[Glucose excursion in senior patients with type 2 diabetes mellitus and coronary artery disease].

Objectives: To explore glucose excursion and incidence of hypoglycemia in senior patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) with different hemoglobin A1c (HbA1c) values. Methods: Eighty-nine outpatients [58 male, 31 female, aged 69.0 (66.0, 73.0) years] diagnosed with T2DM and CAD in Beijing Anzhen Hospital between June 2013 and March 2016 were divided into group A (HbA1c<6.5%, n=25) and group B (HbA1c≥6.5%, n=64). Every patient wore continuous glucose monitoring system (CGMS) for 72 h. Glucose excursion parameters and incidence of hypoglycemia from CGMS readings were calculated. Results: Compared with group B, patients in group A experienced shorter diabetes duration [8.0 (3.5, 15.0) vs 15.0 (8.0, 20.0) years, Z=-2.222, P=0.026], lower standard deviation (SD) of blood glucose from CGMS, mean amplitude of glycemic excursions(MAGE) and mean of the daily differences(MODD) (P=0.001, 0.003, 0.001). However, incidence of hypoglycemia was significantly increased [56.0% (14/25) vs 32.8% (21/64), χ(2)=4.051, P=0.044] in group A. Compared to those who had not experienced hypoglycemia, patients with hypoglycemia had higher SD [1.8(1.4, 2.4) mmol/L vs 1.4(1.1, 1.8) mmol/L, Z=-3.198, P=0.001] and MAGE [6.0(3.2, 7.4) mmol/L vs 3.9(2.7, 4.8 )mmol/L, Z=-2.768, P=0.006] which were appropriate tools for assessing intraday glycemic variability. No statistical difference were found in MODD which was the index for estimating interday glycemic variability. Conclusions: Intensive glycemic control in senior patients with T2DM and CAD had higher incidence of hypoglycemia. Those with hypoglycemia experienced greater intraday glucose excursion.

Effect of glycated hemoglobin on heart function of the patients with revascularization of coronary artery.

BACKGROUND: Patients with diabetes after coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) treatment for coronary artery disease (CAD) had higher mortality rates than those without diabetes. There were limited data comparing the cardiac and metabolic differences between diabetes and non-diabetes for CABG and PCI and about impact of pre-procedure GHb level on systolic heart function in patients with diabetes. AIMS: To explore the cardio-metabolic differences and to evaluate their potential as significant risk factors. SUBJECTS AND METHOD: 124 patients with diabetes and 170 patients without diabetes were enrolled. Coronary lesions (≥ 70% stenosis in at least one major coronary artery) were documented by angiography. Patients with diabetes were divided into different groups by GHb, Coronary lesions (≥ 70% stenosis in at least one major coronary artery) were documented by angiography. CABG and PCI were performed for all the patients. Cardio-metabolic risk factors before revascularization were compared between them. RESULTS: Diabetics with GHb ≥ 8% had lower cardiac ejection fraction (EF) values than those with GHb<8% (P<0.05) or patients without diabetes (P<0.05). And count of vascular lesions between the groups was not statistically significant. Observed EF as a dependent variable negatively correlated to GHb levels (P<0.05). The levels of glycated hemoglobin A1c (GHbA1c) rose with increased fasted blood glucose (FBG) values (P<0.001). Even with treatment for hyperglycemia and dyslipidemia, overall levels of fasting blood sugar (FBG, P<0.001), GHbA1c (P<0.001), and triglycerides (TG, P<0.05) in patients with diabetes were still higher than those without diabetes respectively. CONCLUSION: Poorer glucose control with GHb ≥ 8% and decreased systolic heart function are significant risk factors that potentially contribute to worse prognosis for CABG or PCI treatment. Elevated levels of FBG, GHbA1c, and TG are evident for patients with diabetes compared to patients without diabetes prior to revascularization.