Dataset Information

Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial.

ABSTRACT:

Objective

There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA_1c) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control.

Research design and methods

During the VADT, fasting glucose and HbA_1c were measured every 3 months for up to 84 months in 1,791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose and HbA_1c. Overall mean glucose and HbA_1c measures as well as their maximum and the most recent measurement were also examined.

Results

Variability measures (CV and ARV) of fasting glucose were significantly associated with CVD even after adjusting for other risk factors, including mean fasting glucose. When considering separately groups receiving intensive and standard glycemic control, this relationship was evident in the intensive treatment group but not in the standard group. Additional adjustment for severe hypoglycemic episodes did not alter the relationship between fasting glucose variability and CVD. Interestingly, no HbA_1c measures were associated with CVD after adjusting for multiple baseline risk factors.

Conclusions

Our analysis indicates that in the VADT, variability of fasting glucose plays a role in the development of CVD complications beyond the influence of standard fasting glucose measures. The adverse consequences of fasting glucose variability on CVD appear greatest in those receiving intensive glucose control.

SUBMITTER: Zhou JJ

PROVIDER: S-EPMC6150432 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial.

Zhou Jin J JJ Schwenke Dawn C DC Bahn Gideon G Reaven Peter P

Diabetes care 20180806 10

<h4>Objective</h4>There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA<sub>1c</sub>) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control.<h4>Research design and methods</h4>During the ...[more]

PMID: 30082325

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Project description:AimsCognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive (INT) glucose-lowering reduces the rate(s) of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60?years; diabetes duration, 11?years) from the Veterans Affairs Diabetes Trial.MethodsA battery of neuropsychological tests [digit span, digit symbol substitution (DSym), and Trails-making Test-Part B (TMT-B)] was administered at baseline in ~1700 participants and repeated at year 5. Thirty-seven risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses.ResultsThe mean age-adjusted DSym or TMT-B declined significantly in all study participants (P?<?0.001). Randomized INT glucose-lowering did not significantly alter the rate of cognitive decline. The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta?=?-0.028; P?=?0.0057), lower baseline diastolic blood pressure (BP; beta?=?0.028; P?=?0.002), and baseline calcium channel blocker medication use (beta?=?-0.639; P?<?0.001). Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic BPs. Baseline thiazide diuretic use (beta?=?-0.549; P?=?0.015) was an additional significant predictor of 5-year decline in age-adjusted digit symbol score. Post-baseline systolic BP-lowering was significantly associated (P?<?0.001) with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride-lowering (P?=?0.045) and decline in digit symbol substitution task performance.ConclusionA 5-year period of randomized INT glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic BPs as well as plasma triglycerides appeared as modifiable risk factors of the rate of cognitive decline in older adult type 2 diabetes.

Dataset Information

Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial.

Objective

Research design and methods

Results

Conclusions

Publications

Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial.

Similar Datasets

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