Glycemic Variability Assessed by Continuous Glucose Monitoring and Short-Term Outcome in Diabetic Patients Undergoing Percutaneous Coronary Intervention: An Observational Pilot Study

Abstract

Poor glycemic control is associated with unfavorable outcome in patients undergoing percutaneous coronary intervention (PCI), irrespective of diabetes mellitus. However a complete assessment of glycemic status may not be fully described by glycated hemoglobin or fasting blood glucose levels, whereas daily glycemic fluctuations may influence cardiovascular risk and have even more deleterious effects than sustained hyperglycemia. Thus, this paper investigated the effectiveness of a continuous glucose monitoring (CGM), registering the mean level of glycemic values but also the extent of glucose excursions during coronary revascularization, in detecting periprocedural outcome such as renal or myocardial damage, assessed by serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and troponin I levels. High glycemic variability (GV) has been associated with worse postprocedural creatinine and NGAL variations. Moreover, GV, and predominantly hypoglycemic variations, has been observed to increase in patients with periprocedural myocardial infarction. Thus, our study investigated the usefulness of CGM in the setting of PCI where an optimal glycemic control should be achieved in order to prevent complications and improve outcome.

Incremental role of glycaemic variability over HbA1c in identifying type 2 diabetic patients with high platelet reactivity undergoing percutaneous coronary intervention

“…Consequently, several studies described the clinical impact of GV in patients with coronary artery disease undergoing PCI [14–16]. A high MAGE value has been demonstrated an independent predictor of long-term poor prognosis in a large cohort of patients with acute coronary syndromes undergoing coronary stenting [15].…”

“…Moreover, high levels of GV, assessed by continuous glucose monitoring (CGM), appear to have even more deleterious effects than sustained hyperglycaemia in the pathogenesis of cardiovascular autonomic neuropathy and other cardiovascular complications [12, 13]. Previous studies have already correlated an increased GV to the occurrence of adverse events in patients with acute coronary syndromes undergoing percutaneous coronary revascularization (PCI) [14–16]. Finally, critically ill patients admitted to intensive care unit with high GV have shown a significant increased mortality compared with those with less glycemic variability even with slight hyperglycaemia [17].…”

Glycemic variability in the development of cardiovascular complications in diabetes

“…Based on these data, it has been speculated that myocardial injury could be primarily influenced by hypoglycemia and by rapid glycaemic spikes, whereas the kidney may be mainly susceptible to slower and longer hyperglycaemic excursions. 69 Kuroda et al also observed that MAGEs strongly correlated with neo-intimal growth after stenting, evaluated by optimal coherence tomography, in patients with CAD. 12 In conclusion, the relationship between GV and CV outcome is still a subject of research and debate; however, to date the majority of the evidences collected suggests that we may include GV in the list of potential risk factors for the development of cardiac complications in both diabetic and not diabetic patients.…”

“…In a series of patients treated with elective coronary stenting, a significant correlation between GV and renal and myocardial damage was found, measured by serum creatinine, neutrophil gelatinase-associated lipocalin, and troponin-I levels, supporting the idea that an optimal glycaemic control should be achieved in order to prevent complications and improve outcome also in the setting of PCI. 69 Notably, increased MAGE-up values, predominantly indicating hyperglycaemic peaks, are observed in patients with higher post-procedural creatinine and neutrophil gelatinase-associated lipocalin variations, whereas, a significant correlation after coronary stenting was found between MAGEdown, indicating hypoglycaemic nadirs, and troponin release. Based on these data, it has been speculated that myocardial injury could be primarily influenced by hypoglycemia and by rapid glycaemic spikes, whereas the kidney may be mainly susceptible to slower and longer hyperglycaemic excursions.…”

“…Notably, increased MAGE‐up values, predominantly indicating hyperglycaemic peaks, are observed in patients with higher post‐procedural creatinine and neutrophil gelatinase‐associated lipocalin variations, whereas, a significant correlation after coronary stenting was found between MAGE‐down, indicating hypoglycaemic nadirs, and troponin release. Based on these data, it has been speculated that myocardial injury could be primarily influenced by hypoglycemia and by rapid glycaemic spikes, whereas the kidney may be mainly susceptible to slower and longer hyperglycaemic excursions . Kuroda et al also observed that MAGEs strongly correlated with neo‐intimal growth after stenting, evaluated by optimal coherence tomography, in patients with CAD …”