Annual glycemic variations and risk of cancer among Chinese patients with type 2 diabetes mellitus: A population-based cohort study in Shanghai

BACKGROUND

Long-term glycemic variation in diabetes patients may have contributed to cancer incidence.

AIM

In this study we aimed at the association between annual glycemic variation and the risk of cancer in Chinese patients with type 2 diabetes mellitus (T2DM).

METHODS

Subjects of this study were from an established population-based cohort of T2DM patients in Minhang District of Shanghai, China. Incident cancer were obtained from the Shanghai Cancer Registry. Glycemic variation was evaluated using the annual fasting glucose coefficient of variation (FG-CV), which was used as a time-dependent variable in a Cox regression model to estimate the associations with the cancer risk. Restricted cubic splines were used to explore potential non-linear associations.

RESULTS

A total of 2,140 incident cancers (1100 men and 1040 women) were identified from the 46,202 diabetes patients during 12-year follow-up. The annual FG-CV remained significantly associated with an increased risk of cancer, even after adjusting for the annual mean FG level. A significant non-linear association was found in male T2DM patients, and a significant linear association in female patients.

CONCLUSIONS

The positive association of the annual FG-CV with the risk of cancer in T2DM patients indicate the importance to stabilize the FG level.

Glycemic variation in uncontrolled Graves' disease patients with normal glucose metabolism: Assessment by continuous glucose monitoring

PURPOSE

To observe the glycemic variation (GV) in uncontrolled Graves' disease (GD) patients with normal glucose metabolism measured by continuous glucose monitoring (CGM).

METHODS

This was a single-center, open-label, observational study. From January 2017 to October 2017, 20 GD patients with normal glucose metabolism and 24 healthy control subjects were recruited. Serum samples were obtained at 0, 30, and 120 min after oral glucose loading for glucose, insulin, and C-peptide level measurements. Fasting plasma fasting free triiodothyronine (FT3), free thyroxin (FT4), and thyroid stimulating hormone concentrations were also detected. All participants were subjected to a 3-day CGM after baseline data were collected. The primary endpoint was the difference in the mean amplitude of the glycemic excursions between the two groups.

RESULTS

Compared with the healthy subjects, the GD patients had higher mean amplitude of glycemic excursions (MAGE) (P < 0.01). Multiple linear stepwise regression analysis showed that FT4 level was an independent factor for the MAGE. Interestingly, the GD patients had a significant prolongation in the time to peak glucose, especially after breakfast (P < 0.01), and the elevation in the incremental area under the curve of glucose after breakfast till 4 hours later.

CONCLUSIONS

Uncontrolled GD patients with normal glucose metabolism had a greater GV, and the FT4 level may contributed to the increased GV.

Blood glucose in acute coronary syndromes. How low should you go?

INTRODUCTION AND OBJECTIVES

Hyperglycemia at admission seems to identify a subgroup of patients with acute coronary syndromes with poorer outcome. The aim of this study was to evaluate the impact of the glycemic variation during hospitalization in long-term mortality in nondiabetic patients.

METHODS

Retrospective study of 2043 consecutive patients without known diabetes mellitus admitted for acute coronary syndrome in a single coronary care unit from May 2007 through August 2013. The population was divided in quartiles regarding glycemia at admission (≤ 90 mg/dL, n = 374; 90-140 mg/dL, n = 1307; 141-180 mg/dL, n = 230; ≥ 181mg/dL, n = 111) and the mortality rate quantified for patients with glycemic variation above/below the mean for their respective quartile. The median follow-up was about 1200 days.

RESULTS

The all-cause mortality during follow-up was significantly and successively higher in the upper quartiles (9.1%, 9.7%, 13.5% and 18.9%; P = .007). Multivariate regression analysis showed that hyperglycemia at admission (≥ 181mg/dL) was a strong independent predictor of mortality during follow-up (hazard ratio = 1.74; 95% confidence interval, 1.07-2.8; P = .027). In the fourth quartile (≥ 181mg/dL), the mortality is higher in patients with higher variations of glycemia (37.5% vs 8.5%; P < .001).

CONCLUSIONS

Hyperglycemia at admission is a predictor of all-cause mortality in our population. The mortality is higher in patients with higher glycemic variations. More studies are needed to confirm these data.