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Background Previous studies have suggested that high mean glucose levels and various glycemic abnormalities such as glucose fluctuation and hypoglycemia accelerate the progression of atherosclerosis in patients with type 2 diabetes. Although continuous glucose monitoring (CGM) that could evaluate such glycemic abnormalities has been rapidly adopted, the associations between CGM-derived metrics and arterial stiffness are not entirely clear.
Methods This is an exploratory analysis of an ongoing prospective, multicenter, 5-year follow-up observational study. Study participants included 445 outpatients with type 2 diabetes who underwent CGM and brachial-ankle pulse wave velocity (baPWV) measurement at baseline. Associations between CGM-derived metrics and baPWV were investigated using multivariate regression models.
Results In a linear regression model, all CGM–derived metrics were significantly associated with baPWV, but HbA1c was not. Some CGM–derived metrics related to intra-day glucose variability, hyperglycemia, and hypoglycemia remained significantly associated with baPWV after adjusting for possible atherosclerotic risk factors, including HbA1c. Based on baPWV ≥1,800 cm/s as indicative of high arterial stiffness, multivariate logistic regression found that some CGM-derived metrics related to intra-day glucose variability and hyperglycemia are significantly associated with high arterial stiffness even after adjusting for possible atherosclerotic risk factors, including HbA1c.
Conclusions Multiple CGM-derived metrics are significantly associated with baPWV and high arterial stiffness in patients with type 2 diabetes who have no history of apparent cardiovascular disease. These metrics might be useful for identifying patients at high risk of developing cardiovascular disease.
This study has been registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000032325).
Keywords
glucose variability, continuous glucose monitoring, arterial stiffness, type 2 diabetes
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View the published article at Cardiovascular Diabetology.
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Editorial decision: Major Revision
On 18 Oct, 2020
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Received 14 Oct, 2020
Review #1 received
Received 12 Oct, 2020
Reviewers invited
Invitations sent on 24 Sep, 2020
Reviewer #1 agreed
On 24 Sep, 2020
Reviewer #2 agreed
On 24 Sep, 2020
Reviewer #3 agreed
On 24 Sep, 2020
Reviewer #4 agreed
On 24 Sep, 2020
Editor assigned
On 23 Sep, 2020
Editor invited
On 22 Sep, 2020
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On 19 Sep, 2020
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On 15 Sep, 2020
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See the published version of this preprint at Cardiovascular Diabetology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original investigation
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Cardiovascular Diabetology.
Version 1
Posted 22 Sep, 2020
No community comments so far
Editorial decision: Major Revision
On 18 Oct, 2020
Review #3 received
Received 14 Oct, 2020
Review #2 received
Received 14 Oct, 2020
Review #1 received
Received 12 Oct, 2020
Reviewers invited
Invitations sent on 24 Sep, 2020
Reviewer #1 agreed
On 24 Sep, 2020
Reviewer #2 agreed
On 24 Sep, 2020
Reviewer #3 agreed
On 24 Sep, 2020
Reviewer #4 agreed
On 24 Sep, 2020
Editor assigned
On 23 Sep, 2020
Editor invited
On 22 Sep, 2020
Submission checks complete
On 19 Sep, 2020
First submitted
On 15 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Cardiovascular Diabetology.
Background Previous studies have suggested that high mean glucose levels and various glycemic abnormalities such as glucose fluctuation and hypoglycemia accelerate the progression of atherosclerosis in patients with type 2 diabetes. Although continuous glucose monitoring (CGM) that could evaluate such glycemic abnormalities has been rapidly adopted, the associations between CGM-derived metrics and arterial stiffness are not entirely clear.
Methods This is an exploratory analysis of an ongoing prospective, multicenter, 5-year follow-up observational study. Study participants included 445 outpatients with type 2 diabetes who underwent CGM and brachial-ankle pulse wave velocity (baPWV) measurement at baseline. Associations between CGM-derived metrics and baPWV were investigated using multivariate regression models.
Results In a linear regression model, all CGM–derived metrics were significantly associated with baPWV, but HbA1c was not. Some CGM–derived metrics related to intra-day glucose variability, hyperglycemia, and hypoglycemia remained significantly associated with baPWV after adjusting for possible atherosclerotic risk factors, including HbA1c. Based on baPWV ≥1,800 cm/s as indicative of high arterial stiffness, multivariate logistic regression found that some CGM-derived metrics related to intra-day glucose variability and hyperglycemia are significantly associated with high arterial stiffness even after adjusting for possible atherosclerotic risk factors, including HbA1c.
Conclusions Multiple CGM-derived metrics are significantly associated with baPWV and high arterial stiffness in patients with type 2 diabetes who have no history of apparent cardiovascular disease. These metrics might be useful for identifying patients at high risk of developing cardiovascular disease.
This study has been registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000032325).
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