ASSOCIATION OF GLYCEMIC VARIABILITY AND VASCULAR COMPLICATIONS IN PATIENTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES
Type 2 diabetes mellitus (DM 2) is characterized by a chronic progressive course and is associated with high disability due to the development of numerous micro-and macrovascular complications. A prerequisite for the prevention of late complications of diabetes is strict glycemic control, which consists in main- taining the level of glycated hemoglobin (HbA1c) close to normal. However, scientific evidence shows that the alternation of normal and high concentrations of glucose has an equally important effect on the formation of vascular lesions, compared with consistently high glycemia. The degree of variability of blood glucose concentration is termed glycemic variability (GV). Recently, GV is considered as an independent predictor of complications of DM. The contribution of GV to micro- and macrovascular complications remains unclear. We therefore investigated the association between GV and kidney damage, as well as the severity of atherosclerosis in first identified type 2 diabetic patients. Methods. 102 patients (33 men and 69 women) with newly diagnosed DM 2 type were examined. The level of microalbuminuria (MAU), as well as the albumin-creatinine index (ACI), as early markers of kidney damage, were as a criterion for microvascular lesions. Ultrasonography was used to detect cervical (total carotid) and lower limb (femoral arteries) plaque and to quantify intima-media thickness (IMT) as an index of subclinical atherosclerosis. The standard deviation of blood glucose values (SD) was calculated from 24h blood glucose monitoring data for assessing glycemic variability. Depending on the SD index, all patients were divided into 2 groups: with high and normal GV. The groups were compared with each other by the level of MAU/ACI, IMT and the presence of plaques. Results. It was found kidney damage, as well as various atherosclerotic lesions (of the neck, and lower extremities) in the majority of patients with newly diagnosed type 2 diabetes. In patients at high GV values of MAU and ACI were higher than in patients from groups with low GV. The strongest correlation of SD glycemia was obtained with MAU (r=+0.65, p<0.01). There was no significant difference in the groups with high and low GV in the level of IMT in the total carotid and femoral arteries. Conclusion. GV is associated with microvascular complications in patients with newly diagnosed type 2 DM, and does not affect the severity of atherosclerosis in the onset of the disease. The study of the pattern between changes in GV and the severity of diabetic vascular lesions can be continued in prospective studies in patients with longer DM 2 experience.