Limits...
Factors Associated with Glycemic Variability in Patients with Type 2 Diabetes: Focus on Oral Hypoglycemic Agents and Cardiovascular Risk Factors.

Yoo S, Chin SO, Lee SA, Koh G - Endocrinol Metab (Seoul) (2015)

Bottom Line: GV indices were significantly higher in patients taking sulfonylureas (SUs), but lower in those taking dipeptidyl peptidase-4 inhibitors.In four OHA groups, GV indices increased progressively from group 1 to group 4.However, these did not differ according to quartiles of 10-year ASCVD risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.

ABSTRACT

Background: The role of glycemic variability (GV) in development of cardiovascular diseases remains controversial, and factors that determine glucose fluctuation in patients with diabetes are unknown. We investigated relationships between GV indices, kinds of oral hypoglycemic agents (OHAs), and cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM).

Methods: We analyzed 209 patients with T2DM. The GV index (standard deviation [SD] and mean absolute glucose change [MAG]) were calculated from 7-point self-monitoring of blood glucose profiles. The patients were classified into four groups according to whether they take OHAs known as GV-lowering (A) and GV-increasing (B): 1 (A only), 2 (neither), 3 (both A and B), and 4 (B only). The 10-year risk for atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Equations.

Results: GV indices were significantly higher in patients taking sulfonylureas (SUs), but lower in those taking dipeptidyl peptidase-4 inhibitors. In hierarchical regression analysis, the use of SUs remained independent correlates of the SD (γ=0.209, P=0.009) and MAG (γ=0.214, P=0.011). In four OHA groups, GV indices increased progressively from group 1 to group 4. However, these did not differ according to quartiles of 10-year ASCVD risk.

Conclusion: GV indices correlated significantly with the use of OHAs, particularly SU, and differed significantly according to combination of OHAs. However, cardiovascular risk factors and 10-year ASCVD risk were not related to GV indices. These findings suggest that GV is largely determined by properties of OHAs and not to cardiovascular complications in patients with T2DM.

No MeSH data available.


Related in: MedlinePlus

Differences in standard deviation (A) and mean absolute glucose change (B) grouped according to the use of individual oral hypoglycemic agents. SU, sulfonylurea; DPP4i, dipeptidyl peptidase-4 inhibitor; AGI, α-glucosidase inhibitor; MET, metformin; TZD, thiazolidinedione. aP<0.05 by Student t test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4595361&req=5

Figure 2: Differences in standard deviation (A) and mean absolute glucose change (B) grouped according to the use of individual oral hypoglycemic agents. SU, sulfonylurea; DPP4i, dipeptidyl peptidase-4 inhibitor; AGI, α-glucosidase inhibitor; MET, metformin; TZD, thiazolidinedione. aP<0.05 by Student t test.

Mentions: We investigated the differences of GV indices between user and non-user of individual OHAs using Student t tests. Both the SD and MAG were significantly higher in patients taking SUs, but lower in those taking DPP4is. However, the indices of GV were not different with the use of AGI, metformin, or TZD (Fig. 2). In this study, about 70% of patients took more than two OHAs. In patients with dual-therapy, median value of SD and MAG was significantly higher in patient with taking MET plus SU (SD, 2.547 mmol/L [interquartile range (IQR), 2.140 to 3.158]; MAG, 1.301 mmol/L/hr [IQR, 1.098 to 1.660]) than MET plus DPP4i (SD, 1.658 mmol/L [IQR, 1.352 to 2.267]; MAG, 0.824 mmol/L/hr [IQR, 0.693 to 1.168]; P<0.001, respectively) (Table 3).


Factors Associated with Glycemic Variability in Patients with Type 2 Diabetes: Focus on Oral Hypoglycemic Agents and Cardiovascular Risk Factors.

Yoo S, Chin SO, Lee SA, Koh G - Endocrinol Metab (Seoul) (2015)

Differences in standard deviation (A) and mean absolute glucose change (B) grouped according to the use of individual oral hypoglycemic agents. SU, sulfonylurea; DPP4i, dipeptidyl peptidase-4 inhibitor; AGI, α-glucosidase inhibitor; MET, metformin; TZD, thiazolidinedione. aP<0.05 by Student t test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595361&req=5

Figure 2: Differences in standard deviation (A) and mean absolute glucose change (B) grouped according to the use of individual oral hypoglycemic agents. SU, sulfonylurea; DPP4i, dipeptidyl peptidase-4 inhibitor; AGI, α-glucosidase inhibitor; MET, metformin; TZD, thiazolidinedione. aP<0.05 by Student t test.
Mentions: We investigated the differences of GV indices between user and non-user of individual OHAs using Student t tests. Both the SD and MAG were significantly higher in patients taking SUs, but lower in those taking DPP4is. However, the indices of GV were not different with the use of AGI, metformin, or TZD (Fig. 2). In this study, about 70% of patients took more than two OHAs. In patients with dual-therapy, median value of SD and MAG was significantly higher in patient with taking MET plus SU (SD, 2.547 mmol/L [interquartile range (IQR), 2.140 to 3.158]; MAG, 1.301 mmol/L/hr [IQR, 1.098 to 1.660]) than MET plus DPP4i (SD, 1.658 mmol/L [IQR, 1.352 to 2.267]; MAG, 0.824 mmol/L/hr [IQR, 0.693 to 1.168]; P<0.001, respectively) (Table 3).

Bottom Line: GV indices were significantly higher in patients taking sulfonylureas (SUs), but lower in those taking dipeptidyl peptidase-4 inhibitors.In four OHA groups, GV indices increased progressively from group 1 to group 4.However, these did not differ according to quartiles of 10-year ASCVD risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.

ABSTRACT

Background: The role of glycemic variability (GV) in development of cardiovascular diseases remains controversial, and factors that determine glucose fluctuation in patients with diabetes are unknown. We investigated relationships between GV indices, kinds of oral hypoglycemic agents (OHAs), and cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM).

Methods: We analyzed 209 patients with T2DM. The GV index (standard deviation [SD] and mean absolute glucose change [MAG]) were calculated from 7-point self-monitoring of blood glucose profiles. The patients were classified into four groups according to whether they take OHAs known as GV-lowering (A) and GV-increasing (B): 1 (A only), 2 (neither), 3 (both A and B), and 4 (B only). The 10-year risk for atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Equations.

Results: GV indices were significantly higher in patients taking sulfonylureas (SUs), but lower in those taking dipeptidyl peptidase-4 inhibitors. In hierarchical regression analysis, the use of SUs remained independent correlates of the SD (γ=0.209, P=0.009) and MAG (γ=0.214, P=0.011). In four OHA groups, GV indices increased progressively from group 1 to group 4. However, these did not differ according to quartiles of 10-year ASCVD risk.

Conclusion: GV indices correlated significantly with the use of OHAs, particularly SU, and differed significantly according to combination of OHAs. However, cardiovascular risk factors and 10-year ASCVD risk were not related to GV indices. These findings suggest that GV is largely determined by properties of OHAs and not to cardiovascular complications in patients with T2DM.

No MeSH data available.


Related in: MedlinePlus