Visit-to-visit HbA1c variability is inversely related to baroreflex sensitivity independently of HbA1c value in type 2 diabetes

Matsutani, Daisuke; Sakamoto, Masaya; Minato, Soichiro; Kayama, Yosuke; Takeda, Norihiko; Horiuchi, Ryô; Utsunomiya, Kazunori

doi:10.1186/s12933-018-0743-7

Cited by 14 publications

(9 citation statements)

References 57 publications

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“…First, evidence has suggested that oscillating glucose may trigger increases in oxidative stress, endothelial dysfunction or damage, advanced glycation end-products and inflammatory cytokines, resulting in a higher rate of occurrence and acceleration of atherosclerosis independently of sustained hyperglycemia [12][13][14][28][29][30][31][32][33]. Second, A relationship of cardiovascular autonomic dysfunction with atherosclerosis has been observed [34,35]. Exaggerated glycemic fluctuations were demonstrated to adversely affect endothelial vessel hearing with result of hypoxia and blood flow disorders in neuronal cells, which may lead to autonomic dysfunction [36].…”

Section: Discussionmentioning

confidence: 99%

Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes

Yang

Lin

et al. 2020

Cardiovasc Diabetol

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Background: This study investigated whether visit-to-visit fasting plasma glucose (FPG) variability, as measured by the coefficient of variation (CV), increased peripheral artery disease (PAD) risk.Methods: Individuals with type 2 diabetes from the National Diabetes Care Management Program during the period 2002-2004, ≥ 30 years of age, and free of PAD (n = 30,932) were included and monitored until 2011. Cox proportional hazards regression models were implemented to analyze related determinants of PAD.Results: A total of 894 incident cases of PAD were identified during an average 8.2 years of follow-up, resulting in a crude incidence rate of 3.53 per 1000 person-years. Both FPG-CV and HbA1c were significantly associated with PAD after multivariate adjustment, with corresponding hazard ratios of 1.24 [95% confidence interval (CI) 1.04-1.47] for FPG-CV in the third tertile and 1.50 (95% CI 1.10-2.04) for HbA1c ≥ 10%. The findings of the sensitivity analysis remained consistent after excluding potential confounders, demonstrating the consistency of the results. Conclusions:The associations between HbA1c, variability in FPG-CV, and PAD suggest a linked pathophysiological mechanism, suggesting the crucial role of glycemic variability in clinical management and therapeutic goals in preventing PAD in type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes

Yang

Lin

et al. 2020

Cardiovasc Diabetol

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“…In addition, in our study, we investigated whether short-term GV evaluated by CGM or long-term GV evaluated by visit-to-visit HbA1c variability affected a decrease in BRS, which is also a marker of the onset of CV events. Results showed no significant difference, but there was a tendency for long-term GV to influence the decrease in BRS [ 51 ].…”

Section: Long-term Glycemic Variabilitymentioning

confidence: 99%

Type 2 Diabetes and Glycemic Variability: Various Parameters in Clinical Practice

Sakamoto

2018

J Clin Med Res

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It has become possible to measure blood glucose levels continuously from 24 h to approximately 2 weeks due to the recent development of relevant devices such as continuous glucose monitoring and flash glucose monitoring systems. This has enabled not only medical professionals but also patients to monitor details of glycemic variability (GV) which was not possible in the past. Details of GV for both short and intermediate periods can now be obtained, and it is important in patient care to appropriately evaluate the data obtained. Types of GV in terms of time frame vary from short-term to long-term. Several studies reported that long-term GV was related to micro- and macro-angiopathies in patients with type 2 diabetes mellitus (T2DM). However, there are still unknown aspects regarding the relationships of various durations of GV with prognosis. Further clinical trials are required to examine the mechanism of GV and to evaluate whether GV can be a valuable therapeutic target in treatment of patients with T2DM.

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“…In patients with type 1 diabetes, HbA1c variability was found as an important risk factor for vascular complications such as cardiovascular diseases (CVDs) [8], microvascular diseases (MVDs) [8][9][10][11], and hospitalized hypoglycemia [12]. In patients with type 2 diabetes, although cumulative evidence shows the predictive role of HbA1c variability in the risks of hypoglycemia [12], CVDs [13][14][15][16][17][18][19][20] (such as subclinical left ventricular remodeling and dysfunction [21], reduced baroreflex sensitivity [22], and high thrombotic risk [23]), and allcause mortality [15][16][17][18][19][20][24][25][26][27][28][29][30], studies on MVDs [15,19,22,[31][32][33][34][35][36][37] are relatively limited and yield inconsistent results [34][35][36].…”

Section: Introductionmentioning

confidence: 99%

Comparative predictive ability of visit-to-visit HbA1c variability measures for microvascular disease risk in type 2 diabetes

Chen

Hung

et al. 2020

Cardiovasc Diabetol

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Background: To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes. Methods: Linked data between National Cheng Kung University Hospital and Taiwan's National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patients' baseline HbA1c, demographics, comorbidities/complications, and treatments. Results: In the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42-and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1c < 7.5% (58 mmol/mol) were stronger compared with those in patients with baseline HbA1c ≥ 7.5% (58 mmol/mol). Conclusions: HbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control.

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Visit-to-visit HbA1c variability is inversely related to baroreflex sensitivity independently of HbA1c value in type 2 diabetes

Cited by 14 publications

References 57 publications

Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes

Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes

Type 2 Diabetes and Glycemic Variability: Various Parameters in Clinical Practice

Comparative predictive ability of visit-to-visit HbA1c variability measures for microvascular disease risk in type 2 diabetes

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