Relationship between acute phase blood glucose fluctuation and coronary artery stenosis in patients with type 2 diabetes mellitus and acute coronary syndrome

Abstract

Objective To investigate the change of glucose variability and the relationship between glucose variability and the severity of coronary artery stenosis in patients with type 2 diabetes mellitus(T2DM) with acute coronary syndrome(ACS). Methods A total of 64 hospitalized patients with T2DM and ACS were recruited from November 2010 to October 2011. Thirty cases(19 males and 11 females, aged (60±11) yrs) underwent emergency coronary angiography (group A), and 34 cases(15 males and 19 females, aged (59±10) yrs) in stable condition underwent selective coronary angiography after one week(group B). Twenty T2DM cases without ACS in the same period were set as control group(12 males and 8 females, aged (54±13)yrs). All the participants underwent continuous glucose monitoring(CGM) for 72 hours to evaluate CGMS parameters such as largest amplitude of blood glucose excursion(LAGE), mean amplitude of glycemic excursions(MAGE), standard deviation of blood glucose(SDBG), absolute means of daily differences(MODD), postprandial glucose excursion(MPPGE), the mean postprandial maximum glucose(MPMG). The correlation was analyzed between the parameters and clinical biochemical and the severity of coronary artery stenosis (Gensini score)in T2DM patients with ACS. The measurement data of multiple groups were compared with single factor analysis of variance, and the comparison between two groups was performed with LSD test, correlation analysis with Pearson correlation and multiple stepwise regression analysis. Results Compared with control group((5.6±1.5), (2.5±1.0) mmol/L), the levels of MAGE and MPPGE in group A((7.2±2.2), (3.3±1.1) mmol/L) and group B ((6.2±4.4), (3.2±1.4) mmol/L) were higher (F=8.543, 3.465, all P<0.05). LAGE, MAGE, MODD, MPPGE, homeostatic model assessment-insulin resistance(HOMA-IR), C-reactive protein (CRP)were positively related to Gensini score(r=0.463, 0.439, 0.633, 0.595, 0.282, 0.224, all P<0.05), while left ventricular ejection fraction(LVEF)were negatively related to Gensini score(r=-0.579, P<0.01). Multiple stepwise regression analysis indicated that MODD, LVEF and MPPGE were dependent risk to Gensini score(Y=388.629+ 33.794MODD-93.824 LVEF+ 8.531MPPGE). Conclusions Glucose variability of the patients with type 2 diabetes increases obviously in the acute phase of ACS. MODD and MPPGE were dependent positively correlated to the severity of coronary artery stenosis in patients with T2DM and ACS. Key words: Diabetes mellitus, type 2; Coronary disease; Continuous glucose monitoring