Abstract
BackgroundThe association between glucose variability and the progression of atherosclerosis is not completely understood. We aimed to evaluate the associations of glucose variability with the progression of atherosclerosis in the early stages.MethodsWe conducted a cross-sectional analysis to investigate the associations of glucose variability, assessed by continuous glucose monitoring, with intima-media thickness (IMT) and gray-scale median (GSM) of the carotid arteries, which are different indicators for the progression of atherosclerosis. We used baseline data from a hospital-based multicenter prospective observational cohort study among Japanese patients with type 2 diabetes without a history of cardiovascular diseases aged between 30 and 80 years. Continuous glucose monitoring was performed by Freestyle Libre Pro, and glucose levels obtained every 15 min for a maximum of eight days were used to calculate the metrics of glucose variability. IMT and GSM were evaluated by ultrasonography, and the former indicates thickening of intima-media complex in the carotid artery wall, while the latter indicates tissue characteristics.ResultsAmong 600 study participants (age: 64.9 ± 9.2 (mean ± SD) years; 63.2%: men; HbA1c: 7.0 ± 0.8%), participants with a larger intra- and inter-day glucose variability had a lower GSM and most of these associations were statistically significant. No trend based on glucose variability was shown regarding IMT. Standard deviation of glucose (regression coefficient, β = − 5.822; 95% CI − 8.875 to − 2.768, P < 0.001), glucose coefficient of variation (β = − 0.418; − 0.685 to − 0.151, P = 0.002), mean amplitude of glycemic excursion (β = − 1.689; − 2.567 to − 0.811, P < 0.001), mean of daily differences (β = − 6.500; − 9.758 to − 3.241, P < 0.001), and interquartile range (β = − 4.289; − 6.964 to − 1.614, P = 0.002) had a statistically significant association with mean-GSM after adjustment for conventional cardiovascular risk factors, including HbA1c. No metrics of glucose variability had a statistically significant association with IMT.ConclusionsContinuous glucose monitoring-assessed glucose variability was associated with the tissue characteristics of the carotid artery wall in type 2 diabetes patients without cardiovascular diseases.
Highlights
Clinical studies have evaluated the associations between glucose variability, as assessed by continuous glucose monitoring (CGM), and cardiovascular disease (CVD) or atherosclerosis
Continuous glucose monitoring-assessed glucose variability was associated with the tissue characteristics of the carotid artery wall in type 2 diabetes patients without cardiovascular diseases
We have reported that the addition of intima-media thickness (IMT) and/or ultrasonic tissue characteristics of carotid lesions to traditional risk factors improves the predictive ability of future CVD [23,24,25,26]
Summary
Clinical studies have evaluated the associations between glucose variability, as assessed by continuous glucose monitoring (CGM), and cardiovascular disease (CVD) or atherosclerosis. Cross-sectional studies have reported that glucose variability is associated with the presence and severity of coronary artery disease (CAD) in subjects at high risk of CAD [2] and coronary plaque vulnerability in patients with CAD [3,4,5]. Gray-scale median (GSM) is a semi-quantitative measure of ultrasonic tissue characteristics in the carotid plaque or artery wall, and low GSM values are related to “vulnerable lesion,” such as atheroma and intra-plaque hemorrhage [18,19,20] Both GSM and IMT are indicators of the progress of atherosclerosis, it has been reported that GSM of the intima-media complex and IMT have only a modest correlation with each other [21]. We aimed to evaluate the associations of glucose variability with the progression of atherosclerosis in the early stages
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
