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Observational Study
. 2021 May 4;20(1):95.
doi: 10.1186/s12933-021-01288-5.

Associations of continuous glucose monitoring-assessed glucose variability with intima-media thickness and ultrasonic tissue characteristics of the carotid arteries: a cross-sectional analysis in patients with type 2 diabetes

Naohiro Taya  1 , Naoto Katakami #  2 , Tomoya Mita #  3 , Yosuke Okada  4 , Satomi Wakasugi  5 , Hidenori Yoshii  6 , Toshihiko Shiraiwa  7 , Akihito Otsuka  8 , Yutaka Umayahara  9 , Kayoko Ryomoto  10 , Masahiro Hatazaki  11 , Tetsuyuki Yasuda  12 , Tsunehiko Yamamoto  13 , Masahiko Gosho  14 , Iichiro Shimomura  1 , Hirotaka Watada  5
Affiliations
Observational Study

Associations of continuous glucose monitoring-assessed glucose variability with intima-media thickness and ultrasonic tissue characteristics of the carotid arteries: a cross-sectional analysis in patients with type 2 diabetes

Naohiro Taya et al. Cardiovasc Diabetol. .

Abstract

Background: The association between glucose variability and the progression of atherosclerosis is not completely understood. We aimed to evaluate the associations of glucose variability with the progression of atherosclerosis in the early stages.

Methods: We conducted a cross-sectional analysis to investigate the associations of glucose variability, assessed by continuous glucose monitoring, with intima-media thickness (IMT) and gray-scale median (GSM) of the carotid arteries, which are different indicators for the progression of atherosclerosis. We used baseline data from a hospital-based multicenter prospective observational cohort study among Japanese patients with type 2 diabetes without a history of cardiovascular diseases aged between 30 and 80 years. Continuous glucose monitoring was performed by Freestyle Libre Pro, and glucose levels obtained every 15 min for a maximum of eight days were used to calculate the metrics of glucose variability. IMT and GSM were evaluated by ultrasonography, and the former indicates thickening of intima-media complex in the carotid artery wall, while the latter indicates tissue characteristics.

Results: Among 600 study participants (age: 64.9 ± 9.2 (mean ± SD) years; 63.2%: men; HbA1c: 7.0 ± 0.8%), participants with a larger intra- and inter-day glucose variability had a lower GSM and most of these associations were statistically significant. No trend based on glucose variability was shown regarding IMT. Standard deviation of glucose (regression coefficient, β = - 5.822; 95% CI - 8.875 to - 2.768, P < 0.001), glucose coefficient of variation (β = - 0.418; - 0.685 to - 0.151, P = 0.002), mean amplitude of glycemic excursion (β = - 1.689; - 2.567 to - 0.811, P < 0.001), mean of daily differences (β = - 6.500; - 9.758 to - 3.241, P < 0.001), and interquartile range (β = - 4.289; - 6.964 to - 1.614, P = 0.002) had a statistically significant association with mean-GSM after adjustment for conventional cardiovascular risk factors, including HbA1c. No metrics of glucose variability had a statistically significant association with IMT.

Conclusions: Continuous glucose monitoring-assessed glucose variability was associated with the tissue characteristics of the carotid artery wall in type 2 diabetes patients without cardiovascular diseases.

Keywords: Continuous glucose monitoring; Glucose variability; Gray-scale median; Intima-media thickness; Tissue characteristics; Type 2 diabetes.

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Conflict of interest statement

HW received research funds from Abbott Japan. HW is a member of the advisory board of Abbott Japan. All other authors (NT, NK, TM, YO, SW, HY, TS, AO, YU, KR, MH, TY, TY, MG, and IS) have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Associations between metrics of glucose variability and intima-media thickness. Mean-intima-media thickness (IMT), and CCA-max-IMT are represented according to the tertiles of a standard deviation, b coefficient of variation, c mean amplitude of glycemic excursion, d mean of daily differences, and e interquartile range. Data are presented as means ± standard deviations. P for trend was calculated using a linear regression model. SD standard deviation, CV coefficient of variation, MAGE mean amplitude of glycemic excursion, MODD mean of daily differences, IQR interquartile range
Fig. 2
Fig. 2
Associations between metrics of glucose variability and gray-scale median. Mean-gray-scale median (GSM), thickened lesion-GSM, and plaque-GSM are represented according to the tertiles of a standard deviation, b coefficient of variation, c mean amplitude of glycemic excursion, d mean of daily differences, and e interquartile range. Data are presented as means ± standard deviations. P for trend was calculated using a linear regression model. SD standard deviation, CV coefficient of variation, MAGE mean amplitude of glycemic excursion, MODD mean of daily differences, IQR interquartile range
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