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. 2025 Oct 8;25(1):719.
doi: 10.1186/s12872-025-05182-w.

Relation of glucose variability on mortality from any cause and cardiovascular diseases in individuals with type 2 diabetes: mediation analysis of echocardiographic parameters

Cheng-Chieh Lin  1   2 , Chia-Ing Li  1   3 , Chiu-Shong Liu  1   2 , Chih-Hsueh Lin  1   2 , Shing-Yu Yang  4 , Tsai-Chung Li  5   6
Affiliations

Relation of glucose variability on mortality from any cause and cardiovascular diseases in individuals with type 2 diabetes: mediation analysis of echocardiographic parameters

Cheng-Chieh Lin et al. BMC Cardiovasc Disord. .

Abstract

Background: This study aimed to explore the relationship between glucose variability (GV) and echocardiographic parameters and to investigate the mediating effect of echocardiographic parameters in the association of GV with all-cause and cardiovascular mortality.

Methods: In this retrospective cohort study, we acquired data from the electronic health records of individuals with type 2 diabetes mellitus (T2DM) who visited a medical center during 2001–2020 (Jan to Oct) with follow-up until December 31, 2021. Cox proportional hazards models were conducted to explore the relationship of GV and echocardiographic parameters and mortality. We employed mediation analysis to assess the role of echocardiographic parameters in linking GV to mortality.

Results: There were 3,996 patients with T2DM. Both variability in HbA1c and fasting plasma glucose (FPG) were significantly linked with mortality. FPG variability was correlated with left ventricular mass index (LVMI), left ventricular mass (LVM), e’, and tricuspid regurgitation (TR) velocity according to multivariable regression analyses. At a mean follow-up of 5.2 years, FPG variability, LVM, LVMI, s’, and TR velocity were independently linked with all-cause and expanded cardiovascular disease (CVD) mortality. LVM, LVMI, s’, and TR velocity mediated 3.04%, 3.75%, 2.19%, and 2.71% of the association between FPG variability and mortality from any cause, respectively; and s’ and TR velocity mediated 4.33% and 2.72% of the effect of FPG variability on expanded CVD mortality, respectively. All the tested echocardiographic parameters were not significant mediators of the relationship of HbA1c-CV with mortality from any causes and expanded CVD.

Conclusions: Our study found a weak mediating effect of the echocardiographic parameters of cardiac structure and function in the association between FPG variability and mortality, but not in the association between HbA1c variability and mortality.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12872-025-05182-w.

Keywords: Echocardiographic parameters; Glucose variability; Mediation analysis; Mortality; Type 2 diabetes mellitus.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Helsinki Declaration and approved by the Ethical Review Board of China Medical University Hospital (CMUH113-REC1-216). Informed consent of the study participants was not required because the dataset used in this study consists of de-identified secondary data released for research purposes. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Association of glucose variability and echocardiographic parameters with mortality in persons with type 2 diabetes
See this image and copyright information in PMC

References

    1. GBD. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the global burden of disease study 2021. Lancet. 2023;402(10397):203–34. - PMC - PubMed
    1. Leon BM, Maddox TM. Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes. 2015;6(13):1246–58. - PMC - PubMed
    1. Huo J-L, Feng Q, Pan S, Fu W-J, Liu Z, Liu Z. Diabetic cardiomyopathy: early diagnostic biomarkers, pathogenetic mechanisms, and therapeutic interventions. Cell Death Discov. 2023;9(1):256. - PMC - PubMed
    1. Bertoni AG, Hundley WG, Massing MW, Bonds DE, Burke GL, Goff DC Jr. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care. 2004;27(3):699–703. - PubMed
    1. Ahn J, Koh J, Kim D, Kim G, Hur KY, Seo SW, et al. Mean and visit-to-visit variability of glycemia and left ventricular diastolic dysfunction: a longitudinal analysis of 3025 adults with serial echocardiography. Metabolism. 2021;116:154451. - PubMed

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