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Estimated glucose disposal rate and long-term survival in type 2 diabetes after coronary artery bypass grafting

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Abstract

We performed a nationwide population-based cohort study to investigate the association between estimated glucose disposal rate (eGDR) and long-term survival after coronary artery bypass grafting (CABG) in patients with type 2 diabetes. All patients who underwent primary CABG in Sweden from 2006 to 2013 were identified from the SWEDEHEART register and by record linkage to the National Diabetes Register; all patients with type 2 diabetes were included and formed the study population. Patients were followed until 2013 through national registers for major adverse cardiovascular events and death from any cause. eGDR was calculated using waist circumference, hemoglobin A1c, and presence or the absence of hypertension. The association between eGDR and death was estimated using multivariable Cox regression. A total of 3256 patients were included. During a mean follow-up of 3.1 years (10,227 person-years), in total, 14 % patients died: 17 % (n = 186) in the 1st tertile (lowest eGDR), 14 % (n = 145) in the 2nd tertile, and 13 % (n = 133) in the 3rd tertile (highest eGDR). There was a significant association between eGDR and increased risk of death: adjusted hazard ratio (95 % confidence interval): 1.46 (1.12–1.90) for the 1st eGDR tertile compared to the 3rd and highest eGDR tertile. In conclusion, patients with type 2 diabetes who underwent CABG, a low eGDR, were associated with an increased risk of long-term all-cause mortality that was independent of other cardiovascular and metabolic risk factors. Insulin resistance measured by eGDR could be a useful risk marker in patients with type 2 diabetes and ischemic heart disease.

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Acknowledgments

The authors are grateful to the steering committees of SWEDEHEART and NDR for providing data for this study.

Grant support

This study was supported by grants from the Swedish Society of Medicine (T.N, M.J.H, U.S.), Karolinska Institutet Foundations and Funds (M.J.H. and U.S.), the Mats Kleberg Foundation (U.S.), and the Swedish Heart and Lung Foundation (T.N).

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Authors and Affiliations

  1. Department of Clinical Science and Research, Karolinska Institutet, Stockholm, Sweden

    Thomas Nyström

  2. Division of Internal Medicine at Södersjukhuset, Stockholm, Sweden

    Thomas Nyström

  3. Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden

    Martin J. Holzmann

  4. Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden

    Martin J. Holzmann

  5. Institute of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden

    Björn Eliasson

  6. Centre of Registers in Region Västra Götaland, Göteborg, Sweden

    Ann-Marie Svensson

  7. Department of Cardiovascular Medicine, Danderyds Hospital, Stockholm, Sweden

    Jeanette Kuhl

  8. Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden

    Jeanette Kuhl

  9. Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, 171 76, Stockholm, Sweden

    Ulrik Sartipy

  10. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Ulrik Sartipy

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  1. Thomas Nyström
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Correspondence to Ulrik Sartipy.

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Nyström, T., Holzmann, M.J., Eliasson, B. et al. Estimated glucose disposal rate and long-term survival in type 2 diabetes after coronary artery bypass grafting. Heart Vessels 32, 269–278 (2017). https://doi.org/10.1007/s00380-016-0875-1

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