Association between severe hypoglycemia, adverse macrovascular events, and inflammation in the Edinburgh type 2 diabetes; study Bedenis R, Price AH, Robertson CM, et al. Diabetes Care. 2014; 37(12):3301-3308.
Key objective::
To determine whether a history of severe hypoglycemia was associated with an increased risk of subsequent macrovascular events in people with type 2 diabetes and to explore possible mediation of this association by inflammation.
Results:
At baseline, 87 participants (8.2%) reported one or more episodes of severe hypoglycemia within the preceding year At follow-up 99 participants (9.3%) had suffered a new macrovascular event.
Hypoglycemia was associated with increased odds of macrovascular events (odds ratio [OR] 2.11 [95% CI 1.06, 4.21], p = 0.035), including coronary heart events (OR 2.44 [95% CI 1.13, 5.26], p = 0.023), largely due to increased myocardial infarction (OR 4.02 [95% CI 1.54, 10.48], p = 0.004).
Hypoglycemia was also associated with increased levels of inflammatory markers, including a general inflammation factor derived using principal components analysis (p = 0.030, after adjustment for cardiometabolic risk factors) Significant association between hypoglycemia and macrovascular events persisted after adjustment for inflammatory markers.
Clinical take home message:
The odds of suffering a macrovascular event were higher in patients with type 2 diabetes who had a history of severe hypoglycemia. There was no evidence that a proinflammatory state had a major role in mediating this association.
The prevalence of type 2 diabetes mellitus is increasing worldwide and hence also the complications related to diabetes mellitus. Coronary heart disease (CHD) is one of the most common complications of Type 2 diabetes mellitus. The better control of glycosylated haemoglobin can result in decrease in microvascular but not in macrovascular complications. Intermittent exposure to high glucose is also known to cause more pronounced metabolic changes and cytotoxicity than constant exposure. This also causes the generation of nitrotyrosine, activates the expression of protein kinase C.
Recently a study was conducted to evaluate the relationship between blood glucose fluctuation and macrovascular dysfunction. Researchers recruited eighty eight patients of type 2 diabetes mellitus with or without coronary heart disease. Thirty healthy control subjects were also included. In these patients fasting insulin, C reactive protein and glycosylated hemoglobin was measured. A 72-hour continuous glucose monitoring (CGM) and brachial artery endothelium-dependent flow-mediated dilation (FMD) assessment were performed. The researchers observed that blood glucose fluctuation was more pronounced in type 2 diabetes mellitus patients with coronary heart disease. There are many studies which indicate that oxidative stress play an important role in the process of vascular dysfunction caused by blood glucose fluctuation. It has also been found in this study that C reactive protein was significantly higher in patients with type 2 diabetes mellitus than healthy control subjects. C reactive protein can cause vascular endothelial dysfunction in a number of ways. Researchers concluded that blood glucose fluctuation is an important factor that affects inflammatory response and possibly induces coronary heart disease in type 2 diabetes mellitus patients.
Glycated albumin is more superior to glycosylated hemoglobin and 1,5-anhydroglucitol in diagnosing CAD. Cardiovascular Diabetology 2015; 14:16
One of the risk factors associated with coronary artery disease is diabetes mellitus. The poor control of glucose metabolism can lead to increased incidence of coronary artery disease. Blood glucose level is considered to be a continuous risk factor for cardiovascular disease. The process of atherosclerosis is also accelerated in patients with raised blood glucose level. Hence, researchers started exploring which glycemic is more closely related to coronary artery disease which can help in early screening and intervention of coronary artery disease. Recently a study was done to investigate the associations of two nontraditional glycemic markers, glycated albumin (GA) and 1, 5-anhydroglucitol (1, 5-AG), as well as glycated hemoglobin A1c (HbA1c) with coronary artery disease. In this study researchers enrolled 272 subjects who underwent coronary angiography to diagnose coronary artery disease. The severity of coronary artery stenosis was assessed by the coronary stenosis index. The GA and 1, 5-AG were measured using the enzymatic method, and HbA1c was detected by high-pressure liquid chromatography.
Researchers found that levels of HbA1c and GA were significantly higher in coronary artery disease group as compare those in non-coronary artery disease group. The levels of 1, 5-AG level was significantly lower in coronary artery disease group than that in non- coronary artery disease group. Multivariate logistic regression analysis showed that GA was an independent risk factor for coronary artery disease after adjustment of traditional risk factors for coronary artery disease.
Researchers concluded that glycated albumin is more superior to glycosylated hemoglobin and 1, 5-anhydroglucitol in identifying coronary artery disease.
Diabetic Foot
