1.
Association of various glycemic variability indices and vascular outcomes in type-2 diabetes patients: A retrospective study.
Tong, L, Chi, C, Zhang, Z
Medicine. 2018;(21):e10860
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Abstract
Both blood glucose (BG) level and glycemic variability (GV) significantly associate with diabetes-related complications. However, the criterion standard in GV assessment is absent. We aimed to compare different GV indices in association of vascular outcomes.Ten commonly used GV indices based on self-monitored BG data were calculated, and their associations of vascular outcomes including coronary artery disease (CAD), stroke, and chronic kidney disease (CKD) were compared.In total, 288 type 2 diabetes patients (66.5 ± 11.1 years old) were included in present analysis. Spearman correlation analysis showed that only mean amplitude of glycemic excursions (MAGE) significantly correlated with both estimated glomerular filtration rate and urinary albumin creatinine ratio (P ≤ .03). In Cochran-Armitage trend test, vascular outcomes were significantly associated with the increment of BG risk index and MAGE (P ≤ .03). After adjustment for potential confounders, multiple logistic regression results suggested that BG risk index and MAGE still significantly associated with these three vascular outcomes (P ≤ .01), whereas the other GV indices did not. Receiver operating characteristic curve analysis showed that the abilities of BG risk index and MAGE were similar in identifying CAD, stroke, or CKD.BG risk index and MAGE were better associated with vascular outcomes than other GV indices in type 2 diabetes patients.
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Impact of new-onset diabetes mellitus and glycemic control on the prognosis of heart failure patients: a propensity-matched study in the community.
Romero, SP, Garcia-Egido, A, Escobar, MA, Andrey, JL, Corzo, R, Perez, V, Garcia-Domiguez, GJ, Gomez, F
International journal of cardiology. 2013;(4):1206-16
Abstract
OBJECTIVES To assess the incidence of type 2 diabetes mellitus (DM) in patients with heart failure (HF), and to evaluate the effect of new-onset DM and glycemic control on the prognosis of HF patients treated with a contemporary medical regimen. METHODS Prospective study of 5314 HF patients and previously unknown DM during 9 years. Their mean age was 71.8 ± 7.9 years, 53.0% were women, and 50.2% had non-systolic HF. During a median follow-up of 56.9 ± 18.2 months, 68.9% of the patients died, 88.6% were hospitalized for HF, and 1519 (27.3%) developed new-onset DM. We propensity-matched those 1519 HF patients with DM, with 1519 HF patients non-diagnosed with DM. RESULTS The age- and sex-adjusted incidence (per 100 HF patients/years) of DM in HF patients was 3.20, higher in women and in patients with non-systolic HF (p<0.01). Patients with HF and DM and those with a mean HbA1c>7.0% presented an increased mortality (HR of death [CI 95%]: 2.44 [1.68-3.19] and, HR: 2.56 [1.77-3.35], respectively), mainly due to an increased cardiovascular mortality (HR ≥ 2.40 [1.46-3.34]) (P<0.001). The rate of hospitalization, of 30-day readmissions, and the number of visits were higher among HF patients with DM or with HbA1c>7.0% (p<0.001). These relationships of DM and its poor metabolic control with prognosis were maintained, independently of the gender, the type of HF (systolic or, non-systolic), the comorbidities, and the medication used (P<0.01). CONCLUSION New-onset diabetes mellitus and its poor metabolic control (HbA1c>7.0%) are associated with a increased mortality and morbidity of patients with heart failure.