Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Cardiovasc Diabetol. 2021 May 4;20(1):95. doi: 10.1186/s12933-021-01288-5.
The association between glucose variability and the progression of atherosclerosis is not completely understood. We aimed to evaluate the associations of glucose variability with the progression of atherosclerosis in the early stages.
We conducted a cross-sectional analysis to investigate the associations of glucose variability, assessed by continuous glucose monitoring, with intima-media thickness (IMT) and gray-scale median (GSM) of the carotid arteries, which are different indicators for the progression of atherosclerosis. We used baseline data from a hospital-based multicenter prospective observational cohort study among Japanese patients with type 2 diabetes without a history of cardiovascular diseases aged between 30 and 80 years. Continuous glucose monitoring was performed by Freestyle Libre Pro, and glucose levels obtained every 15 min for a maximum of eight days were used to calculate the metrics of glucose variability. IMT and GSM were evaluated by ultrasonography, and the former indicates thickening of intima-media complex in the carotid artery wall, while the latter indicates tissue characteristics.
Among 600 study participants (age: 64.9 ± 9.2 (mean ± SD) years; 63.2%: men; HbA1c: 7.0 ± 0.8%), participants with a larger intra- and inter-day glucose variability had a lower GSM and most of these associations were statistically significant. No trend based on glucose variability was shown regarding IMT. Standard deviation of glucose (regression coefficient, β = - 5.822; 95% CI - 8.875 to - 2.768, P < 0.001), glucose coefficient of variation (β = - 0.418; - 0.685 to - 0.151, P = 0.002), mean amplitude of glycemic excursion (β = - 1.689; - 2.567 to - 0.811, P < 0.001), mean of daily differences (β = - 6.500; - 9.758 to - 3.241, P < 0.001), and interquartile range (β = - 4.289; - 6.964 to - 1.614, P = 0.002) had a statistically significant association with mean-GSM after adjustment for conventional cardiovascular risk factors, including HbA1c. No metrics of glucose variability had a statistically significant association with IMT.
Continuous glucose monitoring-assessed glucose variability was associated with the tissue characteristics of the carotid artery wall in type 2 diabetes patients without cardiovascular diseases.
葡萄糖变异性与动脉粥样硬化进展之间的关系尚不完全清楚。我们旨在评估葡萄糖变异性与动脉粥样硬化早期进展之间的关系。
我们进行了一项横断面分析，以研究通过连续血糖监测评估的葡萄糖变异性与颈动脉内膜-中层厚度（IMT）和灰阶中位数（GSM）之间的关系，这是动脉粥样硬化进展的不同指标。我们使用了一项基于日本 30 至 80 岁、无心血管疾病史的 2 型糖尿病患者的多中心前瞻性观察队列研究的基线数据。连续血糖监测由 Freestyle Libre Pro 进行，使用 8 天内最长 15 分钟一次的血糖水平来计算葡萄糖变异性的指标。通过超声检查评估 IMT 和 GSM，前者表示颈动脉壁内膜-中层复合体的增厚，后者表示组织特征。
在 600 名研究参与者（年龄：64.9±9.2（均值±标准差）岁；63.2%：男性；HbA1c：7.0±0.8%）中，日内和日间葡萄糖变异性较大的参与者 GSM 较低，这些关联大多具有统计学意义。IMT 没有显示出基于葡萄糖变异性的趋势。葡萄糖标准差（回归系数，β=-5.822；95%置信区间-8.875 至-2.768，P<0.001）、葡萄糖变异系数（β=-0.418；-0.685 至-0.151，P=0.002）、血糖平均波动幅度（β=-1.689；-2.567 至-0.811，P<0.001）、日间血糖平均差（β=-6.500；-9.758 至-3.241，P<0.001）和四分位间距（β=-4.289；-6.964 至-1.614，P=0.002）在调整包括 HbA1c 在内的常规心血管危险因素后，与平均-GSM 具有统计学显著关联。葡萄糖变异性的各项指标与 IMT 均无统计学显著关联。
在无心血管疾病的 2 型糖尿病患者中，连续血糖监测评估的葡萄糖变异性与颈动脉壁的组织特征有关。
