CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Diabetologia. 2021 Aug;64(8):1880-1892. doi: 10.1007/s00125-021-05474-8. Epub 2021 May 15.
CVD is the main cause of morbidity and mortality in individuals with diabetes. It is currently unclear whether daily glucose variability contributes to CVD. Therefore, we investigated whether glucose variability is associated with arterial measures that are considered important in CVD pathogenesis.
We included participants of The Maastricht Study, an observational population-based cohort, who underwent at least 48 h of continuous glucose monitoring (CGM) (n = 853; age: 59.9 ± 8.6 years; 49% women, 23% type 2 diabetes). We studied the cross-sectional associations of two glucose variability indices (CGM-assessed SD [SD] and CGM-assessed CV [CV]) and time in range (TIR) with carotid-femoral pulse wave velocity (cf-PWV), carotid distensibility coefficient, carotid intima-media thickness, ankle-brachial index and circumferential wall stress via multiple linear regression.
Higher SD was associated with higher cf-PWV after adjusting for demographics, cardiovascular risk factors and lifestyle factors (regression coefficient [B] per 1 mmol/l SD [and corresponding 95% CI]: 0.413 m/s [0.147, 0.679], p = 0.002). In the model additionally adjusted for CGM-assessed mean sensor glucose (MSG), SD and MSG contributed similarly to cf-PWV (respective standardised regression coefficients [st.βs] and 95% CIs of 0.065 [-0.018, 0.167], p = 0.160; and 0.059 [-0.043, 0.164], p = 0.272). In the fully adjusted models, both higher CV (B [95% CI] per 10% CV: 0.303 m/s [0.046, 0.559], p = 0.021) and lower TIR (B [95% CI] per 10% TIR: -0.145 m/s [-0.252, -0.038] p = 0.008) were statistically significantly associated with higher cf-PWV. Such consistent associations were not observed for the other arterial measures.
Our findings show that greater daily glucose variability and lower TIR are associated with greater aortic stiffness (cf-PWV) but not with other arterial measures. If corroborated in prospective studies, these results support the development of therapeutic agents that target both daily glucose variability and TIR to prevent CVD.
心血管疾病（CVD）是糖尿病患者发病和死亡的主要原因。目前尚不清楚血糖波动是否与 CVD 有关。因此，我们研究了血糖波动是否与动脉病变的重要指标有关。
我们纳入了 Maastricht 研究的参与者，这是一项观察性的基于人群的队列研究，他们至少进行了 48 小时的连续血糖监测（CGM）（n=853；年龄：59.9±8.6 岁；49%为女性，23%患有 2 型糖尿病）。我们通过多元线性回归研究了两种血糖波动指标（CGM 评估的标准差[SD]和变异系数[CV]）和血糖达标时间（TIR）与颈股脉搏波速度（cf-PWV）、颈动脉扩张系数、颈动脉内中膜厚度、踝臂指数和周向壁应力之间的横断面相关性。
调整人口统计学、心血管危险因素和生活方式因素后，SD 越高与 cf-PWV 越高相关（每增加 1mmol/l SD 的回归系数[B]及其相应的 95%置信区间：0.413m/s[0.147，0.679]，p=0.002）。在模型中进一步调整了 CGM 评估的平均传感器葡萄糖（MSG）后，SD 和 MSG 对 cf-PWV 的贡献相似（各自标准化回归系数[st.β]和 95%CI 为 0.065[-0.018，0.167]，p=0.160；和 0.059[-0.043，0.164]，p=0.272）。在完全调整的模型中，较高的 CV（每增加 10%CV 的 B[95%CI]：0.303m/s[0.046，0.559]，p=0.021）和较低的 TIR（每增加 10%TIR 的 B[95%CI]：-0.145m/s[-0.252，-0.038]，p=0.008）与 cf-PWV 升高均有统计学意义。对于其他动脉指标，没有观察到这种一致的相关性。
我们的研究结果表明，更大的日常血糖波动和较低的 TIR 与更大的主动脉僵硬度（cf-PWV）相关，而与其他动脉指标无关。如果在前瞻性研究中得到证实，这些结果支持开发靶向血糖波动和 TIR 的治疗药物，以预防 CVD。
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