Satomi Wakasugi1, Tomoya Mita2, Naoto Katakami3,4, Yosuke Okada5, Hidenori Yoshii6, Takeshi Osonoi7, Nobuichi Kuribayashi8, Yoshinobu Taneda9, Yuichi Kojima10, Masahiko Gosho11, Iichiro Shimomura3, Hirotaka Watada1. 1. Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Hongo 2-1-1 Bunkyo-ku, Tokyo, Japan. 2. Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Hongo 2-1-1 Bunkyo-ku, Tokyo, Japan. tom-m@juntendo.ac.jp. 3. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan. 4. Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. 5. First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan. 6. Department of Medicine, Diabetology & Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo, 136-0075, Japan. 7. Nakakinen Clinic, 745-5, Nakadai, Naka, Ibaraki, 311-0113, Japan. 8. Misaki Naika Clinic, 6-44-9 Futawahigashi, Funabashi, Chiba, 274-0805, Japan. 9. Taneda Clinic, Iwaki, Fukushima, 973-8402, Japan. 10. Musashino Family Clinic, Minami 3-14-1, Yoshikawa, Saitama, 342-0038, Japan. 11. Department of Biostatistics, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Abstract
BACKGROUND: Previous studies have suggested that high mean glucose levels and glycemic abnormalities such as glucose fluctuation and hypoglycemia accelerate the progression of atherosclerosis in patients with type 2 diabetes. Although continuous glucose monitoring (CGM) that could evaluate such glycemic abnormalities has been rapidly adopted, the associations between CGM-derived metrics and arterial stiffness are not entirely clear. METHODS: This exploratory cross-sectional study used baseline data from an ongoing prospective, multicenter, observational study with 5 years of follow-up. Study participants included 445 outpatients with type 2 diabetes and no history of apparent cardiovascular disease who underwent CGM and brachial-ankle pulse wave velocity (baPWV) measurement at baseline. Associations between CGM-derived metrics and baPWV were analyzed using multivariate regression models. RESULTS: In a linear regression model, all CGM-derived metrics were significantly associated with baPWV, but HbA1c was not. Some CGM-derived metrics related to intra-day glucose variability, hyperglycemia, and hypoglycemia remained significantly associated with baPWV after adjusting for possible atherosclerotic risk factors, including HbA1c. Based on baPWV ≥ 1800 cm/s as indicative of high arterial stiffness, multivariate logistic regression found that some CGM-derived metrics related to intra-day glucose variability and hyperglycemia are significantly associated with high arterial stiffness even after adjusting for possible atherosclerotic risk factors, including HbA1c. CONCLUSIONS: Multiple CGM-derived metrics are significantly associated with baPWV and high arterial stiffness in patients with type 2 diabetes who have no history of apparent cardiovascular disease. These metrics might be useful for identifying patients at high risk of developing cardiovascular disease.
BACKGROUND: Previous studies have suggested that high mean glucose levels and glycemic abnormalities such as glucose fluctuation and hypoglycemia accelerate the progression of atherosclerosis in patients with type 2 diabetes. Although continuous glucose monitoring (CGM) that could evaluate such glycemic abnormalities has been rapidly adopted, the associations between CGM-derived metrics and arterial stiffness are not entirely clear. METHODS: This exploratory cross-sectional study used baseline data from an ongoing prospective, multicenter, observational study with 5 years of follow-up. Study participants included 445 outpatients with type 2 diabetes and no history of apparent cardiovascular disease who underwent CGM and brachial-ankle pulse wave velocity (baPWV) measurement at baseline. Associations between CGM-derived metrics and baPWV were analyzed using multivariate regression models. RESULTS: In a linear regression model, all CGM-derived metrics were significantly associated with baPWV, but HbA1c was not. Some CGM-derived metrics related to intra-day glucose variability, hyperglycemia, and hypoglycemia remained significantly associated with baPWV after adjusting for possible atherosclerotic risk factors, including HbA1c. Based on baPWV ≥ 1800 cm/s as indicative of high arterial stiffness, multivariate logistic regression found that some CGM-derived metrics related to intra-day glucose variability and hyperglycemia are significantly associated with high arterial stiffness even after adjusting for possible atherosclerotic risk factors, including HbA1c. CONCLUSIONS: Multiple CGM-derived metrics are significantly associated with baPWV and high arterial stiffness in patients with type 2 diabetes who have no history of apparent cardiovascular disease. These metrics might be useful for identifying patients at high risk of developing cardiovascular disease.
Authors: H Taniwaki; T Kawagishi; M Emoto; T Shoji; H Kanda; K Maekawa; Y Nishizawa; H Morii Journal: Diabetes Care Date: 1999-11 Impact factor: 19.112
Authors: F Boscari; S Galasso; G Acciaroli; A Facchinetti; M C Marescotti; A Avogaro; D Bruttomesso Journal: Nutr Metab Cardiovasc Dis Date: 2018-01-31 Impact factor: 4.222
Authors: Johanna H M Driessen; Frank de Vries; Hein A W van Onzenoort; Miranda T Schram; Carla van der Kallen; Koen D Reesink; Simone Sep; Coen D A Stehouwer; Nicolaas Schaper; A A Kroon; Casper Schalkwijk; Joop P W van den Bergh; Ronald M A Henry Journal: J Hypertens Date: 2019-02 Impact factor: 4.844
Authors: Lorenita De Angelis; Sandrine C Millasseau; Andrew Smith; GianCarlo Viberti; Richard H Jones; James M Ritter; Philip J Chowienczyk Journal: Hypertension Date: 2004-05-17 Impact factor: 10.190
Authors: Hertzel C Gerstein; Michael E Miller; Robert P Byington; David C Goff; J Thomas Bigger; John B Buse; William C Cushman; Saul Genuth; Faramarz Ismail-Beigi; Richard H Grimm; Jeffrey L Probstfield; Denise G Simons-Morton; William T Friedewald Journal: N Engl J Med Date: 2008-06-06 Impact factor: 91.245
Authors: Gong Su; Shu-hua Mi; Hong Tao; Zhao Li; Hong-Xia Yang; Hong Zheng; Yun Zhou; Lei Tian Journal: Diabetes Care Date: 2013-01-24 Impact factor: 19.112