OBJECTIVE-The effect of glycemic variability (GV) on cardiovascular risk has not been fully clarified in type 2 diabetes. We evaluated the effect of GV, blood pressure (BP), and oxidative stress on intima-media thickness (IMT), left ventricular mass index (LVMI), flow-mediated dilation (FMD), and sympathovagal balance (low frequency [LF]/high frequency [HF] ratio) in 26 type 2 diabetic patients (diabetes duration 4.41 6 4.81 years; HbA 1c 6.70 6 1.25%) receiving diet and/or metformin treatment, with no hypotensive treatment or complications.RESEARCH DESIGN AND METHODS-Continuous glucose monitoring (CGM) data were used to calculate mean amplitude of glycemic excursion (MAGE), continuous overall net glycemic action (CONGA)-2, mean blood glucose (MBG), mean postprandial glucose excursion (MPPGE), and incremental area under the curve (IAUC). Blood pressure (BP), circadian rhythm, and urinary 15-F2t-isoprostane (8-iso-prostaglandin F 2a [PGF 2a ]) were also evaluated. Subjects were divided into dipper (D) and nondipper (ND) groups according to DBP.RESULTS-IMT and LVMI were increased in ND versus D (0.77 6 0.08 vs. 0.68 6 0.13 [P = 0.04] and 67 6 14 vs. 55 6 11 [P = 0.03], respectively). MBG, MAGE, and IAUC were significantly associated with LF/HF ratio at night (r = 0.50, P = 0.01; r = 0.40, P = 0.04; r = 0.41, P = 0.04, respectively), MPPGE was negatively associated with FMD (r = 20.45, P = 0.02), and CONGA-2 was positively associated with LVMI (r = 0.55, P = 0.006). The Dsystolic BP was negatively associated with IMT (r = 20.43, P = 0.03) and with LVMI (r = 20.52, P = 0.01). Urinary 8-iso-PGF 2a was positively associated with LVMI (r = 0.68 P , 0.001).CONCLUSIONS-An impaired GV and BP variability is associated with endothelial and cardiovascular damage in short-term diabetic patients with optimal metabolic control. Oxidative stress is the only independent predictor of increased LV mass and correlates with glucose and BP variability.
