Clinical Heart and Vascular Center
Glycemic Variability and HF Risk
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By Ambarish Pandey, M.D., Assistant Professor of Internal Medicine, and Matthew Segar, M.D., Internal Medicine Resident
At this year’s AHA Scientific Sessions, we presented findings from our study evaluating the associations between long-term change and visit-to-visit fluctuations in glycemia and risk of heart failure among patients with type 2 diabetes. While heart failure is a common cardiovascular complication among patients with diabetes, multiple large-scale randomized clinical trials of intensive glycemic control among patients with type 2 diabetes have not shown that strategy to lower the risk of heart failure. One proposed reason for the null effect of strict glucose control on cardiovascular outcomes has been that a single measurement of glycemia might not reflect chronic glucose exposure. Thus, fluctuations in glycemia have been proposed as an alternative prognostic marker in type 2 diabetes.
“Specifically, individuals with either a substantial decrease or increase in A1c or fasting plasma glucose had a significantly higher risk of heart failure compared with those with stable glycemic values, independently of other risk factors.”
Our study found that there was a nonlinear relationship between changes in both hemoglobin A1c and fasting plasma glucose and risk of heart failure. Specifically, individuals with either a substantial decrease or increase in A1c or fasting plasma glucose had a significantly higher risk of heart failure compared with those with stable glycemic values, independently of other risk factors. Increased long-term variability in A1c or fasting plasma glucose was also significantly associated with higher risk of heart failure.
Our study underscores the prognostic significance of substantial fluctuations in glycemic control among patients with type 2 diabetes in regard to their risk of developing heart failure. Future studies are needed to determine if long-term glycemic variability may be used to guide glycemic control strategies – specifically, whether therapies that lead to less glucose fluctuations can lower the risk of incident heart failure among high-risk patients with type 2 diabetes.
Follow Dr. Pandey on Twitter @ambarish4786 and Dr. Segar on Twitter @MattSegar
Read more articles from our Physician Update AHA Edition.