A Role for Glycemic Variation in Optimizing Management of Diabetes and Vascular Complications

血糖变化在优化糖尿病和血管并发症管理中的作用

• 批准号: 10219353
• 负责人: Peter D Reaven
• 金额: $ 12.72万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10219353
• 关键词: Algorithms; Blood Vessels; Cardiovascular system; Characteristics; Clinical; Clinical Trials; Data; Databases; Development; Diabetes Mellitus; Equilibrium; Event; Genetic; Genetic Markers; Genetic Risk; Glucose; Glycosylated hemoglobin A; Goals; Incidence; Individual; Lead; Life Style; Long-Term Effects; Measures; Microvascular Dysfunction; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient risk; Patients; Play; Population; Principal Investigator; Reporting; Risk; Risk Factors; Role; Sampling; Subgroup; Testing; Time; Variant; Visit; base; blood glucose regulation; cardiovascular disorder risk; cohort; comorbidity; database of Genotypes and Phenotypes; diabetes management; genetic variant; genome-wide; glycemic control; improved; individualized medicine; innovation; machine learning algorithm; macrovascular disease; patient subsets; predictive modeling; prevent; random forest; risk stratification; secondary analysis; standard care; success; treatment arm; treatment effect

PROJECT SUMMARY/ABSTRACT A role for glycemic variation in optimizing management of diabetes and vascular complications It is well demonstrated that high glucose levels lead to more rapid development of macrovascular and microvascular complications in people with diabetes. However, there is less consistent evidence that lowering glucose levels to near normal levels prevent or slows vascular complications, particularly in more advanced stages of type 2 diabetes. The recent VADT, ACCORD, and ADVANCE trials demonstrated that intensive efforts to lower glucose had only modest effects on the rate of vascular complications. Why glycemic control strategies that focused on reduction of glucose levels and HbA1c did not have the anticipated success in reducing vascular outcomes is not clear. This has raised the possibility that (1) there are glycemic metrics beyond those that reflect average glucose control, such as HbA1c, that can explain this paradox, and (2) there exists heterogeneous treatment effects of intensive glycemic therapy for macrovascular and microvascular complications, with subgroups of patients who do less well with intensive treatment counter-balancing those that do respond. In recent reports we have demonstrated long-term glycemic variability was associated with risk of cardiovascular disease (CVD) events, even after adjusting for traditional markers of glycemic control. Importantly, this appeared most relevant to those receiving intensive glycemic control. These preliminary findings support careful examination of determinants and consequences of glycemic variability. In this proposal, we therefore propose to (a) evaluate and compare the importance of glycemic variation, both short-term measured by 1,5-anhydroglucitol and long-term in the development of macro and microvascular complications; (b) to study whether intensive treatment is beneficial in preventing vascular outcomes when glycemic variation is constrained; (c) genetic variants associated with glycemic variation in T2D patients will explain additional risk in progression to vascular complications beyond the genetic variants associated with mean glycemic levels.

项目总结/文摘

项目成果

Risk controlled decision trees and random forests for precision Medicine.

• DOI: 10.1002/sim.9253
• 发表时间: 2022-02-20
• 期刊: Statistics in medicine
• 影响因子: 2
• 作者: Doubleday K;Zhou J;Zhou H;Fu H
• 通讯作者: Fu H

Association of Both Short-term and Long-term Glycemic Variability With the Development of Microalbuminuria in the ACCORD Trial.

ACCORD 试验中短期和长期血糖变异与微量白蛋白尿发展的关联。

• DOI: 10.2337/db23-0374
• 发表时间: 2023
• 期刊: Diabetes
• 影响因子: 7.7
• 作者: Okuno,Tomoki;Vansomphone,Arin;Zhang,Elyse;Zhou,Hua;Koska,Juraj;Reaven,Peter;Zhou,JinJ
• 通讯作者: Zhou,JinJ

Baseline blood pressure modifies the role of blood pressure variability in mortality: Results from the ACCORD trial.

• DOI: 10.1111/dom.14649
• 发表时间: 2022-05
• 期刊: Diabetes, obesity & metabolism
• 作者: Nuyujukian DS;Newell MS;Zhou JJ;Koska J;Reaven PD
• 通讯作者: Reaven PD

High-Performance Statistical Computing in the Computing Environments of the 2020s.

• DOI: 10.1214/21-sts835
• 发表时间: 2022-11
• 期刊: Statistical science : a review journal of the Institute of Mathematical Statistics