Glycemic Variability Is Associated with Markers of Vascular Stress in Adolescents

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• 作者：Paul S. Dasari ; MD¹ ; Benjamin S. Gandomani ; BS² ; April M. Teague ; MS¹ ; Ameya Pitale ; PhD³ ; Michael Otto ; PhD⁴ ; Kevin R. Short ; PhD¹ ; ^{kevin-short@ouhsc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AUC ; Area under the curve ; BMI ; Body mass index ; CGM ; Continuous glucose monitoring ; CRP ; C-reactive protein ; HbA1c ; Hemoglobin A1c ; HDL-C ; High density lipoprotein-cholesterol ; ICAM-1 ; Intercellular adhesion molecule 1 ; iHOMA2 ; Interactive homeostatic model of assessment 2 ; LDL-C ; Low density lipoprotein-cholesterol ; MAGE ; Mean amplitude of glycemic excursions ; NEFA ; Nonesterified fatty acids ; OGTT ; Oral glucose tolerance test ; oxLDL ; Oxidized low density lipoprotein ; sRAGE ; Soluble receptor of
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：172
• 期：Complete
• 页码：47-55.e2
• 全文大小：404 K

文摘

We used continuous glucose monitoring to test the hypothesis that mean amplitude of glycemic excursions (MAGE) is associated with circulating markers of oxidative and vascular stress in adolescents with habitually low physical activity classified as healthy weight, healthy obese, or obese with type 2 diabetes mellitus (T2DM).

Study design

A group of 13- to 21-year-olds (healthy weight = 12, healthy obese = 10, T2DM = 12) wore a continuous glucose monitor and step activity monitor for 5 days.

Results

Physical activity was similar among groups (6551 ± 401 steps/d), but aerobic fitness (peak rate of oxygen consumption) was lower (P < .05) in T2DM (15.6 ± 1.8 mL/kg/min) than either healthy weight (26.2 ± 2.2) or healthy obese (24.4 ± 2.5). MAGE (mg/dL) was higher (P < .01) in T2DM (82 ± 10) vs healthy obese (33 ± 3) and healthy weight (30 ± 3). Average glucose followed a similar pattern as MAGE. Oxidized low density lipoprotein was higher (P < .05) in T2DM (70.3 ± 5.0 U/L) and healthy obese (58.1 ± 3.8) than healthy weight (48.4 ± 2) and positively correlated with MAGE (r = 0.77). Other stress markers that were both elevated in T2DM and correlated with MAGE included E-selectin (r = 0.50), intercellular adhesion molecule 1 (r = 0.35), and C-reactive protein (r = 0.52); soluble receptor for advanced glycosylation end product was lower in T2DM and inversely correlated with MAGE (r = −0.38).

Conclusions

MAGE is highest in obese youth with T2DM. The associations between MAGE and oxidative stress markers support the proposed contribution of glycemic variability to risk for future cardiovascular disease.