Higher long-term visit-to-visit glycemic variability predicts new-onset atrial fibrillation in patients with diabetes mellitus
Open Access
- 23 July 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Cardiovascular Diabetology
- Vol. 20 (1), 1-12
- https://doi.org/10.1186/s12933-021-01341-3
Abstract
Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Glycemic variability (GV) is associated with risk of micro- and macrovascular diseases. However, whether the GV can increase the risk of AF remains unknown. The cohort study used a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 27,246 adult patients with T2DM were enrolled for analysis. Each individual was assessed to determine the coefficients of variability of fasting glucose (FGCV) and HbA1c variability score (HVS). The GV parameters were categorized into quartiles. Multivariate Cox regression models were employed to estimate the relationship between the GV parameters and the risk of AF, transient ischemic accident (TIA)/ischemic stroke and mortality in patients with T2DM. The incidence rates of AF and TIA/ischemic stroke were 21.31 and 13.71 per 1000 person-year respectively. The medium follow-up period was 70.7 months. In Cox regression model with full adjustment, the highest quartile of FGCV was not associated with increased risk of AF [Hazard ratio (HR): 1.12, 95% confidence interval (CI) 0.96–1.29, p = 0.148] or TIA/ischemic stroke (HR: 1.04, 95% CI 0.83–1.31, p = 0.736), but was associated with increased risk of total mortality (HR: 1.33, 95% CI 1.12–1.58, p < 0.001) and non-cardiac mortality (HR: 1.41, 95% CI 1.15–1.71, p < 0.001). The highest HVS was significantly associated with increased risk of AF (HR: 1.29, 95% CI 1.12–1.50, p < 0.001), total mortality (HR: 2.43, 95% CI 2.03–2.90, p < 0.001), cardiac mortality (HR: 1.50, 95% CI 1.06–2.14, p = 0.024) and non-cardiac mortality (HR: 2.80, 95% CI 2.28–3.44, p < 0.001) but was not associated with TIA/ischemic stroke (HR: 0.98, 95% CI 0.78–1.23, p = 0.846). The Kaplan–Meier analysis showed significantly higher risk of AF, cardiac and non-cardiac mortality according to the magnitude of GV (log-rank test, p < 0.001). Our data demonstrate that high GV is independently associated with the development of new-onset AF in patients with T2DM. The benefit of maintaining stable glycemic levels to improve clinical outcomes warrants further studies.Keywords
This publication has 35 references indexed in Scilit:
- Association between blood glucose variability and coronary plaque instability in patients with acute coronary syndromesCardiovascular Diabetology, 2015
- The association between glycemic variability and diabetic cardiovascular autonomic neuropathy in patients with type 2 diabetesCardiovascular Diabetology, 2015
- Glycemic Variability and Oxidative Stress: A Link between Diabetes and Cardiovascular Disease?International Journal of Molecular Sciences, 2014
- Glucose fluctuations increase the incidence of atrial fibrillation in diabetic ratsCardiovascular Research, 2014
- Impact of Intensive Glycemic Control on the Incidence of Atrial Fibrillation and Associated Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study)The American Journal of Cardiology, 2014
- Impact of Visit-to-Visit Glycemic Variability on the Risks of Macrovascular and Microvascular Events and All-Cause Mortality in Type 2 Diabetes: The ADVANCE TrialDiabetes Care, 2014
- Relationship between fluctuations in glucose levels measured by continuous glucose monitoring and vascular endothelial dysfunction in type 2 diabetes mellitusCardiovascular Diabetology, 2013
- Hypoglycemia and Cardiovascular RisksDiabetes Care, 2011
- Effects of Acute Insulin-Induced Hypoglycemia on Indices of InflammationDiabetes Care, 2010
- Activation of Oxidative Stress by Acute Glucose Fluctuations Compared With Sustained Chronic Hyperglycemia in Patients With Type 2 DiabetesJAMA, 2006