Assessment of the impact of nocturnal hyperglycemia and glycemic variability on cardiovascular risk in patients with type 2 diabetes mellitus. The role of continuous glucose monitoring

The prevalence of diabetes mellitus is among the significant medical and social issues of the world, and cardiovascular disease is the main cause of mortality in patients with diabetes. The increasing population of patients with type 2 diabetes, and the necessity to comprehend the correlation of glycaemic control and cardiovascular complications are influencing the development of new practices in the risk assessment of such patients. The customary technique of determining the glycaemic control by means of the glycated haemoglobin (HbA1c) level fails to include key points like the changes in the glucose levels during the day have the potential to raise the risk of cardiovascular problems. Evidence demonstrates that glycaemic variability, which is the presence of nocturnal blood glucose variability, exert a considerable pathophysiological effect on the progression of atherosclerosis and other conditions of the vascular structures. Aim: to assess how nocturnal hyperglycaemia and glycaemic variability contribute to cardiovascular risk among diabetic type 2 patients. Object and methods of the research. This research was done in the Ternopil Regional Hospital on 50 type 2 diabetes patients between the ages of 40 and 75 years. Each and every patient was monitored through continuous glucose monitoring (CGM) of at least 10 days. Nocturnal glycaemic parameters analysed with CGM included time in range, time above/below range and glycaemic variability. The cardiovascular risk factors such as blood pressure, lipids profile and the HbA1c were measured also. Results. These findings demonstrated that patients with type 2 diabetes tend to experience night-time hyperglycaemia and 62 per cent of the patients experienced a night time TIR of less than the recommended 70 per cent. This was linked with high systolic blood pressure and deteriorated lipid profile. Greater glycaemic variability was linked to greater cardiovascular risk and related with the oxidative stress and atherosclerosis development. The results of multiple regression analysis revealed that Night-time TIR 36%, MAGE >5.0 mmol/L are independent predictors of high cardiovascular risk, regardless of other variables. Conclusion. The results of the obtained data support the significance of measuring night-time glycaemic parameters and glycaemic change in improving the evaluation of cardiovascular risk among patients with type 2 diabetes mellitus. Considering the high importance of nocturnal hyperglycaemia effects on metabolic and haemodynamic parameters, CGM should be introduced in clinical practice in order to control glycaemia and cardiovascular complications better.