Impact of long-term glucose variability on coronary atherosclerosis progression in patients with type 2 diabetes: a 2.3 year follow-up study

Suhua Li, Xixiang Tang, Yanting Luo, Bingyuan Wu, Zhuoshan Huang, Zexiong Li, Long Peng, Yesheng Ling, Jieming Zhu, Junlin Zhong, Jinlai Liu, Yanming Chen, Suhua Li, Xixiang Tang, Yanting Luo, Bingyuan Wu, Zhuoshan Huang, Zexiong Li, Long Peng, Yesheng Ling, Jieming Zhu, Junlin Zhong, Jinlai Liu, Yanming Chen

Abstract

Background: Glycemic variability (GV) confers a risk of cardiovascular events. In this study, we aimed to investigate whether long-term GV has an impact on coronary atherosclerosis progression in patients with type 2 diabetes mellitus (T2DM).

Methods: A total of 396 patients with T2DM who had coronary computed tomography angiography and laboratory data available at baseline and for follow-up evaluations [median 2.3 (1.8-3.1) years] were included. Fasting plasma glucose (FPG) was measured every 1-3 months, and HbA1c was measured quarterly. The coefficient of variation (CV) of HbA1c and FPG were calculated as measures of GV. Quantitative assessment of coronary plaques was performed by measuring the annual change and progression rate of total plaque volume (TPV). Significant progression was defined as annual TPV progression ≥ 15%. Multivariable regression analyses were used to assess the effects of GV on atherosclerosis progression.

Results: In the 396 patients, the annual change in TPV was 12.35 ± 14.23 mm3, and annual progression rate was 13.36 ± 12.69%. There were 143 (36.11%) patients with significant progression, and they had a significantly higher CV-HbA1c (P < 0.001) and CV-FPG (P < 0.001) than those without significant progression. In multivariable regression analyses, both CV-HbA1c and CV-FPG were independent predictors of annual change in TPV [CV-HbA1c: β = 0.241 (0.019-0.462), P = 0.034; CV-FPG: β = 0.265 (0.060-0.465), P = 0.012], annual TPV progression [CV-HbA1c: β = 0.214 (0.023-0.405), P = 0.029; CV-FPG: β = 0.218 (0.037-0.399), P = 0.019], and significant atherosclerosis progression [CV-HbA1c: odds ratio [OR] = 1.367 (1.149-1.650), P = 0.010; CV-FPG: OR = 1.321 (1.127-1.634), P = 0.013].

Conclusions: Long-term GV is associated with accelerated progression of coronary atherosclerosis independent of conventional risk factors in patients with T2DM. Trial registration ClinicalTrials.gov (NCT02587741), October 27, 2015; retrospectively registered.

Keywords: Atherosclerosis progression; Coronary computed tomography angiography; Glycemic variability; Type 2 diabetes.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchat of the present study
Fig. 2
Fig. 2
Distribution of the annual change and progression rate in TPV
Fig. 3
Fig. 3
Representative imaging for the change of the total plaque volume at the beginning and the follow-up. The 3-dimensional reconstruction and analysis of coronary CTA images of a 60-year-old female patient with type 2 diabetes were performed. The baseline CTA showed a moderate stenosis in the proximal segment of the left anterior descending coronary artery (a, b), with a total plaque volume of 119 mm3 (c). After a 2.8-year follow up, clinically significant progression (d–f) was observed, with the total plaque volume progressed to 194 mm3. The annual progression rate in total plaque volume was 22.51%
Fig. 4
Fig. 4
Comparison between patients with non-progression and progression in coronary atherosclerosis
Fig. 5
Fig. 5
Correlation between glucose variability and atherosclerosis progression. a Y = 6.63 + 0.34 * x, R2 = 0.036, P < 0.001. b Y = 6.81 + 0.39 * x, R2 = 0.059, P < 0.001. c Y = 8.85 + 0.25 * x, R2 = 0.033, P < 0.001. d Y = 8.82 + 0.33 * x, R2 = 0.070, P < 0.001

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