Jung-Chi Hsu, Yen-Yun Yang, Shu-Lin Chuang, Lian-Yu Lin
{"title":"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","authors":"Jung-Chi Hsu, Yen-Yun Yang, Shu-Lin Chuang, Lian-Yu Lin","doi":"10.1210/clinem/dgae715","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>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.</p><p><strong>Objective: </strong>To investigate the association between increased GV and cardiovascular outcomes in diabetic patients with HFpEF.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1929-1937"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-Term Glycemic Variability Predicts Adverse Outcomes in Diabetic Heart Failure With Preserved Ejection Fraction.\",\"authors\":\"Jung-Chi Hsu, Yen-Yun Yang, Shu-Lin Chuang, Lian-Yu Lin\",\"doi\":\"10.1210/clinem/dgae715\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>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.</p><p><strong>Objective: </strong>To investigate the association between increased GV and cardiovascular outcomes in diabetic patients with HFpEF.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":50238,\"journal\":{\"name\":\"Journal of Clinical Endocrinology & Metabolism\",\"volume\":\" \",\"pages\":\"1929-1937\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Endocrinology & Metabolism\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1210/clinem/dgae715\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Endocrinology & Metabolism","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1210/clinem/dgae715","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Long-Term Glycemic Variability Predicts Adverse Outcomes in Diabetic Heart Failure With Preserved Ejection Fraction.
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.
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.
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