Visit-to-visit fasting plasma glucose variability is an important risk factor for long-term changes in left cardiac structure and function in patients with type 2 diabetes

Xixiang Tang, Junlin Zhong, Hui Zhang, Yanting Luo, Xing Liu, Long Peng, Yanling Zhang, Xiaoxian Qian, Boxiong Jiang, Jinlai Liu, Suhua Li, Yanming Chen, Xixiang Tang, Junlin Zhong, Hui Zhang, Yanting Luo, Xing Liu, Long Peng, Yanling Zhang, Xiaoxian Qian, Boxiong Jiang, Jinlai Liu, Suhua Li, Yanming Chen

Abstract

Background: To investigate the effect of visit-to-visit fasting plasma glucose (FPG) variability on the left cardiac structure and function in patients with type 2 diabetes mellitus (T2DM).

Methods: In this prospective cohort study, 455 T2DM patients were included and follow-up for a median of 4.7 years. FPG measured on every hospital visit was collected. FPG variability was calculated by its coefficient of variation (CV-FPG). Left cardiac structure and function were assessed using echocardiography at baseline and after follow-up. Multivariable linear regression analyses were used to estimate the effect of FPG variability on the annualized changes in left cardiac structure and function. Subgroup analysis stratified by mean HbA1c levels (< 7% and ≥ 7%) were also performed.

Result: In multivariable regression analyses, CV-FPG was independently associated with the annualized changes in left ventricle (β = 0.137; P = 0.031), interventricular septum (β = 0.215; P = 0.001), left ventricular posterior wall thickness (β = 0.129; P = 0.048), left ventricular mass index (β = 0.227; P < 0.001), and left ventricular ejection fraction (β = - 0.132; P = 0.030). After additionally stratified by mean HbA1c levels, CV-FPG was still independently associated with the annualized changes in the above parameters in patients with HbA1c ≥ 7%, while not in patients with HbA1c < 7%.

Conclusions: Visit-to-visit variability in FPG could be a novel risk factor for the long-term adverse changes in left cardiac structure and systolic function in patients with type 2 diabetes. Trial registration ClinicalTrials.gov (NCT02587741), October 27, 2015, retrospectively registered.

Keywords: Cardiac structure; Echocardiography; Fasting plasma glucose; Glucose 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
Annualized change in left cardiac structural and functional parameters of patients grouped by quartile of CV-FPG levels. a Anualized change in LA (a), LVDd (b), IVS (c), LVPW (d), LVMI (e), LVEF (f), E/A ratio (g) and E/e′ ratio (h) among groups divided by quartile of CV-FPG levels. Data are shown as mean ± SD. *P < 0.05, **P < 0.01 versus the Q1 group; #P < 0.05, ##P < 0.01 versus the Q2 group; &P < 0.05, &&P < 0.01 versus the Q3 group by one-way ANOVA. LA, left atrium; LVDd, left ventricular internal end-diastole dimension; IVS, interventricular septum; LVPW, left ventricular posterior wall thicknesses; LVMI, left ventricular mass index; LVEF, left ventricular ejection fraction; Q1, the first quartile; Q2, the second quartile; Q3, the third quartile; Q4, the fourth quartile
Fig. 3
Fig. 3
Correlation between annualized changes of left cardiac structure and function and CV-FPG. a Y = − 0.02 + 1.24 * X, R linear = 0.190, R2 linear = 0.036, P < 0.001; b Y = − 0.08 + 1.58 * X, R linear = 0.199, R2 linear = 0.039, P < 0.001; c Y = − 0.25 + 0.63 * X, R linear = 0.175, R2 linear = 0.031, P < 0.001; d Y = − 0.09 + 0.58 * X, R linear = 0.168, R2 linear = 0.028, P < 0.001; e Y = − 1.95 + 14.12 * X, R linear = 0.269, R2 linear = 0.072, P < 0.001; f Y = 0.19 − 2.32 * X, R linear = − 0.209, R2 linear = 0.044, P < 0.001.

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