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

• Published in: Cardiovascular diabetology Vol. 18; no. 1; p. 50
• Main Authors: Tang, Xixiang, Zhong, Junlin, Zhang, Hui, Luo, Yanting, Liu, Xing, Peng, Long, Zhang, Yanling, Qian, Xiaoxian, Jiang, Boxiong, Liu, Jinlai, Li, Suhua, Chen, Yanming
• Format: Journal Article
• Language: English
• Published: England BioMed Central 16-04-2019; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - blood; Blood Glucose - metabolism; Blood pressure; Cardiac structure; Cardiomyopathy; Cholesterol; Coefficient of variation; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Echocardiography; Echocardiography, Doppler; Fasting; Fasting - blood; Fasting plasma glucose; Female; Glucose; Glucose variability; Glycated Hemoglobin A; Heart; Heart failure; Humans; Hyperglycemia; Hypertension; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Insulin resistance; Laboratory testing; Male; Middle Aged; Mortality; Original Investigation; Oxidative stress; Prognosis; Prospective Studies; Risk Factors; Septum; Standard deviation; Statistical analysis; Stroke Volume; Structure-function relationships; Time Factors; Type 2 diabetes; Variability; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; Type 2 diabetes; Glucose variability; Cardiac structure; Echocardiography; Fasting plasma glucose
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-019-0854-9

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).
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.
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%.
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.