Glucose Fluctuation and Severe Internal Carotid Artery Siphon Stenosis in Type 2 Diabetes Patients

Abstract

The impact of glucose fluctuation on intracranial artery stenosis remains to be elucidated. This study aimed to investigate the association between glucose fluctuation and intracranial artery stenosis. This was a cross-sectional study of type 2 diabetes mellitus (T2DM) patients equipped with the FreeStyle Libre Pro continuous glucose monitoring system (Abbott Laboratories) between February 2019 and June 2020. Glucose fluctuation was evaluated according to the standard deviation (SD) of blood glucose, coefficient of variation (%CV), and mean amplitude of glycemic excursions (MAGE). Magnetic resonance angiography was used to evaluate the degree of intracranial artery stenosis. Of the 103 patients, 8 patients developed severe internal carotid artery (ICA) siphon stenosis (≥70%). SD, %CV, and MAGE were significantly higher in the severe stenosis group than in the non-severe stenosis group (<70%), whereas there was no significant intergroup difference in the mean blood glucose and HbA1c. Multivariable logistic regression analysis adjusted for sex showed that SD, %CV, and MAGE were independent factors associated with severe ICA siphon stenosis. In conclusion, glucose fluctuation is significantly associated with severe ICA siphon stenosis in T2DM patients. Thus, glucose fluctuation can be a target of preventive therapies for intracranial artery stenosis and ischemic stroke.

Long-term glycemic variability and risk of stroke in patients with diabetes: a meta-analysis

“…Pathophysiologically, glucose fluctuation, particularly the short-term glycemic fluctuation has been associated with the severity of systematic atherosclerosis, possibly via the inducing oxidative stress, inflammatory cytokines, and endothelial damage [ 27 , 28 ]. Consistently, a recent cross-sectional study showed that glucose fluctuation is significantly associated with severe siphon stenosis of internal carotid artery in T2DM patients, suggesting that glucose fluctuation might be a risk factor for intracranial artery stenosis and ischemic stroke [ 29 ]. An early study also showed that time-scale-dependent glycemic fluctuations might contribute to brain atrophy and cognitive outcomes in patients with T2DM, which may deteriorate the cognitive function after stroke [ 30 ].…”

HbA1c Variability and the Risk of Dementia in Patients with Diabetes: A Meta-Analysis

“…For example, increased glycemic fluctuation has been associated with vascular complications of diabetes and atherosclerosis of cerebral arteries, and cerebral ischemia has been identified as major risk factors for cognitive impairment in these patients [ 28 ]. A recent study showed that glucose fluctuation is significantly associated with severe internal carotid artery siphon stenosis in T2DM patients [ 29 ], a known cause of vascular dementia. In addition, increased glycemic fluctuation is related to the severity of oxidative stress, a major pathogenesis and therapeutic target for AD-related dementia [ 30 , 31 ].…”

Acute Glycemic Variability and Functional Outcome in Patients with Acute Ischemic Stroke: A Meta-Analysis

“…Pathophysiologically, increased glycemic fluctuation has been associated with enhanced inflammatory response [44] and oxidative stress [45], two key factors that have been involved in the development of functional impairment in patients after AIS [46]. Moreover, a cross-sectional study showed that glucose fluctuation is significantly associated with severe internal carotid artery siphon stenosis, which may also be a marker of poor prognosis in patients with AIS [47]. Interestingly, a recent clinical trial showed that targeted intervention to reduce acute glycemic fluctuation was associated with improved nerve function for diabetic patients following AIS [48].…”