Association of glycemic variability and the presence and severity of coronary artery disease in patients with type 2 diabetes

Gong Su, Shuhua Mi, Hong Tao, Zhao Li, Hongxia Yang, Hong Zheng, Yun Zhou, Changsheng Ma, Gong Su, Shuhua Mi, Hong Tao, Zhao Li, Hongxia Yang, Hong Zheng, Yun Zhou, Changsheng Ma

Abstract

Background: Glucose variability is one of components of the dysglycemia in diabetes and may play an important role in development of diabetic vascular complications. The objective of this study was to assess the relationship between glycemic variability determined by a continuous glucose monitoring (CGM) system and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM).

Methods: In 344 T2DM patients with chest pain, coronary angiography revealed CAD (coronary stenosis ≥ 50% luminal diameter narrowing) in 252 patients and 92 patients without CAD. Gensini score was used to assess the severity of CAD. All participants' CGM parameters and biochemical characteristics were measured at baseline.

Results: Diabetic patients with CAD were older, and more were male and cigarette smokers compared with the controls. Levels of the mean amplitude of glycemic excursions (MAGE) (3.7 ± 1.4 mmol/L vs. 3.2 ± 1.2 mmol/L, p < 0.001), postprandial glucose excursion (PPGE) (3.9 ± 1.6 mmol/L vs. 3.6 ± 1.4 mmol/L, p = 0.036), serum high-sensitive C-reactive protein (hs-CRP) (10.7 ± 12.4 mg/L vs. 5.8 ± 6.7 mg/L, p < 0.001) and creatinine (Cr) (87 ± 23 mmol/L vs. 77 ± 14 mmol/L, p < 0.001) were significantly higher in patients with CAD than in patients without CAD. Gensini score closely correlated with age, MAGE, PPGE, hemoglobin A1c (HbA1c), hs-CRP and total cholesterol (TC). Multivariate analysis indicated that age (p < 0.001), MAGE (p < 0.001), serum levels of HbA1c (p = 0.022) and hs-CRP (p = 0.005) were independent determinants for Gensini score. Logistic regression analysis revealed that MAGE ≥ 3.4 mmol/L was an independent predictor for CAD. The area under the receiver-operating characteristic curve for MAGE (0.618, p = 0.001) was superior to that for HbA1c (0.554, p = 0.129).

Conclusions: The intraday glycemic variability is associated with the presence and severity of CAD in patients with T2DM. Effects of glycemic excursions on vascular complications should not be neglected in diabetes.

Figures

Figure 1
Figure 1
Distribution of Gensini score among participants.
Figure 2
Figure 2
Simple linear correlation of Gensini score and age, MAGE, PPGE and hemoglobin A1c in patients with type 2 diabetes.
Figure 3
Figure 3
Multivariate analysis for independent determinants of coronary artery disease (CAD). Smoking, male, older age, MAGE and hs-CRP were independent risk factors for CAD.
Figure 4
Figure 4
Receiver-operating characteristic (ROC) curve for MAGE and hemoglobin A1c (HbA1c) in predicting coronary artery disease (CAD) in patients with type 2 diabetes (T2DM). Area under the receiver-operating characteristic curve: MAGE 0.618 (95% CI 0.555, 0.680), p = 0.001; HbA1c 0.554 (95% CI 0.487, 0.620), p = 0.129. MAGE, but not HbA1c, displayed significant value in predicting CAD in patients with T2DM.

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