Association of long-term visit-to-visit glycemic variability with risk of adverse clinical outcomes in diabetic patients with heart failure with preserved ejection fraction

Abstract Background Previous research has linked glycemic variability (GV) with cardiovascular issues in type 2 diabetes mellitus. However, its impact on patients with heart failure with preserved ejection fraction (HFpEF) remains understudied. Purpose In this study, we aim to examine how glycemic variability influences on clinical cardiovascular outcomes in diabetic HFpEF patients. Methods We conducted a retrospective cohort analysis utilizing the electronic medical records of a tertiary medical center in Taiwan between 2014 and 2019. Diabetic patients diagnosed with HFpEF were included in the study. The coefficient of variability of fasting glucose (FGCV) was determined for each individual, and the FGCVs were categorized into tertiles. We analyzed the association between FGCV and the risks of hospitalization for heart failure (HHF), atrial fibrillation (AF), cardiac mortality, and overall mortality. Results A total of 74,835 patients were enrolled in this study. Among them, 753 diabetic patients with concomitant with HFpEF and measured FGCV were identified, with a median follow-up duration of 38.1 months. In the multivariable regression model, the third tertile of FGCV demonstrated a significant association with an elevated risk of HHF and overall mortality compared to the first tertile (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.03-1.50, p = 0.026; HR 1.64 [1.15-2.26], p = 0.006). Although a higher FGCV exhibited a trend towards increased AF and cardiac mortality, statistical significance was not reached (HR 1.19 [0.91-1.56], p=0.208; HR 1.64 [0.87-3.12], p=0.129). The Kaplan-Meier analyses revealed a significant association between higher FGCV and both HHF and overall mortality (log-rank p = 0.022 and <0.001, respectively). Conclusions Our study highlights a significant association between increased GV and a higher incidence of HHF as well as an overall mortality rate in diabetic individuals with HFpEF.