Glycaemic variability and risk of adverse cardiovascular events in acute coronary syndrome

Zhang, Lei; Li, Feng; Liu, Huan-Huan; Zhang, Zhiyuan; Yang, Fan; Qian, Lingling; Wang, Ru-Xing

doi:10.1177/14791641221137736

Cited by 11 publications

(7 citation statements)

References 45 publications

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“…More and more recent studies have focused on GV and its association with the prognosis of coronary artery disease, and a meta-analysis indicated that increased GV may be associated with poor prognosis in coronary artery disease patients regardless of DM status [ 17 ]. Similarly, another meta-analysis suggested that increased GV is correlated with poorer prognosis in acute coronary syndrome patients [ 18 ]. Specifically for acute myocardial infarction, Zhang et al first demonstrated that GV serves as an independent predictor for composite 30-day MACEs in DM patients with STEMI undergoing primary PCI [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

Wang,

Yang

et al. 2024

Cardiovasc Diabetol

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Background Given the increasing attention to glycemic variability (GV) and its potential implications for cardiovascular outcomes. This study aimed to explore the impact of acute GV on short-term outcomes in Chinese patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled 7510 consecutive patients diagnosed with acute STEMI from 274 centers in China. GV was assessed using the coefficient of variation of blood glucose levels. Patients were categorized into three groups according to GV tertiles (GV1, GV2, and GV3). The primary outcome was 30-day all-cause death, and the secondary outcome was major adverse cardiovascular events (MACEs). Cox regression analyses were conducted to determine the independent correlation between GV and the outcomes. Results A total of 7136 patients with STEMI were included. During 30-days follow-up, there was a significant increase in the incidence of all-cause death and MACEs with higher GV tertiles. The 30-days mortality rates were 7.4% for GV1, 8.7% for GV2 and 9.4% for GV3 (p = 0.004), while the MACEs incidence rates was 11.3%, 13.8% and 15.8% for the GV1, GV2 and GV3 groups respectively (p < 0.001). High GV levels during hospitalization were significantly associated with an increased risk of 30-day all-cause mortality and MACEs. When analyzed as a continuous variable, GV was independently associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.679, 95% confidence Interval [CI] 1.005–2.804) and MACEs (HR 2.064, 95% CI 1.386–3.074). Additionally, when analyzed as categorical variables, the GV3 group was found to predict an increased risk of MACEs, irrespective of the presence of diabetes mellitus (DM). Conclusion Our study findings indicate that a high GV during hospitalization was significantly associated with an increased risk of 30-day all-cause mortality and MACE in Chinese patients with STEMI. Moreover, acute GV emerged as an independent predictor of increased MACEs risk, regardless of DM status.

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Section: Discussionmentioning

confidence: 99%

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

Wang,

Yang

et al. 2024

Cardiovasc Diabetol

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“…Variability in glucose levels was determined based on the SD (mg/dL) and CV of all the available blood glucose measurements within 1 year of surgery. To calculate the CV, the following formula was used: CV = (SD/mean value) × 100% ( 19 ). In the absence of any information regarding the timing of the glucose testing with respect to eating, glucose scores were considered to represent random, non-fasting assessments.…”

Section: Methodsmentioning

confidence: 99%

A surgical nursing perspective analysis of glucose variability in BCLC stage B–C hepatocellular carcinoma patients with and without T2D within 1 year of hepatectomy: a retrospective cohort study from 2016 to 2020

Wang¹,

Zhu²,

Zhan³

et al. 2023

J Gastrointest Oncol

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Background Previous research has reported that variability in glucose levels is associated with a variety of patient characteristics in colon cancer. However, relevant research is still lacking in relation to hepatocellular carcinoma (HCC). Methods A total of 95 HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage B–C who underwent liver resection at the Eastern Hepatobiliary Surgery Hospital and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included in this study. The patients were divided into 2 groups with type 2 diabetes (T2D) and without T2D. The primary outcome variable was blood glucose variability at 1 month and within 1 year of HCC surgery. Results In this study, the age of patients with T2D was greater than that of patients without T2D (mean age: 70.3±8.45 vs. 60.4±11.27 years, P=0.031). Compared to the patients without T2D, those with T2D had higher blood glucose measurements within 1 month (33 vs. 7) and 1 year (46.5 vs. 22.5, P<0.001) of surgery. The T2D patients and non-T2D patients did not differ in terms of chemotherapy medication or other characteristics. Among the 95 patients with BCLC stage B–C HCC, those with T2D had higher variability in glucose levels (P<0.001) than those without T2D within 1 month of surgery [standard deviation (SD) =46.43 mg/dL, coefficient of variation (CV) =23.5% vs. SD =21.56 mg/dL, CV =13.21%], and within 1 year of surgery (SD =42.49 mg/dL, CV =26.14% vs. SD =20.45 mg/dL, CV =17.36%). A correlation was found between a lower body mass index and higher variability in glucose levels within 1 month of surgery among patients with T2D [SD (r=–0.431, P<0.05) and CV (r=–0.464, P<0.01)]. A higher preoperative blood glucose level in T2D patients was correlated with a higher blood glucose variability within 1 year of surgery (r=0.435, P<0.01). Variability in glucose levels was weakly correlated with the demographic and clinical characteristics of patients who do not have T2D. Conclusions HCC patients with T2D in BCLC stage B–C showed greater variability in glucose levels within 1 month and 1 year of surgery. Preoperative hyperglycemia, insulin use, and a lower cumulative dose of steroids were clinical features correlated with a higher variability in glucose levels in T2D patients.

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“…[42][43][44][45] Several studies in critically ill and non-critically ill hospitalized patients have shown the independent association between high GV and poor clinical outcomes. [35][36][37]42,43,45,46,47 Although studies assessing GV have usually included all value points during hospital stay, evaluation of daily data on hospitalized patients may provide sufficient information to make therapeutic changes when needed. Though multiple metrics have been suggested to measure GV, CV, and SD are the most commonly reported.…”

Section: Hospital Glycemic Variabilitymentioning

confidence: 99%

A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials

Spanakis,

Cook,

Kulasa

et al. 2023

J Diabetes Sci Technol

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Diabetes Technology Society organized an expert consensus panel to develop metrics for research in the use of continuous glucose monitors (CGMs) in a hospital setting. The experts met virtually in small groups both before and after an April 13, 2023 virtual meeting of the entire panel. The goal of the panel was to develop consensus definitions in anticipation of greater use of CGMs in hospital settings in the future. Establishment of consensus definitions of inpatient analytical metrics will be easier to compare outcomes between studies. Panelists defined terms related to 10 dimensions of measurements related to the use of CGMs including (1) hospital hypoglycemia, (2) hospital hyperglycemia, (3) hospital time in range, (4) hospital glycemic variability, (5) hospital glycemia risk index, (6) accuracy of CGM devices and reference methods for CGMs in the hospital, (7) meaningful time blocks for hospital glycemic goals, (8) hospital CGM data sufficiency, (9) using CGM data for insulin dosing, and (10) miscellaneous factors. The panelists voted on 51 proposed recommendations. Based on the panel vote, 51 recommendations were classified as either strong (43) or mild (8). Additional research is needed on CGM performance in the hospital. This consensus report is intended to support that type of research intended to improve outcomes for hospitalized people with diabetes.

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Glycaemic variability and risk of adverse cardiovascular events in acute coronary syndrome

Cited by 11 publications

References 45 publications

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

Impact of acute glycemic variability on short-term outcomes in patients with ST-segment elevation myocardial infarction: a multicenter population-based study

A surgical nursing perspective analysis of glucose variability in BCLC stage B–C hepatocellular carcinoma patients with and without T2D within 1 year of hepatectomy: a retrospective cohort study from 2016 to 2020

A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials

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