Abstract 14455: Glucose Variability Determined by Continuous Glucose Monitoring System Is More Associated with Poor Clinical Characteristics in ST-Segment Elevation Myocardial Infarction Patients with Type 2 Diabetes Mellitus and Impaired Glucose Tolerance, in Comparison with Hemoglobin A1c Levels

Abstract

Background: Glucose variability may play an important role in development of atherosclerosis. The objective of this study was to assess the relationship of glycemic variability determined by a continuous glucose monitoring system (CGMS) to clinical characteristics in ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT), in comparison with hemoglobin A1c (HbA1c).

Methods: In 23 patients with STEMI (66±11 years, 20 males; 15 T2DM, 8 IGT), CGMS was performed for consecutive 24 hours immediately after successful primary coronary intervention in the fasting state. Glycemic variety was analyzed by calculating levels of the mean amplitude of glycemic excursions (MAGE) based on CGMS data. Gensini score was used to assess the severity of coronary artery disease. Neutrophil/lymphocyte ratio (NLR), high-sensitive C reactive protein (hs-CRP) and urinary liver-type fatty acid-binding protein (L-FABP) levels (as index of oxidative stress) were measured. Platelet reactivity on admission was determined by P2Y12 reaction units (PRU) in the VerifyNow P2Y12 assay. Endothelial function was assessed by reactive hyperemia index (RHI), using Endo-PAT 2000.

Results: The relationships of MAGE and HbA1c levels to clinical characteristics were shown in table 1. MAGE was positively correlated with Gensini score, NLR, hs-CRP, urinary L-FABP and PRU levels, and negatively with RHI. Although, on the other hand, HbA1c levels were also correlated with Gensini score and PRU levels, they were not with the remains.

Conclusions: Glucose variability was more closely associated with poor clinical characteristics than HbA1c levels. These findings may explain contribution of glucose variability to diabetic complications and poor outcomes. The effects of glycemic excursions on vascular complications should be considered in the management of STEMI patients with T2DM and IGT.