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首页> 外文期刊>Cardiovascular Diabetology >Higher long-term visit-to-visit glycemic variability predicts new-onset atrial fibrillation in patients with diabetes mellitus
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Higher long-term visit-to-visit glycemic variability predicts new-onset atrial fibrillation in patients with diabetes mellitus

机译：较高的长期访问访问血糖可变性预测糖尿病患者的新出现心房颤动

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Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Glycemic variability (GV) is associated with risk of micro- and macrovascular diseases. However, whether the GV can increase the risk of AF remains unknown. The cohort study used a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 27,246 adult patients with T2DM were enrolled for analysis. Each individual was assessed to determine the coefficients of variability of fasting glucose (FGCV) and HbA1c variability score (HVS). The GV parameters were categorized into quartiles. Multivariate Cox regression models were employed to estimate the relationship between the GV parameters and the risk of AF, transient ischemic accident (TIA)/ischemic stroke and mortality in patients with T2DM. The incidence rates of AF and TIA/ischemic stroke were 21.31 and 13.71 per 1000 person-year respectively. The medium follow-up period was 70.7?months. In Cox regression model with full adjustment, the highest quartile of FGCV was not associated with increased risk of AF [Hazard ratio (HR): 1.12, 95% confidence interval (CI) 0.96–1.29, p?=?0.148] or TIA/ischemic stroke (HR: 1.04, 95% CI 0.83–1.31, p?=?0.736), but was associated with increased risk of total mortality (HR: 1.33, 95% CI 1.12–1.58, p??0.001) and non-cardiac mortality (HR: 1.41, 95% CI 1.15–1.71, p??0.001). The highest HVS was significantly associated with increased risk of AF (HR: 1.29, 95% CI 1.12–1.50, p??0.001), total mortality (HR: 2.43, 95% CI 2.03–2.90, p??0.001), cardiac mortality (HR: 1.50, 95% CI 1.06–2.14, p?=?0.024) and non-cardiac mortality (HR: 2.80, 95% CI 2.28–3.44, p??0.001) but was not associated with TIA/ischemic stroke (HR: 0.98, 95% CI 0.78–1.23, p?=?0.846). The Kaplan–Meier analysis showed significantly higher risk of AF, cardiac and non-cardiac mortality according to the magnitude of GV (log-rank?test,?p??0.001). Our data demonstrate that high GV is independently associated with the development of new-onset AF in patients with T2DM. The benefit of maintaining stable glycemic levels to improve clinical outcomes warrants further studies.
机译：心房颤动（AF）患有2型糖尿病（T2DM）的患者普遍存在。血糖变异性（GV）与微血管和大血管疾病的风险有关。但是，GV是否可以增加AF的风险仍然未知。队列研究使用了台湾三级医疗中心的国立台湾大学医院的数据库。 2014年至2019年间，共有27,246名成年人T2DM患者进行分析。评估每个人以确定空腹葡萄糖（FGCV）和HBA1C变异评分（HVS）的变异系数。 GV参数分为四分位数。采用多元COX回归模型来估算GV参数与AF，短暂性缺血事故（TIA）/缺血性卒中和T2DM患者患者死亡率之间的关系。 AF和TIA /缺血性卒中的发病率分别为每1000人的21.31和13.71。中等随访期为70.7？个月。在COX回归模型全调节时，FGCV的最高四分位与AF的风险增加无关[危险比（HR）：1.12,95％置信区间（CI）0.96-1.29，P？= 0.148]或TIA /缺血性卒中（HR：1.04,95％CI 0.83-1.31，p？= 0.736），但与总死亡率的风险增加有关（HR：1.33,95％CI 1.12-1.58，P？＆ 0.001）和非心脏病死亡率（HR：1.41,95％CI 1.15-1.71，P≤≤0.001）。 HVS最高的HV与AF的风险增加显着相关（HR：1.29,95％CI 1.12-1.50，P？<0.001），总死亡率（HR：2.43,95％CI 2.03-2.90，P？ 0.001），心脏死亡率（HR：1.50,95％CI 1.06-2.14，P？= 0.024）和非心脏病死亡率（HR：2.80,95％CI 2.28-3.44，P？<0.001）但不是与TIA /缺血性卒中有关（HR：0.98,95％CI 0.78-1.23，P？= 0.846）。 Kaplan-Meier分析表现出根据GV的幅度的AF，心脏和非心脏病死亡风险显着较高（对数级α试验，ΔP≤≤0.001）。我们的数据表明，高GV与T2DM患者的新发起AF的开发独立相关。维持稳定的血糖水平以改善临床结果的益处需要进一步研究。

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