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      Association between glycemia risk index and arterial stiffness in type 2 diabetes

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          ABSTRACT

          Aim

          This study aims to investigate the association of glycemia risk index (GRI), a novel composite metric derived from continuous glucose monitoring (CGM), with arterial stiffness in patients with type 2 diabetes.

          Materials and Methods

          A total of 342 adults with type 2 diabetes were enrolled between April and June 2023 from 11 communities in Shanghai, China. Medical examinations, including measurements of anthropometric parameters, blood pressure, and venous blood samples were conducted. Brachial‐ankle pulse wave velocity (baPWV) was examined to evaluate arterial stiffness. All the participants underwent a 14 day CGM recording and GRI was calculated from the CGM data.

          Results

          The mean age was 70.3 ± 6.8 years, and 162 (47.4%) were male. Participants with a higher baPWV had significantly higher levels of GRI and hyperglycemia component (both P for trend < 0.05). Linear regression revealed the significant positive linear associations of the GRI with baPWV in unadjusted or adjusted models (All P < 0.05). In the multivariable logistic analysis, each increase in the GRI quartile was associated with a 1.30‐fold (95% CI 1.01–1.68, P for trend < 0.05) higher prevalence of increased arterial stiffness after adjustment for age, sex, BMI, diabetes duration, current smoking status, blood pressure, and lipid profile. Subgroup analyses showed that the association between the GRI quartiles and increased arterial stiffness was stronger among participants with a diabetes duration ≥15 years ( P for interaction = 0.014).

          Conclusion

          Glycemia risk index assessed by continuous glucose monitoring is associated with increased arterial stiffness in type 2 diabetes.

          Abstract

          Glycemia risk index (GRI), is a novel composite metric, derived from continuous glucose monitoring data, reflecting both hypoglycemia and hyperglycemia. The study found that GRI is associated with increased arterial stiffness in type 2 diabetes.

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          Most cited references33

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          IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045

          To provide global, regional, and country-level estimates of diabetes prevalence and health expenditures for 2021 and projections for 2045.
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            Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.

            To determine the relation between exposure to glycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes. Prospective observational study. 23 hospital based clinics in England, Scotland, and Northern Ireland. 4585 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk. Primary predefined aggregate clinical outcomes: any end point or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photo-coagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 1% reduction in updated mean HbA(1c) adjusted for possible confounders at diagnosis of diabetes. The incidence of clinical complications was significantly associated with glycaemia. Each 1% reduction in updated mean HbA(1c) was associated with reductions in risk of 21% for any end point related to diabetes (95% confidence interval 17% to 24%, P<0.0001), 21% for deaths related to diabetes (15% to 27%, P<0.0001), 14% for myocardial infarction (8% to 21%, P<0.0001), and 37% for microvascular complications (33% to 41%, P<0.0001). No threshold of risk was observed for any end point. In patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia. Any reduction in HbA(1c) is likely to reduce the risk of complications, with the lowest risk being in those with HbA(1c) values in the normal range (<6.0%).
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              Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement.

              The present study was conducted to evaluate the validity and reproducibility of noninvasive brachial-ankle pulse wave velocity (baPWV) measurements and to examine the alteration of baPWV in patients with coronary artery disease (CAD). Simultaneous recordings of baPWV by a simple, noninvasive method and aortic pulse wave velosity (PWV) using a catheter tip with pressure manometer were performed in 41 patients with CAD, vasospastic angina, or cardiomyopathy. In 32 subjects (15 controls and 17 patients with CAD), baPWV was recorded independently by two observers in a random manner. In 55 subjects (14 controls and 41 patients with CAD), baPWV was recorded twice by a single observer on different days. baPWV were compared among 172 patients with CAD (aged 62 +/- 8 years); 655 age-matched patients without CAD but with hypertension, diabetes mellitus, or dyslipidemia; and 595 age-matched healthy subjects without these risk factors. baPWV correlated well with aortic PWV (r=0.87, p<0.01). Pearson's correlation coefficients of interobserver and intraobserver reproducibility were r=0.98 and r=0.87, respectively. The corresponding coefficients of variation were 8.4% and 10.0%. baPWV were significantly higher in CAD patients than in non-CAD patients with risk factors, for both genders (p<0.01). In addition, baPWV were higher in non-CAD patients with risk factors than in healthy subjects without risk factors. Thus, the validity and reproducibility of baPWV measurements are considerably high, and this method seems to be an acceptable marker reflecting vascular damages. baPWV measured by this simple, noninvasive method is suitable for screening vascular damages in a large population.
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                Author and article information

                Contributors
                luyingli2008@126.com
                Journal
                J Diabetes Investig
                J Diabetes Investig
                10.1111/(ISSN)2040-1124
                JDI
                Journal of Diabetes Investigation
                John Wiley and Sons Inc. (Hoboken )
                2040-1116
                2040-1124
                22 January 2024
                May 2024
                : 15
                : 5 ( doiID: 10.1111/jdi.v15.5 )
                : 614-622
                Affiliations
                [ 1 ] Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
                [ 2 ] Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging Ministry of Education Jinan Shandong China
                [ 3 ] Department of Endocrinology Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan Shandong China
                [ 4 ] iHuman Institute, School of Life Science and Technology ShanghaiTech University Shanghai China
                [ 5 ] Department of Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
                Author notes
                [*] [* ] Correspondence

                Yingli Lu

                E‐mail address: luyingli2008@ 123456126.com . Tel: 86‐21‐53315760.

                Author information
                https://orcid.org/0000-0001-9591-6991
                https://orcid.org/0000-0002-5117-1614
                Article
                JDI14153 JDI-OA-2023-0716.R1
                10.1111/jdi.14153
                11060162
                38251792
                ae380d34-e76f-4144-986a-c6c8e4a4b2fd
                © 2024 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 05 January 2024
                : 02 December 2023
                : 10 January 2024
                Page count
                Figures: 3, Tables: 3, Pages: 622, Words: 7010
                Funding
                Funded by: the Project of Biobank from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
                Award ID: YBKB202218
                Funded by: Science and Technology Commission of Shanghai Municipality , doi 10.13039/501100003399;
                Award ID: 22015810500
                Funded by: Major Science and Technology Innovation Program of Shanghai Municipal Education Commission
                Award ID: 2019‐01‐07‐00‐01‐E00059
                Funded by: National Natural Science Foundation of China , doi 10.13039/501100001809;
                Award ID: 82120108008
                Award ID: 82170870
                Categories
                Original Article
                Articles
                Clinical Science and Care
                Custom metadata
                2.0
                May 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.0 mode:remove_FC converted:30.04.2024

                arterial stiffness,continuous glucose monitoring,glycaemia risk index

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