Key result
Long-term glucose variability was independently associated with accelerated progression of coronary atherosclerosis in patients with type 2 diabetes, with each 1-unit increase in CV-HbA1c increasing the risk of significant progression by 36.7% (OR 1.367).
Why the study?
Glycemic variability confers a risk of cardiovascular events, but whether long-term glycemic variability impacts coronary atherosclerosis progression in patients with type 2 diabetes mellitus remained to be investigated.
Does long-term glycemic variability accelerate coronary atherosclerosis progression in patients with type 2 diabetes?
Cohort (n=396)
No
Does long-term glycemic variability accelerate coronary atherosclerosis progression in patients with type 2 diabetes?
Long-term glycemic variability is independently associated with accelerated progression of coronary atherosclerosis in patients with type 2 diabetes.
Answers are grounded in this paper and cite their sources.
Glycemic variability assessment may inform risk stratification in type 2 diabetes; leaves open whether targeting variability slows atherosclerosis progression.
Background Glycemic variability (GV) confers a risk of cardiovascular events. In this study, we aimed to investigate whether long-term GV has an impact on coronary atherosclerosis progression in patients with type 2 diabetes mellitus (T2DM). Methods A total of 396 patients with T2DM who had coronary computed tomography angiography and laboratory data available at baseline and for follow-up evaluations [median 2.3 (1.8–3.1) years] were included. Fasting plasma glucose (FPG) was measured every 1–3 months, and HbA1c was measured quarterly. The coefficient of variation (CV) of HbA1c and FPG were calculated as measures of GV. Quantitative assessment of coronary plaques was performed by measuring the annual change and progression rate of total plaque volume (TPV). Significant progression was defined as annual TPV progression ≥ 15%. Multivariable regression analyses were used to assess the effects of GV on atherosclerosis progression. Results In the 396 patients, the annual change in TPV was 12.35 ± 14.23 mm3, and annual progression rate was 13.36 ± 12.69%. There were 143 (36.11%) patients with significant progression, and they had a significantly higher CV-HbA1c (P < 0.001) and CV-FPG (P < 0.001) than those without significant progression. In multivariable regression analyses, both CV-HbA1c and CV-FPG were independent predictors of annual change in TPV [CV-HbA1c: β = 0.241 (0.019–0.462), P = 0.034; CV-FPG: β = 0.265 (0.060–0.465), P = 0.012], annual TPV progression [CV-HbA1c: β = 0.214 (0.023–0.405), P = 0.029; CV-FPG: β = 0.218 (0.037–0.399), P = 0.019], and significant atherosclerosis progression [CV-HbA1c: odds ratio [OR] = 1.367 (1.149–1.650), P = 0.010; CV-FPG: OR = 1.321 (1.127–1.634), P = 0.013]. Conclusions Long-term GV is associated with accelerated progression of coronary atherosclerosis independent of conventional risk factors in patients with T2DM. Trial registration ClinicalTrials.gov (NCT02587741), October 27, 2015; retrospectively registered
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Li et al. (2020) conducted a cohort in Type 2 diabetes mellitus (n=396). Long-term glucose variability (CV-HbA1c) vs. Lower glucose variability was evaluated on Clinically significant atherosclerosis progression (annual total plaque volume progression ≥ 15%) (OR 1.367, 95% CI 1.149-1.650, p=0.010). Long-term glucose variability was independently associated with accelerated progression of coronary atherosclerosis in patients with type 2 diabetes, with each 1-unit increase in CV-HbA1c increasing the risk of significant progression by 36.7% (OR 1.367).
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