Abstract 12186: Sleep Blood Pressure, Sleep Glucose Values, and Target Organ Damages in Treated Type 2 Diabetes Patients

Abstract

Objective: Due to advances in medical technology, blood pressure (BP) or glucose values in vivo can be evaluated clinically not only during waking, but also sleeping time periods. In the field of BP management, the associations between sleep blood pressure (BP) and cardiovascular risk are well established. However, the associations between sleep glucose values, including nocturnal hypoglycemia, and cardiovascular risk in diabetes remain unclear. Research Design and

Methods: In this cross-sectional study of 49 treated type 2 diabetes patients (mean, 67.3years;61.0% men; mean treatment duration, 9.4 years), we performed 24-h continuous glucose monitoring simultaneously with BP monitoring, and evaluated several TODs (echocardiographic left ventricular mass index [LVMI], urinary albumin excretion [UAE], carotid-artery intima-media thickness [IMT], and brachial-ankle pulse wave velocity [baPWV]).

Results: Sleep average systolic BP values were independently associated with the extent of LVMI, log-transformed UAE, or baPWV (all P<0.05). In contrast, sleep average glucose values, rather than awake glucose values or glucose variability, were independently associated with the extent of common carotid-artery IMT (CCA-IMT) or baPWV (all P<0.05). We divided the study participants into 3 groups according to the sleep glucose values (a group with sleep average glucose values<148mg/dl, a group with nocturnal hypoglycemia [<70 mg/dl at least one point during sleep], and a group with sleep average glucose values>148mg/dl), and compared the extent of TODs among them. Patients with sleep average glucose values>148mg/dl, but not those with nocturnal hypoglycemia, had a higher extent of CCA-IMT or baPWV than the reference group, and the differences remained significant even after adjustment for covariates (both P<0.05 by ANCOVA).

Conclusions: High sleep BP and/or glucose values, rather than awake glucose values or glucose variability, were independently associated with a high degree of cardiovascular remodeling among treated type 2 diabetes.