Association between estimated glucose disposal rate and lower extremity arterial disease in type 2 diabetes: A nationwide cross-sectional study from China

Abstract

Aims: Lower extremity arterial disease (LEAD), a prevalent but under-recognised macrovascular complication of type 2 diabetes mellitus (T2DM), is closely linked to insulin resistance (IR). The estimated glucose disposal rate (eGDR), a surrogate marker of IR, may facilitate early LEAD risk stratification; however, its clinical utility remains underexplored. Materials and Methods: This cross-sectional analysis of 7482 adults aged ≥50 years with T2DM, from the China DIA-LEAD study evaluated the association between eGDR (quartiles: Q1-Q4) and LEAD, defined by the ankle–brachial index (ABI <0.9 or >1.3). Multivariate logistic regression and restricted cubic spline (RCS) models were used to assess the nonlinear relationships, adjusted for demographics, metabolic factors and comorbidities. Results: Participants in the lower eGDR quartiles showed a progressively higher LEAD prevalence (Q1: 31.4% vs. Q4: 12.8%), worse glycaemic control (HbA1c Q1: 9.8% vs. Q4: 7.3%) and a greater comorbidity burden (all p < 0.001). In fully adjusted models, Q1 had a 2.23-fold higher LEAD risk versus Q4 (95% CI 1.47–3.37). Each 1-unit eGDR increase conferred a 24% lower LEAD risk (adjusted OR 0.76, 95% CI 0.70–0.84). RCS analysis revealed an L-shaped relationship, with sharp risk escalation at eGDR < 8 mg/kg/min (p for nonlinearity = 0.003). Subgroup analyses confirmed consistency across populations (all p for interaction >0.05). Conclusions: eGDR demonstrated a significant inverse L-shaped association with LEAD in patients with T2DM. These findings support the clinical utility of eGDR as a practical indicator of LEAD risk screening and management. Patients with lower eGDR may benefit from insulin-sensitising therapies, which could reduce both glucose levels and the risk of LEAD.