Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in individuals with type 1 diabetes mellitus (T1DM), with insulin resistance (IR) increasingly recognized as a key contributor. The estimated glucose disposal rate (eGDR), a surrogate marker of insulin sensitivity, has been proposed as a predictor of adverse cardiovascular outcomes in T1DM. This systematic review and meta-analysis aimed to assess the association between eGDR and adverse cardiovascular outcomes.