Gender Differences in the Association Between Insulin Resistance Assessed by Estimated Glucose Disposal Rate and the Risk of All-cause and Cardiovascular Deaths in Adults Without Diabetes

Aim: We intended to examine the relationship between estimated glucose disposal rate (eGDR) and risks of all-cause and cardiovascular deaths in non-diabetic adults.

Methods: 38,175 participants from the National Health and Nutrition Examination Survey (1999-2018) were included, and deaths were identified through the National Death Index.

Results: With a median follow-up of 9.8 years, we found that dose-response relationships between eGDR level and the risk of death differed between genders. In female participants, higher eGDR level was linearly correlated with lower risks of all-cause and cardiovascular deaths. In contrast, among male participants, there were L-shaped relationships between eGDR and risks of all-cause and cardiovascular deaths, with threshold points of 8.50 and 8.49 mg/kg/min, respectively. To the left of threshold points, eGDR was negatively linked with risks of all-cause (HR 0.91, 95 % CI 0.88-0.94, P < 0.001) and cardiovascular deaths (HR 0.87, 95 % CI 0.82-0.93, P < 0.001). After the inflection point, an increase in eGDR was not related to lower risks of all-cause and cardiovascular deaths (P > 0.05).

Conclusion: Higher eGDR level was associated with lower risks of all-cause and cardiovascular deaths in a linear dose-response manner among non-diabetic females, while L-shaped relationships were observed among non-diabetic males.