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Association between visit-to-visit variability of glycemic indices and lipid profile and the incidence of coronary heart disease in adults with type 2 diabetes

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Abstract

Coronary heart disease (CHD) is one of the major causes of mortality and morbidity in patients with type 2 diabetes mellitus. In this study, we aimed to assess the association between visit-to-visit variability of fasting blood sugar (FBS), HbA1c, blood sugar 2 h post-prandial (BS2hpp), lipid indices, creatinine, systolic and diastolic blood pressure (SBP, DBP) and incident CHD in patients with type 2 diabetes during a median follow-up of ten years. The current case-cohort study consisted of 1500 individuals with type 2 diabetes, followed up for the occurrence of CHD from 2002 to 2019. The patients had at least four annual follow-ups during which glycemic and lipid profile were measured. Co-efficient of variance (CV) for each parameter was calculated by 10-21 measurements. Cox regression analysis was performed to assess the association between CV of glycemic indices, lipid profile, blood pressure, creatinine, weight and incident CHD during the follow-up period. Hazard ratios (HR) were adjusted for the confounding variables. Glycemic indices variability (i.e., CV-HbA1c, CV-FBS, and CV-BS2hpp), were significantly higher in the group with incident CHD (P=0.034, P=0.042, and P=0.044, respectively). Hazard ratios were 1.42 (95 % CI=1.13-2.09) for CV-HbA1c, 1.37 (95 % CI=1.02-2.10) for CV-FBS, and 1.16 (95 % CI=1.01-1.63) for CV-BS2hpp (P=0.012, P=0.046, P=0.038, respectively). Creatinine was significantly higher in the group with incident CHD (P=0.036) and it was significantly associated with higher incidence of CHD (HR=1.14, 95 % CI=1.02-2.17, P=0.048). Visit to visit variability of glycemic indices of the patients with type 2 diabetes is associated with incident CHD independent of their baseline and mean values.

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Data availability

Data is available as requested.

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Abbreviations

CHD:

Coronary heart disease

DM:

Diabetes mellitus

FBS:

Fasting blood sugar

BS2hpp:

Blood sugar 2 h post-prandial

HDL:

High-density lipoprotein

LDL:

Low density lipoprotein

TG:

Triglyceride

SBP:

systolic blood pressure

DBP:

diastolic blood pressure

CV:

Co-efficient variance

GV:

Glucose variability

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Acknowledgements

Authors wish to thank patients for their participation and kind cooperation.

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Authors and Affiliations

  1. Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, P.O. Box: 13145-784, Tehran, Iran

    Fatemeh Moosaie, Marjan Mouodi, Ali Sheikhy, Aida Fallahzadeh, Soghra Rabizadeh, Fatemeh Dehghani Firouzabadi, Manouchehr Nakhjavani & Alireza Esteghamati

  2. Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Niloofar Deravi

  3. Department of Pediatrics, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran

    Seyede Marzie Fatemi Abhari

  4. Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Alipasha Meysamie

Authors
  1. Fatemeh Moosaie
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  2. Marjan Mouodi
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  3. Ali Sheikhy
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  4. Aida Fallahzadeh
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  11. Alireza Esteghamati
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Contributions

Alireza Esteghamati, Marjan Mouodi, and Soghra Rabizadeh contributed to conception. Fatemeh Moosaie, Alipasha Meysamie, and Fatemeh Dehghani Firouzabadi contributed to data analysis. Ali Sheikhy, Aida Fallahzadeh, and Niloofar Deravi contributed to drafting. Fatemeh Moosaie, Seyede Marzie Fatemi Abhari, and Manouchehr Nakhjavani contributed to revision.

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Correspondence to Alireza Esteghamati.

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Fatemeh Moosaie and Marjan Mouodi contributed equally as co-first authors.

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Moosaie, F., Mouodi, M., Sheikhy, A. et al. Association between visit-to-visit variability of glycemic indices and lipid profile and the incidence of coronary heart disease in adults with type 2 diabetes. J Diabetes Metab Disord 20, 1715–1723 (2021). https://doi.org/10.1007/s40200-021-00930-z

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