Abstract
BackgroundLittle is known about whether the influence of glycemic variability on arrhythmia is related to age in type 2 diabetes mellitus (T2DM). Therefore, we aimed to compare the association between glycemic variability and arrhythmia in middle-aged and elderly T2DM patients.MethodsA total of 107 patients were divided into two groups: elderly diabetes mellitus group (EDM, n = 73) and middle-aged diabetes mellitus group (MDM, n = 34). The main clinical data, continuous glucose monitoring (CGM) and dynamic ECG reports were collected. The parameters including standard deviation of blood glucose (SDBG), largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE), absolute means of daily differences (MODD), time in range (TIR), time below range (TBR), time above range (TAR), coefficient of variation (CV) were tested for glycemic variability evaluation.ResultsIn terms of blood glucose fluctuations, MAGE (5.77 ± 2.16 mmol/L vs 4.63 ± 1.89 mmol/L, P = 0.026), SDBG (2.39 ± 1.00 mmol/L vs 2.00 ± 0.82 mmol/L, P = 0.048), LAGE (9.53 ± 3.37 mmol/L vs 7.84 ± 2.64 mmol/L, P = 0.011) was significantly higher in EDM group than those of MDM group. The incidences of atrial premature beat, couplets of atrial premature beat, atrial tachycardia and ventricular premature beat were significantly higher in EDM group compared with the MDM group (all P < 0.05). Among patients with hypoglycemia events, the incidences of atrial premature beat, couplets of atrial premature beat, atrial tachycardia and ventricular premature beat (all P < 0.05) were significantly higher in the EDM group than those in the MDM group. In EDM group, TIR was negatively correlated with atrial tachycardia in the MAGE1 layer and with atrial tachycardia and ventricular premature beat in the MAGE2 layer, TBR was significantly positively correlated with atrial tachycardia in the MAGE2 layer (all P < 0.05). In MDM group, TAR was positively correlated with ventricular premature beat and atrial tachycardia in the MAGE2 layer (all P < 0.05).ConclusionsThe study demonstrated the elderly patients had greater glycemic variability and were more prone to arrhythmias. Therefore, active control of blood glucose fluctuation in elderly patients will help to reduce the risk of severe arrhythmia.
Highlights
Little is known about whether the influence of glycemic variability on arrhythmia is related to age in type 2 diabetes mellitus (T2DM)
There was no significant difference in fasting blood glucose, hemoglobin A1c, uric acid, creatinine and blood lipid levels between the two groups (Table 1)
Our current study found that the levels of standard deviation of blood glucose (SDBG), largest amplitude of glycemic excursions (LAGE) and mean amplitude of glycemic excursions (MAGE) in Elderly diabetes mellitus group (EDM) group were statistically higher than those in Middleaged diabetes mellitus (MDM) group, indicating the greater blood glucose fluctuations in EDM patients
Summary
Little is known about whether the influence of glycemic variability on arrhythmia is related to age in type 2 diabetes mellitus (T2DM). We aimed to compare the association between glycemic variability and arrhythmia in middle-aged and elderly T2DM patients. A series of studies showed that glycemic variability had more deleterious effects than sustained hyperglycemia in the pathogenesis of diabetic cardiovascular complications [1]. In patients of acute myocardial infarction with poor blood glucose control, notonlychronic hyperglycemia and glycemic variability is associated with severity of coronary artery disease [2]. Another study demonstrated that glycemic variability predicted rapid progression of nonculprit lesions in patients with acute coronary syndrome [3]. The ALLHAT study showed that greater visit-tovisit variability of fasting blood glucose was associated with increased risk of cardiovascular events and all-cause mortality [5]. The mechanism by which glycemic variability aggravates the progression of cardiovascular disease is not fully understood, several researches demonstrated that non-enzymatic glycation, oxidative stress, activation of inflammation and endothelial dysfunction might play a critical role [6, 7]
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