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

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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.”

Ambarish Pandey, M.D. and Matthew Segar, M.D.
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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. 

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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.