Department of Cardiovascular Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
Cardiovasc Diabetol. 2020 Sep 25;19(1):146. doi: 10.1186/s12933-020-01126-0.
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).
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.
In the 396 patients, the annual change in TPV was 12.35 ± 14.23 mm, 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].
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.
血糖变异性（GV）与心血管事件风险相关。本研究旨在探讨 2 型糖尿病（T2DM）患者长期 GV 是否对冠状动脉粥样硬化进展有影响。
共纳入 396 例 T2DM 患者，这些患者基线和随访评估时均有冠状动脉计算机断层扫描血管造影和实验室数据（中位时间 2.3（1.8-3.1）年）。空腹血糖（FPG）每 1-3 个月测量一次，HbA1c 每季度测量一次。HbA1c 和 FPG 的变异系数（CV）被计算为 GV 的指标。通过测量总斑块体积（TPV）的年度变化和进展率来定量评估冠状动脉斑块。显著进展定义为 TPV 年进展量≥15%。多变量回归分析用于评估 GV 对动脉粥样硬化进展的影响。
在 396 例患者中，TPV 的年度变化为 12.35±14.23mm，年度进展率为 13.36±12.69%。有 143 例（36.11%）患者有显著进展，他们的 CV-HbA1c（P<0.001）和 CV-FPG（P<0.001）显著高于无显著进展的患者。多变量回归分析显示，CV-HbA1c 和 CV-FPG 均是 TPV 年度变化的独立预测因子[CV-HbA1c：β=0.241（0.019-0.462），P=0.034；CV-FPG：β=0.265（0.060-0.465），P=0.012]，TPV 年度进展[CV-HbA1c：β=0.214（0.023-0.405），P=0.029；CV-FPG：β=0.218（0.037-0.399），P=0.019]，以及显著动脉粥样硬化进展[CV-HbA1c：比值比[OR] =1.367（1.149-1.650），P=0.010；CV-FPG：OR=1.321（1.127-1.634），P=0.013]。
在 2 型糖尿病患者中，长期 GV 与传统危险因素无关，与冠状动脉粥样硬化的加速进展有关。
ClinicalTrials.gov（NCT02587741），2015 年 10 月 27 日；回顾性注册。
