Shi Rui, Xu Wenbo, Feng Lei, Ye Dan, Luo Beibei, Liu Yanmei, Cao Huiying, Tang Lingtong
Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan Province, People's Republic of China.
Clinical Laboratory, Yan'an Hospital of Kunming City, Kunming City, Yunnan Province, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Sep 14;17:3433-3445. doi: 10.2147/DMSO.S469436. eCollection 2024.
This investigation aims to assess the predictive value of the glycemic dispersion index (GDI), calculated by incorporating glycated hemoglobin, fasting plasma glucose, and 2-hour postprandial plasma glucose, in predicting major adverse cardiovascular events (MACE) within a 12-month timeframe for diabetic patients with concomitant acute coronary syndrome (ACS).
A retrospective study was conducted on 3261 diabetic patients with ACS who were hospitalized in the Department of Cardiology, the Sixth Affiliated Hospital of Kunming Medical University, from January 2016 to July 2022. Based on the inclusion and exclusion criteria, 512 patients were ultimately enrolled in the study. Their general information and laboratory test indicators were collected, and the occurrence of MACE within 12 months after admission was followed up and recorded for the enrolled patients, With the last follow-up having been concluded on July 31, 2023. The enrolled patients were stratified into four groups (Q1, Q2, Q3, Q4) based on their GDI values, from the lowest to the highest. Cox proportional hazards regression analysis and Kaplan-Meier survival analysis were employed to investigate the risk factors associated with MACE occurrence across these groups and to assess the cumulative risk of MACE over time within each group.
The percentages of enrolled patients experiencing MACE in groups Q1 to Q4 were 10.16%, 12.50%, 15.63%, and 16.41%, respectively. GDI independently predicted the hazards for MACE in enrolled patients. The cumulative risk of MACE over time was considerably more significant in those with a GDI>4.21 than those with a GDI≤4.21.
The elevated GDI is correlated with an augmented risk of MACE in diabetic patients with concomitant ACS, thereby serving as an early indicator for assessing the unfavorable clinical prognosis of patients. This study offers novel insights into glycemic variability monitoring, enhancing prevention and treatment strategies for cardiovascular disease in people with diabetes.
本研究旨在评估通过合并糖化血红蛋白、空腹血糖和餐后2小时血糖计算得出的血糖离散指数（GDI）对伴有急性冠状动脉综合征（ACS）的糖尿病患者在12个月内发生主要不良心血管事件（MACE）的预测价值。
对2016年1月至2022年7月在昆明医科大学第六附属医院心内科住院的3261例伴有ACS的糖尿病患者进行回顾性研究。根据纳入和排除标准，最终512例患者纳入研究。收集他们的一般信息和实验室检查指标，并对纳入研究的患者入院后12个月内MACE的发生情况进行随访记录，最后一次随访于2023年7月31日结束。根据GDI值将纳入研究的患者从低到高分为四组（Q1、Q2、Q3、Q4）。采用Cox比例风险回归分析和Kaplan-Meier生存分析来研究这些组中与MACE发生相关的危险因素，并评估每组中MACE随时间的累积风险。
Q1至Q4组中发生MACE的纳入患者百分比分别为10.16%、12.50%、15.63%和16.41%。GDI独立预测纳入研究患者发生MACE的风险。GDI>4.21的患者中MACE随时间的累积风险比GDI≤4.21的患者显著更高。
GDI升高与伴有ACS的糖尿病患者发生MACE的风险增加相关，从而可作为评估患者不良临床预后的早期指标。本研究为血糖变异性监测提供了新的见解，加强了糖尿病患者心血管疾病的预防和治疗策略。
