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Cardiovascular autonomic neuropathy is associated with increased glycemic variability driven by hyperglycemia rather than hypoglycemia in patients with diabetes

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submitted on 2024-01-21, 08:58 and posted on 2024-01-21, 10:05 authored by Hoda Gad, Einas Elgassim, Ibrahim Mohammed, Ahmad Yaser Alhaddad, Hussein Ahmed Hussein Zaky Aly, John-John Cabibihan, Abdulaziz Al-Ali, Kishor Kumar Sadasivuni, Ioannis N. Petropoulos, Georgios Ponirakis, Wajeeha Abuhelaiqa, Amin Jayyousi, Dabia AlMohanadi, Khaled Baagar, Rayaz A. Malik

Aim

Cardiac autonomic neuropathy (CAN) has been suggested to be associated with hypoglycemia and impaired hypoglycemia unawareness. We have assessed the relationship between CAN and extensive measures of glucose variability (GV) in patients with type 1 and type 2 diabetes.

Methods

Participants with diabetes underwent continuous glucose monitoring (CGM) to obtain measures of GV and the extent of hyperglycemia and hypoglycemia and cardiovascular autonomic reflex testing.

Results

Of the 40 participants (20 T1DM and 20 T2DM) (aged 40.70 ± 13.73 years, diabetes duration 14.43 ± 7.35 years, HbA1c 8.85 ± 1.70%), 23 (57.5%) had CAN. Despite a lower coefficient of variation (CV) (31.26 ± 11.87 vs. 40.33 ± 11.03, P = 0.018), they had a higher CONGA (8.42 ± 2.58 vs. 6.68 ± 1.88, P = 0.024) with a lower median LBGI (1.60 (range: 0.20–3.50) vs. 4.90 (range: 3.20–7.40), P = 0.010) and percentage median time spent in hypoglycemia (4 (range:4–13) vs. 1 (range:0–5), P = 0.008), compared to those without CAN. The percentage GRADEEuglycemia (3.30 ± 2.78 vs. 5.69 ± 3.09, P = 0.017) and GRADEHypoglycemia (0.3 (range: 0 – 3.80) vs. 1.8 (range: 0.9–6.5), P = 0.036) were significantly lower, while the percentage median GRADEHyperglycemia (95.45 (range:93–98) vs. 91.6 (82.8–95.1), P = 0.013) was significantly higher in participants with CAN compared to those without CAN.

Conclusion

CAN was associated with increased glycemic variability with less time in euglycemia attributed to a greater time in hyperglycemia but not hypoglycemia.

Other Information

Published in: Diabetes Research and Clinical Practice
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1016/j.diabres.2023.110670

Additional institutions affiliated with: National Diabetes Center - HMC

Funding

Open Access funding provided by the Qatar National Library.

History

Language

  • English

Publisher

Elsevier

Publication Year

  • 2023

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License.

Institution affiliated with

  • Weill Cornell Medicine - Qatar
  • Qatar University
  • Center for Advanced Materials - QU
  • College of Engineering - QU
  • KINDI Center for Computing Research - CENG
  • Hamad Medical Corporation