Association of estimated glucose disposal rate with metabolic syndrome prevalence and mortality risks: a population-based study

Cardiovasc Diabetol. 2025 Jan 22;24(1):38. doi: 10.1186/s12933-025-02599-7.

Abstract

Background: Insulin resistance (IR) is a central pathophysiological factor in metabolic syndrome (MetS) and an essential driver of cardiovascular disease (CVD) and mortality. The estimated glucose disposal rate (eGDR) is a reliable marker of IR and has been associated with CVD prognosis. This study aims to examine the relationship between eGDR, MetS, and their predictive roles in clinical outcomes.

Methods: Data from the NHANES (2001-2018) were utilized, with a cross-sectional design applied to evaluate the association between eGDR and MetS prevalence, and a cohort design employed for mortality follow-up. Weighted logistic regression models were used to examine the association between eGDR and MetS. Weighted Cox proportional hazard models were applied to assess the link between eGDR and both all-cause and CVD mortality. To examine the non-linear associations between the eGDR, MetS, and mortality outcomes, restricted cubic spline (RCS) analysis was applied. Additionally, the predictive performance of eGDR, and other IR indices (TyG, HOMA-IR), for mortality was assessed using the C-statistic.

Results: A robust negative association between eGDR and MetS prevalence was found, following full covariate adjustment (p < 0.001). The core findings were consistent across subgroups (all p < 0.001). Cox regression analysis indicated that in individuals with MetS, each standard deviation (SD) increment in eGDR was associated with an 11% and 18% decrement in the risk of all-cause and CVD mortality, respectively. RCS analysis displayed a non-linear association between eGDR and MetS prevalence, while a linear association between eGDR and mortality. The C-statistic showed that eGDR, compared to the TyG index and HOMA-IR, significantly improved predictive power for all-cause mortality (p = 0.007).

Conclusion: eGDR is strongly associated with MetS and predicts all-cause and CVD mortality in individuals with MetS. Compared to TyG and HOMA-IR, eGDR offers superior predictive value for all-cause mortality, highlighting its potential as a useful tool in clinical risk assessment.

Keywords: Estimated glucose disposal rate; Insulin resistance; Metabolic syndrome; Mortality; NHANES.

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Blood Glucose* / metabolism
  • Cardiovascular Diseases* / blood
  • Cardiovascular Diseases* / diagnosis
  • Cardiovascular Diseases* / epidemiology
  • Cardiovascular Diseases* / mortality
  • Cause of Death
  • Cross-Sectional Studies
  • Female
  • Humans
  • Insulin Resistance*
  • Male
  • Metabolic Syndrome* / blood
  • Metabolic Syndrome* / diagnosis
  • Metabolic Syndrome* / epidemiology
  • Metabolic Syndrome* / mortality
  • Middle Aged
  • Nutrition Surveys*
  • Predictive Value of Tests
  • Prevalence
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • United States / epidemiology

Substances

  • Blood Glucose
  • Biomarkers