention may be needed to improve insulin resistance in patients aged <65 years, patients with diabetes mellitus duration <10 years and in men.”
Peng, J, Li A, Yin L, Yang Q, Pan J, Yi Bin. Estimated glucose disposal rate predicts renal progression in type 2 diabetes mellitus: a retrospective cohort study. J Endocr Soc. Published online June 1, 2023. doi:10.1210/jendso/bvad069