Incremental role of glycaemic variability over HbA1c in identifying type 2 diabetic patients with high platelet reactivity undergoing percutaneous coronary intervention

• Main Authors: Annunziata Nusca, Dario Tuccinardi, Claudio Proscia, Rosetta Melfi, Silvia Manfrini, Antonio Nicolucci, Antonio Ceriello, Paolo Pozzilli, Gian Paolo Ussia, Francesco Grigioni, Germano Di Sciascio
• Format: Article
• Language: English
• Published: BMC 2019-11-01
• Series: Cardiovascular Diabetology
• Subjects: Glycated haemoglobin; Glycaemic variability; Continuous glucose monitoring; Platelet reactivity; Percutaneous coronary intervention
• Online Access: http://link.springer.com/article/10.1186/s12933-019-0952-8

Abstract Background Diabetic patients with on-treatment high platelet reactivity (HPR) show an increased risk of thrombotic events. Whether measuring glycated haemoglobin (HbA1c) levels and/or glycaemic variability (GV) may help identifying diabetic patients at higher risk deserving tailored antiplatelet and/or glucose lowering strategies is unknown. We aimed to investigate the relationship between GV, HbA1c levels and platelet reactivity in patients with type 2 diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI). Methods Platelet reactivity was measured in type 2 DM patients using VerifyNow P2Y12 assay. HPR was defined as P2Y12 Reaction Unit (PRU) > 240. GV was expressed through mean amplitude of glycaemic excursions (MAGE) and coefficient of variance (CV) by using the iPro™ continuous glucose recorder. Results Thirty-five patients (age 70 ± 9 years, 86% male, mean HbA1c 7.2 ± 1.0%) on clopidogrel therapy were enrolled. HbA1c was independently associated with HPR (OR 7.25, 95% CI 1.55–33.86, p = 0.012). Furthermore, when factored into the model, GV indexes provided independent (OR 1.094, 95% CI 1.007–1.188, p < 0.034) and additional (p < 0.001) diagnostic significance in identifying diabetic patients with HPR. Conclusions Glyco-metabolic state significantly correlates with HPR in well-controlled type 2 DM patients on clopidogrel therapy. HbA1c identifies patients at higher thrombotic risk but the highest diagnostic accuracy is achieved by combining GV and HbA1c. Whether individualized antithrombotic and glucose-lowering therapies based on the assessment of these parameters may reduce the incidence of thrombotic events in patients undergoing PCI should be further investigated.