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Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients

OBJECTIVE: The effect of glycemic variability (GV) on cardiovascular risk has not been fully clarified in type 2 diabetes. We evaluated the effect of GV, blood pressure (BP), and oxidative stress on intima-media thickness (IMT), left ventricular mass index (LVMI), flow-mediated dilation (FMD), and s...

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Autores principales: Di Flaviani, Alessandra, Picconi, Fabiana, Di Stefano, Paola, Giordani, Ilaria, Malandrucco, Ilaria, Maggio, Paola, Palazzo, Paola, Sgreccia, Fabrizio, Peraldo, Carlo, Farina, Fabrizio, Frajese, Gaetano, Frontoni, Simona
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120198/
https://www.ncbi.nlm.nih.gov/pubmed/21610126
http://dx.doi.org/10.2337/dc11-0034
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author Di Flaviani, Alessandra
Picconi, Fabiana
Di Stefano, Paola
Giordani, Ilaria
Malandrucco, Ilaria
Maggio, Paola
Palazzo, Paola
Sgreccia, Fabrizio
Peraldo, Carlo
Farina, Fabrizio
Frajese, Gaetano
Frontoni, Simona
author_facet Di Flaviani, Alessandra
Picconi, Fabiana
Di Stefano, Paola
Giordani, Ilaria
Malandrucco, Ilaria
Maggio, Paola
Palazzo, Paola
Sgreccia, Fabrizio
Peraldo, Carlo
Farina, Fabrizio
Frajese, Gaetano
Frontoni, Simona
author_sort Di Flaviani, Alessandra
collection PubMed
description OBJECTIVE: The effect of glycemic variability (GV) on cardiovascular risk has not been fully clarified in type 2 diabetes. We evaluated the effect of GV, blood pressure (BP), and oxidative stress on intima-media thickness (IMT), left ventricular mass index (LVMI), flow-mediated dilation (FMD), and sympathovagal balance (low frequency [LF]/high frequency [HF] ratio) in 26 type 2 diabetic patients (diabetes duration 4.41 ± 4.81 years; HbA(1c) 6.70 ± 1.25%) receiving diet and/or metformin treatment, with no hypotensive treatment or complications. RESEARCH DESIGN AND METHODS: Continuous glucose monitoring (CGM) data were used to calculate mean amplitude of glycemic excursion (MAGE), continuous overall net glycemic action (CONGA)-2, mean blood glucose (MBG), mean postprandial glucose excursion (MPPGE), and incremental area under the curve (IAUC). Blood pressure (BP), circadian rhythm, and urinary 15-F2t-isoprostane (8-iso-prostaglandin F(2α) [PGF(2α)]) were also evaluated. Subjects were divided into dipper (D) and nondipper (ND) groups according to ΔBP. RESULTS: IMT and LVMI were increased in ND versus D (0.77 ± 0.08 vs. 0.68 ± 0.13 [P = 0.04] and 67 ± 14 vs. 55 ± 11 [P = 0.03], respectively). MBG, MAGE, and IAUC were significantly associated with LF/HF ratio at night (r = 0.50, P = 0.01; r = 0.40, P = 0.04; r = 0.41, P = 0.04, respectively), MPPGE was negatively associated with FMD (r = −0.45, P = 0.02), and CONGA-2 was positively associated with LVMI (r = 0.55, P = 0.006). The Δsystolic BP was negatively associated with IMT (r = −0.43, P = 0.03) and with LVMI (r = −0.52, P = 0.01). Urinary 8-iso-PGF(2α) was positively associated with LVMI (r = 0.68 P < 0.001). CONCLUSIONS: An impaired GV and BP variability is associated with endothelial and cardiovascular damage in short-term diabetic patients with optimal metabolic control. Oxidative stress is the only independent predictor of increased LV mass and correlates with glucose and BP variability.
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spelling pubmed-31201982012-07-01 Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients Di Flaviani, Alessandra Picconi, Fabiana Di Stefano, Paola Giordani, Ilaria Malandrucco, Ilaria Maggio, Paola Palazzo, Paola Sgreccia, Fabrizio Peraldo, Carlo Farina, Fabrizio Frajese, Gaetano Frontoni, Simona Diabetes Care Original Research OBJECTIVE: The effect of glycemic variability (GV) on cardiovascular risk has not been fully clarified in type 2 diabetes. We evaluated the effect of GV, blood pressure (BP), and oxidative stress on intima-media thickness (IMT), left ventricular mass index (LVMI), flow-mediated dilation (FMD), and sympathovagal balance (low frequency [LF]/high frequency [HF] ratio) in 26 type 2 diabetic patients (diabetes duration 4.41 ± 4.81 years; HbA(1c) 6.70 ± 1.25%) receiving diet and/or metformin treatment, with no hypotensive treatment or complications. RESEARCH DESIGN AND METHODS: Continuous glucose monitoring (CGM) data were used to calculate mean amplitude of glycemic excursion (MAGE), continuous overall net glycemic action (CONGA)-2, mean blood glucose (MBG), mean postprandial glucose excursion (MPPGE), and incremental area under the curve (IAUC). Blood pressure (BP), circadian rhythm, and urinary 15-F2t-isoprostane (8-iso-prostaglandin F(2α) [PGF(2α)]) were also evaluated. Subjects were divided into dipper (D) and nondipper (ND) groups according to ΔBP. RESULTS: IMT and LVMI were increased in ND versus D (0.77 ± 0.08 vs. 0.68 ± 0.13 [P = 0.04] and 67 ± 14 vs. 55 ± 11 [P = 0.03], respectively). MBG, MAGE, and IAUC were significantly associated with LF/HF ratio at night (r = 0.50, P = 0.01; r = 0.40, P = 0.04; r = 0.41, P = 0.04, respectively), MPPGE was negatively associated with FMD (r = −0.45, P = 0.02), and CONGA-2 was positively associated with LVMI (r = 0.55, P = 0.006). The Δsystolic BP was negatively associated with IMT (r = −0.43, P = 0.03) and with LVMI (r = −0.52, P = 0.01). Urinary 8-iso-PGF(2α) was positively associated with LVMI (r = 0.68 P < 0.001). CONCLUSIONS: An impaired GV and BP variability is associated with endothelial and cardiovascular damage in short-term diabetic patients with optimal metabolic control. Oxidative stress is the only independent predictor of increased LV mass and correlates with glucose and BP variability. American Diabetes Association 2011-07 2011-06-17 /pmc/articles/PMC3120198/ /pubmed/21610126 http://dx.doi.org/10.2337/dc11-0034 Text en © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Original Research
Di Flaviani, Alessandra
Picconi, Fabiana
Di Stefano, Paola
Giordani, Ilaria
Malandrucco, Ilaria
Maggio, Paola
Palazzo, Paola
Sgreccia, Fabrizio
Peraldo, Carlo
Farina, Fabrizio
Frajese, Gaetano
Frontoni, Simona
Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients
title Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients
title_full Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients
title_fullStr Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients
title_full_unstemmed Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients
title_short Impact of Glycemic and Blood Pressure Variability on Surrogate Measures of Cardiovascular Outcomes in Type 2 Diabetic Patients
title_sort impact of glycemic and blood pressure variability on surrogate measures of cardiovascular outcomes in type 2 diabetic patients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120198/
https://www.ncbi.nlm.nih.gov/pubmed/21610126
http://dx.doi.org/10.2337/dc11-0034
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