Abstract
BackgroundTo investigate the effect of visit-to-visit fasting plasma glucose (FPG) variability on the left cardiac structure and function in patients with type 2 diabetes mellitus (T2DM).MethodsIn this prospective cohort study, 455 T2DM patients were included and follow-up for a median of 4.7 years. FPG measured on every hospital visit was collected. FPG variability was calculated by its coefficient of variation (CV-FPG). Left cardiac structure and function were assessed using echocardiography at baseline and after follow-up. Multivariable linear regression analyses were used to estimate the effect of FPG variability on the annualized changes in left cardiac structure and function. Subgroup analysis stratified by mean HbA1c levels (< 7% and ≥ 7%) were also performed.ResultIn multivariable regression analyses, CV-FPG was independently associated with the annualized changes in left ventricle (β = 0.137; P = 0.031), interventricular septum (β = 0.215; P = 0.001), left ventricular posterior wall thickness (β = 0.129; P = 0.048), left ventricular mass index (β = 0.227; P < 0.001), and left ventricular ejection fraction (β = − 0.132; P = 0.030). After additionally stratified by mean HbA1c levels, CV-FPG was still independently associated with the annualized changes in the above parameters in patients with HbA1c ≥ 7%, while not in patients with HbA1c < 7%.ConclusionsVisit-to-visit variability in FPG could be a novel risk factor for the long-term adverse changes in left cardiac structure and systolic function in patients with type 2 diabetes.Trial registration ClinicalTrials.gov (NCT02587741), October 27, 2015, retrospectively registered.
Highlights
To investigate the effect of visit-to-visit fasting plasma glucose (FPG) variability on the left cardiac structure and function in patients with type 2 diabetes mellitus (T2DM)
Accumulate evidences shown that glycemic variability, irrespective of the magnitude of hyperglycemia, was an independent risk factor for cardiovascular diseases (CVD) [5], ischemic stroke [6], cardiovascular mortality [7] and all-cause mortality [8,9,10,11] in T2DM patients
No significant differences were observed in the other baseline profiles among subjects with different coefficient of variation of fasting plasma glucose (CVFPG) quartiles
Summary
To investigate the effect of visit-to-visit fasting plasma glucose (FPG) variability on the left cardiac structure and function in patients with type 2 diabetes mellitus (T2DM). Accumulate evidences shown that glycemic variability, irrespective of the magnitude of hyperglycemia, was an independent risk factor for CVDs [5], ischemic stroke [6], cardiovascular mortality [7] and all-cause mortality [8,9,10,11] in T2DM patients. No study has examined the effects of visit-to-visit glycemic variation, determined by coefficient of variation of fasting plasma glucose (CVFPG), on the left cardiac structure and function. The objective of this study was to examine the association of visit-to-visit FPG variability with long-term changes in left cardiac structure and function among patients with T2DM, irrespective of HbA1c and other conventional risk factors
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