Liang Shuang, Yin Hang, Wei Chunxiang, Xie Linjun, He Hua, Liu Xiaoquan
Department of Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China.
J Diabetes Metab Disord. 2017 Nov 14;16:45. doi: 10.1186/s40200-017-0323-5. eCollection 2017.
It is consensus that glucose variability (GV) plays an important role in maccomplications of type 2 diabetes, but whether GV has a causal role is not yet clear for cardiovascular disease (CVD). This study sought to explore the effect on GV for CVD risk factors with type 2 diabetes.
The systematic literature search was performed to identify all GV and CVD risk factors, including total cholesterol (TC), LDL cholesterol (LDL-C), triglyceride (TG), HDL cholesterol (HDL-C), Body Mass Index (BMI), waist circumference (WC), High-Sensitivity C-reactive protein (Hs-CRP), Homeostasis model assessment (HOMA) and carotid intima-media thickness (IMT). Preferred Reporting Items was synthesized for Systematic reviews and Meta Analyses guideline. And the pooled analyses were undertaken using Review Manager 5.3.
Twenty two studies were included with a total of 1143 patients in high glucose variability group (HGVG) and 1275 patients low glucose variability group (LGVG). Among these selected CVD risk factors, HOMA-IR and reduced IMT were affected by GV. HOMA-IR level was significantly lower in LGVG than in HGVG (MD = 0.58, 95% CI: 0.26 to 0.91, = 0.0004), with evidence of heterogeneity between studies (I = 0%; = 0.47).Reduced IMT level was significantly lower in LGVG than in HGVG (SMD = 0.28, 95% CI: 0.09 to 0.47, = 0.003), with evidence of heterogeneity between studies (I = 0%; = 0.48). However, the others were no significant statistical difference.
Among these selected CVD risk factors in type 2 diabetes, minimizing GV could improve insulin resistance and reduced IMT, consistent with a lowering in risk of CVD.
目前已达成共识，血糖变异性（GV）在2型糖尿病的微血管并发症中起重要作用，但对于心血管疾病（CVD），GV是否具有因果关系尚不清楚。本研究旨在探讨2型糖尿病患者的GV对CVD危险因素的影响。
进行系统文献检索以确定所有GV和CVD危险因素，包括总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）、腰围（WC）、高敏C反应蛋白（Hs-CRP）、稳态模型评估（HOMA）和颈动脉内膜中层厚度（IMT）。按照系统评价和Meta分析的首选报告项目指南进行合成。并使用Review Manager 5.3进行汇总分析。
共纳入22项研究，高血糖变异性组（HGVG）共有1143例患者，低血糖变异性组（LGVG）有1275例患者。在这些选定的CVD危险因素中，HOMA-IR和IMT降低受GV影响。LGVG中的HOMA-IR水平显著低于HGVG（MD = 0.58，95%CI：0.26至0.91，P = 0.0004），研究间存在异质性证据（I² = 0%；P = 0.47）。LGVG中的IMT降低水平显著低于HGVG（SMD = 0.28，95%CI：0.09至0.47，P = 0.003），研究间存在异质性证据（I² = 0%；P = 0.48）。然而，其他因素无显著统计学差异。
在2型糖尿病这些选定的CVD危险因素中，最小化GV可改善胰岛素抵抗并降低IMT，这与降低CVD风险一致。
