Relationship Between Glycosylated Hemoglobin Variability And Coronary Stenosis In Patients With Type 2 Diabetes Mellitus With Coronary Heart Disease

Objectives: Glycosylated hemoglobin(HbA1c)variability was a risk factor for cardiovascular diseases in patients with type 2 diabetes mellitus(T2DM).However,the relationship between HbA1c variability and coronary stenosis in patients with T2DM with coronary heart disease(CHD)has been relatively unexplored.In the present study,we explore the relationship between HbA1c variability and coronary stenosis in patients with T2DM with CHD,in order to further improve the survival of patients with T2DM.Methods: We select 147 patients with T2DM complicated with CHD who completed coronary angiography.HbA1c variability was expressed as standard deviation(SDHbA1c),coefficient of variation(CV-HbA1c),variation independent of mean-HbA1c(VIM-HbA1c),HbA1c time in range(HbA1c TIR).Coronary stenosis expressed as number of involved vessels and Gensini score.Multivariate regression models were constructed to test the relationship between HbA1c variability and number of involved vessels,the models were adjusted for risk factors and results were expressed as adjusted hazard ratios.Then,the relationship between HbA1c variability and Gensini score were analyzed by linear regression analysis.Finally,We further explored the relationship between HbA1c variability and the degree of coronary artery stenosis by subgroup analysis according to whether being at glycemic target(HbA1c ≤ 7%).Results: We analysis the relationship between the number of involved vessels by logistic analysis.After adjusting the relevant risk factors,we found that VIM-HbA1c[OR=2.60(1.15,5.899)P=0.026],HbA1c Time in range[OR=0.13(0.043,0.41)P<0.001]was independent risk factors for the number of involved vessels.CV-HbA1c and SDHbA1c were not related to the number of involved vessels.We divided patients into T1,T2 and T3 groups according to the third percentile of Gensini score.After adjusting relevant risk factors,we found that HbA1c TIR[OR=0.009(0.002,0.036)P<0.001],SD-HbA1c[OR=4.122(1.64,10.346)P=0.001],CV-HbA1c[OR=1.408(1.035,1.915)P=0.007],VIM-HbA1c[OR=3.264(1.426,7.472)P=0.003] were were the independent risk factors for Gensini score.We analyzed the relationship between HbA1c variability and Gensini score by linear regression analysis.Through linear regression analysis,we found that Gensini score was negatively correlated with HbA1c time in range(β=-0.63 P<0.001),positively correlated with SD-HbA1c(β= 0.271 P=0.001),CV-HbA1c(β=0.176 P=0.031).We further explored the relationship between glycosylated hemoglobin variability and coronary stenosis in type 2 diabetes patients with coronary heart disease according to whether HbA1c ≤7%.HbA1c TIR was a risk factor for the number of involved vessels,was negatively correlated with Gensini score at HbA1c≤7 group.We found that when HbA1c>7%,HbA1c Time in range was a risk factor for the number of coronary artery,was no statistical significance after adjusting for the relevant risk factors.Linear regression analysis showed that the Gensini score was negatively correlated with HbA1c Time in range(β=-0.576 P<0.001),positive correlation with SD-HbA1c(β= 0.215P=0.037).Conclusions:1 HbA1c variability is a risk factor for the degree of coronary stenosis in T2DM patients with coronary heart disease.Patients with higher HbA1c variability may have more severe coronary stenosis.HbA1c variability,expecially HbA1c time in range,deserves our attention during glucose management.2 Regardless of being at glycemic target(HbA1c≤7%),HbA1c time in range is an risk factor for the degree of coronary artery stenosis in T2DM patients with coronary heart disease.