(Circulation. 1997;96:1750-1754.)
© 1997 American Heart Association, Inc.
Articles |
Long-term Instability of Fasting Plasma Glucose, a Novel Predictor of Cardiovascular Mortality in Elderly Patients With Non–Insulin-Dependent Diabetes Mellitus
The Verona Diabetes Study
From the Division of Endocrinology and Metabolic Diseases (M.M., E.B., G.Z., M.C.) and the Division of Medical Statistics (G.V., R. de M.), University of Verona, Italy.
Correspondence to Prof Michele Muggeo, Divisione di Endocrinologia e Malattie del Metabolismo, Ospedale Civile Maggiore, Piazzale Stefani, 1, 37126 Verona, Italy.
Background We recently reported that long-term fasting plasma glucose (FPG) instability predicts all-cause mortality in elderly patients with non–insulin-dependent diabetes mellitus (NIDDM). The aim of the present study was to evaluate whether glucose instability, as represented by the coefficient of variation of FPG concentrations (CV-FPG) measured during a 3-year period, can predict specific causes of death in the subsequent 5 years.
Methods and Results Five hundred sixty-six elderly patients with NIDDM were followed up for 5 years to assess mortality and causes of death. All FPG determinations of the 3 years preceding the follow-up available in the clinical records were collected and analyzed. Patients were grouped in tertiles of mean FPG, CV-FPG, and the slope of FPG. These parameters of glucose control, as well as sex, age, duration of diabetes, insulin treatment, cigarette smoking, hypertension, and total cholesterol, were included in a multivariate analysis of mortality. During the follow-up, 63 men and 128 women died. Diabetes- and malignancy-related mortality were not independently associated with any parameter of glucose control, whereas cardiovascular-related mortality was independently associated with CV-FPG (P=.007) but not with the mean or the slope of FPG. In particular, the relative risk of cardiovascular mortality in subjects in tertile III versus tertile I of CV-FPG was 2.40 (95% CI, 1.28 to 4.53).
Conclusions These results indicate that FPG instability is a predictor of cardiovascular-related mortality in elderly patients with NIDDM and suggest that glucose stability might be a goal in the management of these patients.
Key Words: diabetes mellitus • metabolism • mortality • aging • glucose • cardiovascular diseases
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