Abstract
BackgroundGlucose variability is one of components of the dysglycemia in diabetes and may play an important role in development of diabetic vascular complications. The objective of this study was to assess the relationship between glycemic variability determined by a continuous glucose monitoring (CGM) system and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM).MethodsIn 344 T2DM patients with chest pain, coronary angiography revealed CAD (coronary stenosis ≥ 50% luminal diameter narrowing) in 252 patients and 92 patients without CAD. Gensini score was used to assess the severity of CAD. All participants' CGM parameters and biochemical characteristics were measured at baseline.ResultsDiabetic patients with CAD were older, and more were male and cigarette smokers compared with the controls. Levels of the mean amplitude of glycemic excursions (MAGE) (3.7 ± 1.4 mmol/L vs. 3.2 ± 1.2 mmol/L, p < 0.001), postprandial glucose excursion (PPGE) (3.9 ± 1.6 mmol/L vs. 3.6 ± 1.4 mmol/L, p = 0.036), serum high-sensitive C-reactive protein (hs-CRP) (10.7 ± 12.4 mg/L vs. 5.8 ± 6.7 mg/L, p < 0.001) and creatinine (Cr) (87 ± 23 mmol/L vs. 77 ± 14 mmol/L, p < 0.001) were significantly higher in patients with CAD than in patients without CAD. Gensini score closely correlated with age, MAGE, PPGE, hemoglobin A1c (HbA1c), hs-CRP and total cholesterol (TC). Multivariate analysis indicated that age (p < 0.001), MAGE (p < 0.001), serum levels of HbA1c (p = 0.022) and hs-CRP (p = 0.005) were independent determinants for Gensini score. Logistic regression analysis revealed that MAGE ≥ 3.4 mmol/L was an independent predictor for CAD. The area under the receiver-operating characteristic curve for MAGE (0.618, p = 0.001) was superior to that for HbA1c (0.554, p = 0.129).ConclusionsThe intraday glycemic variability is associated with the presence and severity of CAD in patients with T2DM. Effects of glycemic excursions on vascular complications should not be neglected in diabetes.
Highlights
Glucose variability is one of components of the dysglycemia in diabetes and may play an important role in development of diabetic vascular complications
We examined the parameters of glucose profile using continuous glucose monitoring system (CGMS) in type 2 diabetes mellitus (T2DM) patients with CAD, and established a correlation between glycemic variability and the severity of coronary artery disease assessed by coronary angiogram, using the Gensini score
The receiver-operating characteristic (ROC) plot demonstrated that the mean amplitude of glycemic excursions (MAGE) level was a significant predictor for the presence of CAD (p = 0.001), whereas hemoglobin A1c (HbA1c) was not (p = 0.129). These results indicate that intraday glucose excursion might contribute to generation of atherosclerosis even than sustained chronic hyperglycemia
Summary
Glucose variability is one of components of the dysglycemia in diabetes and may play an important role in development of diabetic vascular complications. The objective of this study was to assess the relationship between glycemic variability determined by a continuous glucose monitoring (CGM) system and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). Diabetic patients usually present various factors contributing to the risk of cardiovascular diseases, which include hyperglycemia, fluctuation of blood glucose, central obesity, hyperlipidemia and hypertension and so on [2]. Interventional studies have established that cardiovascular complications are mainly or partly dependent on sustained chronic hyperglycemia [3,4] This glycemic disorder can be estimated as a whole from the determination of hemoglobin A1c (HbA1c) level, which integrates both basal and postprandial hyperglycemia [5,6]. There have been no sufficient studies presented so far that evaluated the relationship between glycemic variability and coronary artery disease in diabetic patients
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