Glucose variability, another measure of glycemic control, also relates to CV outcomes. This metric quantitates the change in glucose concentration from before a meal to that obtained afterwards and can be used to assess risk and monitor treatment effectiveness. When control is targeted to minimize glucose fluctuations, even if the HbA1c is above normal, there are cardiovascular advantages.

Consider an example of two patients with type 2 diabetes and similar HbA1c results: one patient with the continuous glucose monitoring (CGMS) tracing A, the other with tracing B (Figure 1). The tracings record three days each. Then ask, .Do these two patients have the same cardiovascular risk?. Current evidence suggests the answer is no! The patient with tracing A, with greater variability, carries a two- to three-fold increased risk of primary and secondary macrovascular disease.2,3 The purpose of this review is to examine the relationship between glucose variability and cardiovascular disease.

Controlling blood glucose in patients with diabetes mellitus reduces the risk of cardiovascular (CV) complications.1 While the UK Prospective Diabetes Study and others have related fasting plasma glucose level (FPG) and hemoglobin A1c (HbA1c) to CV outcomes, a recent interim analysis of the major NIH-funded study of patients with type 2 diabetes, the ACCORD trial, now indicates that there might be a limit to the benefits and degree of HbA1c reduction. Although specifics of the trial are yet to be published, the data analysis and safety board terminated the tight control arm of this treatment trial because of a small but significant increase in mortality. As a result, the target HbA1c for many patients with CVD will, in all likelihood, remain above the nondiabetic range.
" />
Glucose variability, another measure of glycemic control, also relates to CV outcomes. This metric quantitates the change in glucose concentration from before a meal to that obtained afterwards and can be used to assess risk and monitor treatment effectiveness. When control is targeted to minimize glucose fluctuations, even if the HbA1c is above normal, there are cardiovascular advantages.

Consider an example of two patients with type 2 diabetes and similar HbA1c results: one patient with the continuous glucose monitoring (CGMS) tracing A, the other with tracing B (Figure 1). The tracings record three days each. Then ask, .Do these two patients have the same cardiovascular risk?. Current evidence suggests the answer is no! The patient with tracing A, with greater variability, carries a two- to three-fold increased risk of primary and secondary macrovascular disease.2,3 The purpose of this review is to examine the relationship between glucose variability and cardiovascular disease.

Controlling blood glucose in patients with diabetes mellitus reduces the risk of cardiovascular (CV) complications.1 While the UK Prospective Diabetes Study and others have related fasting plasma glucose level (FPG) and hemoglobin A1c (HbA1c) to CV outcomes, a recent interim analysis of the major NIH-funded study of patients with type 2 diabetes, the ACCORD trial, now indicates that there might be a limit to the benefits and degree of HbA1c reduction. Although specifics of the trial are yet to be published, the data analysis and safety board terminated the tight control arm of this treatment trial because of a small but significant increase in mortality. As a result, the target HbA1c for many patients with CVD will, in all likelihood, remain above the nondiabetic range.
"> Author Profile – Methodist Journal
Methodist Journal

IN THIS ISSUE

Cardiovascular Imaging

Vol 16, Issue 2 (2020)


FEATURED GUEST EDITOR

ISSUE INTRO

Cardiovascular Imaging: A Window into Diagnostic and Therapeutic Management

See More
RECOGNITIONS

Guest Editor Dipan J. Shah Lends Expertise and Insight to Special Issue on Cardiovascular Imaging

See More

REVIEW ARTICLES See More

Cardiac Computed Tomography for Comprehensive Coronary Assessment: Beyond Diagnosis of Anatomic Stenosis

Cardiac Magnetic Resonance in Nonischemic Cardiomyopathies

Cardiac Computed Tomography for Structural Heart Disease Assessment and Therapeutic Planning: Focus on Prosthetic Valve Dysfunction

Fluorodeoxyglucose Applications in Cardiac PET: Viability, Inflammation, Infection, and Beyond

Cardiac Magnetic Resonance in Valvular Heart Disease: Assessment of Severity and Myocardial Remodeling

Patient-Specific Modeling for Structural Heart Intervention: Role of 3D Printing Today and Tomorrow

Artificial Intelligence in Cardiovascular Imaging

Myocardial Perfusion Imaging Using Positron Emission Tomography

CASE REPORTS See More

COVID-19: A Potential Risk Factor for Acute Pulmonary Embolism

Cardiac Lymphoma Presenting with Recurrent STEMI

Complete Heart Block in Systemic Sclerosis with Characterization on Cardiac MRI

Repair of Extent III Thoracoabdominal Aneurysm in the Presence of Aortoiliac Occlusion

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

A T2-Weighty Discovery: Aortitis on Cardiac MRI with Histopathologic Correlation

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

Case-Based Points on the Role of Imaging in Kidney Disease

POINTS TO REMEMBER

Acute Kidney Injury in Cardiogenic Shock

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”