Abstract
BackgroundGlycemic variability (GV) creates challenges to glycemic control and may be an independent marker for unfavorable outcome in management of patients with diabetes. This study was designed to investigate the effect of excessive visit-to-visit GV on the progression of endothelial and renal dysfunction in patients with type 2 diabetes mellitus (T2DM).MethodsTwo hundred and thirty nine patients with T2DM, who were recruited from outpatient, completed 48-month follow-up visit. Visit-to-visit GV was calculated by the standard deviation (SD) and coefficient of variation (CV) of serially measured HbA1c and fasting plasma glucose (FPG). Endothelial and renal function was assessed at baseline and end of follow-up.ResultsAt end of follow-up, brachial flow-mediated dilation (FMD), nitric oxide (NO), creatinine-based estimated glomeruar filtration rate (eGFR-Cr), and cystatin C-based estimated glomeruar filtration rate (eGFR-Cys C) increased, and endothelin-1 and urine albumin/creatinine ratio (ACR) declined as compared with baseline in overall (P < 0.05). The increment of FMD, NO, eGFR-Cr, and eGFR-Cys C and the decrement of endothelin-1 and ACR in first tertile group were significantly greater than those in third tertile group classified by tertile of either SD of HbA1c or SD of FPG. Change percentage of FMD, NO, eGFR-Cr, and eGFR-Cys C were positively, and change percentage of endothelin-1 and ACR were negatively correlated with SDs of HbA1c and FPG, and CVs of HbA1c FPG (P < 0.01, respectively). After adjusted for mean HbA1c, mean FPG, baseline demographic, and clinical characteristics, SD of HbA1c and SD of FPG were always statistically correlated with change percentage of FMD, NO, endothelin-1, ACR, eGFR-Cr, and eGFR-Cys C.ConclusionExcessive visit-to-visit GV independently deteriorates the progression of endothelial and renal dysfunction in patients with T2DM.
Highlights
Glycemic variability (GV) creates challenges to glycemic control and may be an independent marker for unfavorable outcome in management of patients with diabetes
Endothelial function [assessed by brachial flow-mediated dilation (FMD), nitric oxide (NO) and endothelin-1 (ET-1)] and renal function [assessed by urinary albumin/creatinine ratio (ACR), estimated Glomerular filtration rate (GFR) based on creatinine and estimated GFR based on cystatin C] were evaluated at baseline and end of follow-up visit
Change percentage of ACR, Estimated glomerular filtration rate (eGFR)-Cr, and eGFR-Cys C correlate with change percentage of brachial FMD, NO, and ET-1 in total patients We evaluated the correlations of change percentage of ACR, estimated GFR based on creatinine (eGFR-Cr), and eGFR-Cys C with change percentage of brachial FMD, NO, and ET-1 in total patients
Summary
Glycemic variability (GV) creates challenges to glycemic control and may be an independent marker for unfavorable outcome in management of patients with diabetes. This study was designed to investigate the effect of excessive visit-to-visit GV on the progression of endothelial and renal dysfunction in patients with type 2 diabetes mellitus (T2DM). It is well accepted that type 2 diabetes mellitus (T2DM) is a progressive multisystemic disease accompanied by endothelial [1, 2] and renal dysfunction [3]. Endothelial dysfunction is regarded as a crucial factor in the pathogenesis of vascular disease in diabetes mellitus [4,5,6]. It is broadly defined as an imbalance between endothelium-dependent vasodilatation and vasoconstriction as well as antithrombotic and prothrombotic factors [7]. A remarkable meta-analysis, included 45 cohorts and a total of 1,555,332 participants, confirmed that each GFR and UAE is independent predictor of renal outcomes [11]
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