Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441, Saudi Arabia.
Sci Rep. 2024 Oct 14;14(1):24062. doi: 10.1038/s41598-024-74535-w.
Glycemic variability (GV), independently of glycemic control, has emerged as a prognostic marker in patients with type 2 diabetes mellitus (DM). In this study, we assessed the prognostic value of long-term GV for predicting major adverse cardiovascular events (MACE) in our local population. We also assessed its prognostic value for diabetic microvascular complications (DMC) and its relationships with antidiabetic medications. This was a retrospective cohort study that recruited 680 patients with type 2 DM across 2015-2017. MACE were defined as: the composite of; total death, myocardial infarction (MI), stroke, hospitalization due to heart failure, and revascularization. GV was calculated for two glycemic control markers: glycated hemoglobin (G-Hb) and fasting blood sugar (FBS); via three metrics- standard deviation (SD), coefficient of variation (CV), and variability independent from the mean (VIM). Cox proportional hazard models and Kruskal-Wallis tests were used in the statistical analysis. 105 events classified as MACE were identified in 86 patients and 104 DMC in 98 patients in an average follow-up period of 78.43 months. Long-term GV was found to be an independent predictor of MACE, particularly for FBS-CV but not a predictor of DMC. FBS-CV ≥ 17.51% as compared with < 17.51% was a significant and independent predictor of MACE, with HR 1.589 (95% CI; 1.022, 2.472) (P = 0.040). DMC were predicted mainly by the duration of type 2 DM, and by the glycemic control; similarly represented by G-Hb and FBS. Patients on metformin, and dipeptidyl peptidase (DPP) 4 inhibitors, had the lowest GV, as compared with patients whose treatments included insulin/sulphonylureas (P < 0.001). In our population, long-term GV predicted MACE: with FBS-CV superior to the "gold standard" glycemic control marker G-Hb. Further, GV may be explained, partially at least, by the choice of antidiabetic medications: this finding might contribute to the cardiovascular protection attributed to one class rather than another.
血糖变异性（GV），独立于血糖控制，已成为 2 型糖尿病（DM）患者的预后标志物。在本研究中，我们评估了长期 GV 预测主要不良心血管事件（MACE）的预后价值，该研究在我们的本地人群中进行。我们还评估了其对糖尿病微血管并发症（DMC）的预后价值及其与抗糖尿病药物的关系。这是一项回顾性队列研究，纳入了 2015 年至 2017 年期间的 680 名 2 型 DM 患者。MACE 定义为：总死亡、心肌梗死（MI）、中风、心力衰竭住院和血运重建的复合事件。通过三种指标——标准差（SD）、变异系数（CV）和均值独立变异（VIM），计算了两种糖化血红蛋白（G-Hb）和空腹血糖（FBS）的血糖控制标志物的 GV。Cox 比例风险模型和 Kruskal-Wallis 检验用于统计分析。在平均 78.43 个月的随访期间，86 例患者中有 105 例发生 MACE，98 例患者中有 104 例发生 DMC。长期 GV 是 MACE 的独立预测因子，尤其是 FBS-CV，但不是 DMC 的预测因子。与 FBS-CV<17.51%相比，FBS-CV≥17.51%是 MACE 的显著和独立预测因子，HR 为 1.589（95%CI；1.022，2.472）（P=0.040）。DMC 主要由 2 型 DM 的持续时间和血糖控制预测；同样由 G-Hb 和 FBS 代表。与接受胰岛素/磺脲类药物治疗的患者相比，接受二甲双胍和二肽基肽酶（DPP）4 抑制剂治疗的患者的 GV 最低（P<0.001）。在我们的人群中，长期 GV 预测 MACE：FBS-CV 优于血糖控制的“金标准”标志物 G-Hb。此外，GV 至少部分可以通过抗糖尿病药物的选择来解释：这一发现可能有助于归因于一类药物而非另一类药物的心血管保护。
