Glycemic variability is an important risk factor for cardiovascular autonomic neuropathy in newly diagnosed type 2 diabetic patients

Wen Xu; Yanhua Zhu; Xubin Yang; Hongrong Deng; Jinhua Yan; Shaoda Lin; Huazhang Yang; Hong Chen; Jianping Weng

doi:10.1016/j.ijcard.2016.04.078

Glycemic variability is an important risk factor for cardiovascular autonomic neuropathy in newly diagnosed type 2 diabetic patients

Int J Cardiol. 2016 Jul 15:215:263-8. doi: 10.1016/j.ijcard.2016.04.078. Epub 2016 Apr 14.

Authors

Wen Xu¹, Yanhua Zhu¹, Xubin Yang¹, Hongrong Deng¹, Jinhua Yan¹, Shaoda Lin², Huazhang Yang³, Hong Chen⁴, Jianping Weng⁵

Affiliations

¹ Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong 510630, China.
² Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
³ Department of Endocrinology and Metabolism, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China.
⁴ Department of Endocrinology and Metabolism, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
⁵ Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong 510630, China. Electronic address: wjianp@mail.sysu.edu.cn.

PMID: 27128543
DOI: 10.1016/j.ijcard.2016.04.078

Abstract

Background: The relationship between glycemic variability, another component of glycemic disorders as well as chronic sustained hyperglycemia, and cardiovascular autonomic neuropathy (CAN) has not been clarified. Our aim is to investigate the association between glycemic variability and CAN in newly diagnosed type 2 diabetic patients.

Methods: Ewing tests were performed in 90 newly diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as control from May 1, 2009, through September 30, 2010. According to the scores from Ewing tests, diabetic patients were divided into two groups: without CAN (CAN-) and with CAN (CAN+). All participants underwent a 48-h to 72-h continuous glucose monitoring (CGM). Coefficient of variability of glycemia (%CV), mean amplitude of glycemic excursions (MAGE) and means of daily differences (MODD) were calculated with the CGM data.

Results: The prevalence of CAN in patients with newly diagnosed type 2 diabetes was 22.2%. An increasing trend of glycemic variability was found from control group, CAN- group to CAN+ group. MAGE in CAN+ group was significantly higher than that in CAN- group (5.27±1.99mmol/L vs. 4.04±1.39mmol/L, P=0.001). In the Logistic regression analysis, a significant relationship was shown between MAGE and CAN [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.01-2.73, P=0.018)]. The area under the receiver-operating characteristic curve for MAGE was superior to those for other dysglycemic indices in detecting CAN.

Conclusions: Glycemic variability is associated with CAN in patients with newly diagnosed type 2 diabetes. Among the glycemic variability indices, MAGE is a significant indicator for detecting CAN.

Keywords: Cardiovascular autonomic neuropathy; Glycemic variability; Type 2 diabetes mellitus.

MeSH terms

Adult
Area Under Curve
Autonomic Nervous System Diseases / epidemiology*
Autonomic Nervous System Diseases / etiology
Blood Glucose / metabolism*
Cardiovascular Diseases / epidemiology*
Cardiovascular Diseases / etiology
Diabetes Mellitus, Type 2 / complications
Diabetes Mellitus, Type 2 / metabolism*
Diabetic Neuropathies / epidemiology*
Female
Humans
Logistic Models
Male
Middle Aged
Prevalence
ROC Curve
Risk Factors

Substances

Blood Glucose