Visit-to-visit HbA1c variability is associated with aortic stiffness progression in participants with type 2 diabetes

Abstract

Background Glycemic variability plays an important role in the development of cardiovascular disease (CVD). This study aims to determine whether long-term visit-to-visit glycemic variability is associated with aortic stiffness progression in participants with type 2 diabetes (T2D). Methods Prospective data were obtained from 2115 T2D participants in the National Metabolic Management Center (MMC) from June 2017 to December 2022. Two brachial-ankle pulse wave velocity (ba-PWV) measurements were performed to assess aortic stiffness over a mean follow-up period of 2.6 years. A multivariate latent class growth mixed model was applied to identify trajectories of blood glucose. Logistic regression models were used to determine the odds ratio (OR) for aortic stiffness associated with glycemic variability evaluated by the coefficient of variation (CV), variability independent of the mean (VIM), average real variability (ARV), and successive variation (SV) of blood glucose. Results Four distinct trajectories of glycated hemoglobin (HbA1c) or fasting blood glucose (FBG) were identified. In the U-shape class of HbA1c and FBG, the adjusted ORs were 2.17 and 1.21 for having increased/persistently high ba-PWV, respectively. Additionally, HbA1c variability (CV, VIM, SV) was significantly associated with aortic stiffness progression, with ORs ranging from 1.20 to 1.24. Cross-tabulation analysis indicated that the third tertile of the HbA1c mean and VIM conferred a 78% (95% confidence interval [CI] 1.23–2.58) higher odds of aortic stiffness progression. Sensitivity analysis demonstrated that the SD of HbA1c and the highest HbA1c variability score (HVS) were significantly associated with the adverse outcomes independent of the mean of HbA1c during the follow-up. Conclusions Long-term visit-to-visit HbA1c variability was independently associated with aortic stiffness progression, suggesting that HbA1c variability was a strong predictor of subclinical atherosclerosis in T2D participants.

Alterations in Aortic Elasticity Indices among Type 2 Diabetes Patients in a Low and Middle Income Country Using M-Mode Echocardiography: A Cross-Sectional Comparative Study

“…Emerging evidence suggests that blood glucose variability could exert a more significant impact on aortic stiffness. Individuals with diabetes, particularly those with poorly managed blood glucose levels and significant variability, face an elevated risk of aortic stiffness and related cardiovascular complications [45,46]. Therefore, emphasizing the control of blood glucose fluctuations through comprehensive diabetes management strategies is pivotal for mitigating the risk of aortic stiffness and enhancing cardiovascular health outcomes among individuals with diabetes.…”

Impact of baseline and trajectory of the atherogenic index of plasma on incident diabetic kidney disease and retinopathy in participants with type 2 diabetes: a longitudinal cohort study

“…T2D participants were recruited from the National Metabolic Management Center (MMC) at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine [ 26 – 28 ]. A total of 4831 T2D participants with either DKD or DR follow-up data were included between June 2017 and June 2023.…”

“…In this project, people who never smoked or successfully stopped smoking for over one year were classified as ‘ideal smoking’ status. More elaborate definitions and collection methods for covariates were provided in previous publications [ 26 , 29 ].…”

The relationship between HbA1c control pattern and atherosclerosis progression of diabetes: a prospective study of Chinese population

“…In a nationally representative cross-sectional study conducted in mainland China with 173,642 participants in 2018, the estimated prevalence of diabetes was 12.4%, and of prediabetes was 38.1% [ 2 ]. Vascular complications of diabetes can lead to disability of diabetic patients and further affect the quality of life of patients [ 3 – 5 ]. A recent epidemiologic study has shown that cardiovascular disease (CVD) has climbed to the leading cause of mortality and morbidity in diabetes patients [ 6 ].…”

“…When interpreting blood glucose data, individual-level analysis encompasses single time point measurements, trends between two consecutive blood glucose measurements, and variability across multiple tests. At the group level, clustering patterns of blood glucose changes can be employed to describe collective modes of blood glucose control [ 5 , 11 – 14 ].…”