What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 2 diabetes (n=445). Intervention: Continuous glucose monitoring (CGM) derived metrics. Primary outcome: High arterial stiffness (baPWV ≥ 1800 cm/s) associated with SD (1 mmol/L increase) (OR 1.92, 95% CI 1.22-3.03, p=0.005).

January 7, 2021Open Access

Associations between continuous glucose monitoring-derived metrics and arterial stiffness in Japanese patients with type 2 diabetes

Key Result

Continuous glucose monitoring-derived metrics related to intra-day glucose variability, such as standard deviation (OR 1.92), are significantly associated with high arterial stiffness in type 2 diabetes.

Study Design

Type

Cross-Sectional (n=445)

Multicenter

Yes

Structured PICO

Do continuous glucose monitoring-derived metrics predict arterial stiffness in Japanese patients with type 2 diabetes?

Population

445 Japanese outpatients with type 2 diabetes and no history of apparent cardiovascular disease, aged 30-80 years, with stable diabetes control. Mean age 65.9 years, 67.6% male.

Intervention

Continuous glucose monitoring (CGM) with FreeStyle Libre Pro Device for up to 14 days to derive metrics of glucose variability and dysglycemia (SD, CV, MAGE, TIR, TAR, TBR, LBGI, HBGI, MODD, IQR).

Outcome

Arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) at baseline.surrogate

CGM-derived metrics of glucose variability and hyperglycemia, but not HbA1c, are significantly associated with arterial stiffness in patients with type 2 diabetes without apparent cardiovascular disease.

Main Result

Effect estimate: OR 1.92 (95% CI 1.22-3.03)

p-value: p=0.005

Limitations

Exploratory study with a relatively small sample size
Cross-sectional study design makes it impossible to evaluate causal relationships
CGM-derived metrics were evaluated based on measurements during a limited time
Only recruited Japanese patients, limiting generalizability
Potential conventional risk factors for arterial stiffness such as fasting hyperglycemia or insulin resistance were not included in the multivariate regression analysis

Abstract

BACKGROUND: Previous studies have suggested that high mean glucose levels and glycemic abnormalities such as glucose fluctuation and hypoglycemia accelerate the progression of atherosclerosis in patients with type 2 diabetes. Although continuous glucose monitoring (CGM) that could evaluate such glycemic abnormalities has been rapidly adopted, the associations between CGM-derived metrics and arterial stiffness are not entirely clear. METHODS: This exploratory cross-sectional study used baseline data from an ongoing prospective, multicenter, observational study with 5 years of follow-up. Study participants included 445 outpatients with type 2 diabetes and no history of apparent cardiovascular disease who underwent CGM and brachial-ankle pulse wave velocity (baPWV) measurement at baseline. Associations between CGM-derived metrics and baPWV were analyzed using multivariate regression models. RESULTS: In a linear regression model, all CGM-derived metrics were significantly associated with baPWV, but HbA1c was not. Some CGM-derived metrics related to intra-day glucose variability, hyperglycemia, and hypoglycemia remained significantly associated with baPWV after adjusting for possible atherosclerotic risk factors, including HbA1c. Based on baPWV ≥ 1800 cm/s as indicative of high arterial stiffness, multivariate logistic regression found that some CGM-derived metrics related to intra-day glucose variability and hyperglycemia are significantly associated with high arterial stiffness even after adjusting for possible atherosclerotic risk factors, including HbA1c. CONCLUSIONS: Multiple CGM-derived metrics are significantly associated with baPWV and high arterial stiffness in patients with type 2 diabetes who have no history of apparent cardiovascular disease. These metrics might be useful for identifying patients at high risk of developing cardiovascular disease.

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