Long-Term Glycemic Variability Predicts Adverse Outcomes in Diabetic Heart Failure With Preserved Ejection Fraction.

IF 5 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Endocrinology & Metabolism Pub Date : 2025-06-17 DOI:10.1210/clinem/dgae715

Jung-Chi Hsu, Yen-Yun Yang, Shu-Lin Chuang, Lian-Yu Lin

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引用次数: 0

Abstract

Context: Previous studies have shown associations between glycemic variability (GV) and cardiovascular outcomes in patients with type 2 diabetes. However, the effect of GV on outcomes in diabetic patients with heart failure with preserved ejection fraction (HFpEF) has not been investigated.

Objective: To investigate the association between increased GV and cardiovascular outcomes in diabetic patients with HFpEF.

Methods: Between 2014 and 2019, we conducted a retrospective cohort analysis using the electronic medical records of a tertiary medical center in Taiwan. Diabetic patients with HFpEF were enrolled. Each individual's coefficient of variability of fasting glucose (FGCV) was determined and the FGCVs were categorized into tertiles. Multivariable Cox regression models and the Kaplan-Meier with log-rank test were used to assess the association between the FGCV and the risk of hospitalization for heart failure (HHF), atrial fibrillation (AF), cardiovascular mortality, and overall mortality.

Results: In a cohort comprising 74 835 individuals diagnosed with diabetes, a subset of 753 patients was identified with HFpEF and measurement of FGCV. The median follow-up duration was 38.1 months. In the model of full adjustment, the third FGCV tertile was statistically significantly associated with an increased risk of HHF compared to the first tertile (hazard ratio [HR] = 1.32; 95% CI, 1.04-1.69; P = .025). Likewise, the highest FGCV tertile was associated with an increased risk of death (HR 1.65; 95% CI, 1.16-2.35; P = .005), whereas it was not associated with increased of AF and cardiovascular mortality. Kaplan-Meier analyses revealed a statistically significant association between FGCV and both HHF and overall mortality (log-rank P = .022 and <.001, respectively).

Conclusion: Our study highlights a significant association between increased GV and a higher incidence of HHF as well as an elevated overall mortality rate in individuals with diabetes and HFpEF.

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长期血糖变异性可预测射血分数保留型糖尿病心力衰竭的不良预后

背景：先前的研究显示，2 型糖尿病患者的血糖变异性（GV）与心血管预后之间存在关联。然而，尚未研究血糖变异性对射血分数保留型心力衰竭（HFpEF）患者预后的影响：方法：2014 年至 2019 年期间，我们利用台湾一家三级医疗中心的电子病历进行了一项回顾性队列分析。方法：2014 年至 2019 年期间，我们利用台湾三级医疗中心的电子病历进行了回顾性队列分析。测定了每个人的空腹血糖变异系数（FGCV），并将 FGCV 分为三等分。采用多变量 Cox 回归模型和 Kaplan-Meier 加对数秩检验来评估空腹血糖变异系数与心力衰竭（HHF）住院风险、心房颤动（AF）、心血管死亡率和总死亡率之间的关系：在由 74,835 名确诊糖尿病患者组成的队列中，确定了 753 名患有高频心力衰竭并测量了 FGCV 的患者。中位随访时间为 38.1 个月。在全面调整模型中，与第一分位数相比，FGCV 第三分位数与 HHF 风险增加显著相关（危险比 [HR] = 1.32，95% 置信区间 [CI] 1.04-1.69，P = 0.025）。同样，最高 FGCV 四分位数与死亡风险增加有关（HR 1.65，95% 置信区间：1.16-2.35，p = 0.005），而与房颤和心血管死亡率增加无关。Kaplan-Meier 分析显示，FGCV 与 HHF 和总死亡率之间存在显著关联（对数秩 p = 0.022）：我们的研究表明，在糖尿病合并高频心衰患者中，GV 增加与 HHF 发生率升高和总死亡率升高之间存在显著关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Endocrinology & Metabolism 医学-内分泌学与代谢

CiteScore

11.40

自引率

5.20%

发文量

673

审稿时长

1 months

期刊介绍： The Journal of Clinical Endocrinology & Metabolism is the world"s leading peer-reviewed journal for endocrine clinical research and cutting edge clinical practice reviews. Each issue provides the latest in-depth coverage of new developments enhancing our understanding, diagnosis and treatment of endocrine and metabolic disorders. Regular features of special interest to endocrine consultants include clinical trials, clinical reviews, clinical practice guidelines, case seminars, and controversies in clinical endocrinology, as well as original reports of the most important advances in patient-oriented endocrine and metabolic research. According to the latest Thomson Reuters Journal Citation Report, JCE&M articles were cited 64,185 times in 2008.