Key result
There was no significant difference in the index of microcirculatory resistance between high and low glycemic variability groups (median 16.0 vs 13.0, p=0.39), though higher variability correlated with reduced coronary flow reserve.
Why the study?
Glycemic variability may contribute to diabetic vascular complications like coronary microvascular dysfunction, but its relationship with coronary microvascular function assessed by intracoronary thermodilution was unclear.
Cross-Sectional (n=38)
No
Higher glycemic variability on continuous glucose monitoring is associated with reduced coronary flow reserve in stable patients with coronary artery disease, suggesting an early effect on coronary microvascular function.
Glycemic variability may associate with reduced coronary flow reserve; leaves open whether CGMS-guided interventions improve microvascular outcomes in CAD.
Objective Glycemic variability is being increasingly recognized as an early indicator of glucose metabolic disorder and may contribute to the development of diabetic vascular complications, such as coronary microvascular dysfunction. The present study sought to investigate the relationship between coronary microvascular function assessed by intracoronary thermodilution method and glycemic variability on a continuous glucose monitoring system (CGMS). Methods We prospectively enrolled 40 patients with or without known diabetes mellitus who had epicardial coronary artery disease referred for coronary angiography and were not treated with diabetic medications. Of these, two had a significant stenosis in the left main coronary artery and were therefore excluded from the analyses. In the end, 38 patients were equipped with a CGMS and underwent intracoronary physiological assessments in the unobstructed left anterior descending artery. The mean amplitude of glycemic excursion (MAGE) and standard deviation were calculated from the obtained CGMS data as indicators of glucose variability. Results Coronary flow reserve (CFR) was negatively correlated with MAGE (r=-0.328, p=0.044) and standard deviation (r=-0.339, p=0.037) on CGMS, while the index of microcirculatory resistance showed no such correlation. Multivariable linear regression analyses showed that MAGE on CGMS was significantly associated with CFR after adjusting for age, sex, fractional flow reserve and hemoglobin A1c. Conclusion Higher MAGE on CGMS was associated with reduced CFR in stable patients with coronary artery disease, suggesting a potential effect of glycemic variability on coronary microvascular flow regulation. A further study with a larger sample size needs to be conducted to confirm our findings.
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Nishi et al. (2020) conducted a cross-sectional in Coronary Artery Disease (n=38). High glycemic variability (MAGE ≥84.7 mg/dL) vs. Low glycemic variability (MAGE <84.7 mg/dL) was evaluated on Difference in the index of microcirculatory resistance (IMR) between high and low glycemic variability groups (p=0.39). There was no significant difference in the index of microcirculatory resistance between high and low glycemic variability groups (median 16.0 vs 13.0, p=0.39), though higher variability correlated with reduced coronary flow reserve.
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