A Decrease in Glucose Variability Does Not Reduce Cardiovascular Event Rates in Type 2 Diabetic Patients After Acute Myocardial Infarction
Open accessAbstract
OBJECTIVE: To assess the effect of intraday glucose variability (GV) on cardiovascular outcomes in a reanalysis of Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (HEART2D) study data. RESEARCH DESIGN AND METHODS: Type 2 diabetic patients after acute myocardial infarction were randomized to an insulin treatment strategy targeting postprandial (PRANDIAL; n = 557) or fasting/interprandial (BASAL; n = 558) hyperglycemia. GV was calculated as mean amplitude of glycemic excursions (MAGE), mean absolute glucose (MAG) change, and SD. RESULTS: The PRANDIAL strategy resulted in an 18% lower MAG than BASAL (mean [SEM] difference 0.09 [0.04] mmol/L/h, P = 0.02). In addition, MAGE and SD were lower in the PRANDIAL group, however, not significantly. HbA1c levels and cardiovascular event rates were comparable between groups. CONCLUSIONS: A PRANDIAL strategy demonstrated lower intraday GV vs. a BASAL strategy with similar overall glycemic control but did not result in a reduction in cardiovascular outcomes. This does not support the hypothesis that targeting GV would be beneficial in reducing subsequent secondary cardiovascular events.
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In HEART2D, there was no association between glycemic variability and cardiovascular disease (MAG p=0.57, MAGE p=0.49, SD p=0.52).
“No association between GV and CVD.MAG p=0.57, MAGE p=0.49 and SD p=0.52.”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [52]
In the DIGAMI 2 study, there was lack of association between glycemic variability during the initial phase during hospitalization and the composite of mortality, non-fatal stroke and reinfarction after 1 year of follow-up.
“The authors reported lack of association between GV during the initial phase during hospitalization or in the composite of mortality, non-fatal stroke and reinfarction after 1 year of follow-up.52”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [52]
In the HEART2D study, there was no difference in glycemic variability between patients who experienced cardiovascular events and those without events.
“reported no difference in GV in patients who experienced cardiovascular events and those without events.52”
From Glycemic variability and cardiovascular disease in patients with type 2 diabetes (2021) · cites this paper as [52]
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References 11 · Cited by 89
- Authors
- Siegelaar, S. E., Kerr, L., Jacober, S. J., & Devries, J. H.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Eli Lilly (United States) (US)
- Corresponding author
- Siegelaar, Sarah E.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2011-03-21
- Volume
- 34
- Issue
- 4
- Pages
- 855-857
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3064040
- OpenAlex
- W2134161989
- Cited by
- 89
- References
- 11
- Citations by year
- 2025: 4 · 2024: 5 · 2023: 4 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 4 · 2017: 8 · 2016: 4 · 2015: 10 · 2014: 10 · 2013: 16 · 2012: 10
- FWCI
- 10.74
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, acute myocardial infarction, postprandial hyperglycemia, basal insulin, glycemic excursions, cardiovascular events, secondary prevention, glycemic control
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Fasting, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Myocardial Infarction, Postprandial Period
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