Glycaemic variability is associated with severity of coronary artery disease in patients with poorly controlled type 2 diabetes and acute myocardial infarction

M Benalia; M Zeller; B Mouhat; C Guenancia; V Yameogo; C Greco; H Yao; M Maza; B Vergès; Y Cottin

doi:10.1016/j.diabet.2019.01.012

Glycaemic variability is associated with severity of coronary artery disease in patients with poorly controlled type 2 diabetes and acute myocardial infarction

Diabetes Metab. 2019 Oct;45(5):446-452. doi: 10.1016/j.diabet.2019.01.012. Epub 2019 Feb 11.

Authors

M Benalia¹, M Zeller², B Mouhat¹, C Guenancia¹, V Yameogo³, C Greco⁴, H Yao¹, M Maza¹, B Vergès⁵, Y Cottin¹

Affiliations

¹ Cardiology Department, University Hospital Center, 21000 Dijon Bourgogne, France.
² Physiopathology and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460 University of Bourgogne Franche-Comté, 21000 Dijon, France. Electronic address: marianne.zeller@u-bourgogne.fr.
³ Cardiology Department, University Hospital Center Yalgado Ouédraogo, 21000 Ouagadougou, Burkina Faso.
⁴ Cardiology Department, University Hospital Center, 21000 Dijon Bourgogne, France; Physiopathology and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460 University of Bourgogne Franche-Comté, 21000 Dijon, France.
⁵ Endocrinology Department, University Hospital Center, 21000 Dijon Bourgogne, France.

PMID: 30763700
DOI: 10.1016/j.diabet.2019.01.012

Abstract

Background: In patients with type 2 diabetes (T2D), glycaemic variability (GV), another component of glycaemic abnormalities, is a novel potentially aggravating factor for coronary artery disease (CAD).

Objectives: The aim of our study was to identify interactions between GV and severity of CAD in diabetes patients admitted for acute myocardial infarction (AMI).

Methods: All patients with T2D admitted to our university hospital for AMI from March 2015 to February 2017 who received intravenous (IV) insulin therapy and underwent coronary angiography were included. GV was assessed by mean amplitude of blood glucose excursion (MAGE) values taken within 2 days of admission. Patients with higher GV (highest MAGE tertile) were compared with those with lower GV (first and second MAGE tertiles).

Results: A total of 204 patients were included: median age was 72 (61-81) years; 32% were female; HbA_1c was 7.3% (6.4-8.2%); diabetes duration was 10 (2-17.5) years; and MAGE value was 0.65 (0.43-0.92) g/L. Compared with those with lower GV, patients with the highest GV were more often women, treated with previous insulin, and had higher blood glucose and HbA_1c levels. In addition, patients with elevated GV had significantly higher SYNTAX scores: 17 (10-28) vs. 12 (6-22) (P = 0.009). Indeed, SYNTAX scores (OR: 1.05, 95% CI: 1.02-1.08; P = 0.001) remained independently associated with high GV beyond HbA_1c levels (OR: 1.51, 95% CI: 1.2-1.89; P < 0.001).

Conclusion: In AMI patients with poorly controlled diabetes, GV is associated with CAD severity beyond chronic hyperglycaemia. Although no causality can be determined from our observational study, the results suggest that, in AMI, early evaluation of GV might contribute to the identification of those diabetes patients at high risk, and serve as a therapeutic target for both primary and secondary prevention.

Keywords: Acute myocardial infarction; Coronary artery disease; Glycaemic variability; Glycated haemoglobin A1c; Type 2 diabetes.

MeSH terms

Aged
Aged, 80 and over
Blood Glucose*
Coronary Artery Disease / blood*
Coronary Artery Disease / complications
Coronary Artery Disease / diagnosis
Diabetes Mellitus, Type 2 / blood*
Diabetes Mellitus, Type 2 / complications
Diabetes Mellitus, Type 2 / drug therapy
Female
Humans
Hypoglycemic Agents / therapeutic use
Insulin / therapeutic use
Male
Middle Aged
Myocardial Infarction / blood*
Myocardial Infarction / complications
Severity of Illness Index
Sex Factors

Substances

Blood Glucose
Hypoglycemic Agents
Insulin