{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:01:12Z","timestamp":1780131672407,"version":"3.54.0"},"reference-count":35,"publisher":"IMR Press","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br. J. Hosp. Med. (Lond)"],"abstract":"<jats:p>Aims\/Background: Patients with concomitant heart failure (HF) and type 2 diabetes mellitus (T2DM) are at high risk for adverse clinical outcomes. Glycemic variability (GV) has emerged as a crucial metric for assessing dysglycemia. However, its determinants in this specific patient population remain poorly characterized. This study aimed to investigate factors associated with GV in hospitalized patients with HF and T2DM. Methods: A total of 150 patients hospitalized with T2DM and HF were enrolled. Clinical and laboratory data were collected, and multiple linear regression analysis was performed to identify independent factors associated with four GV indices: standard deviation of blood glucose (SDBG), coefficient of variation (CV), mean of daily differences (MODD), and mean amplitude of glycemic excursions (MAGE). Results: Multivariate analysis revealed that C-peptide level was significantly negatively associated with all four GV indices (SDBG: \u03b2 = \u20130.219, p &lt; 0.001; log(CV): \u03b2 = \u20130.080, p &lt; 0.001; MODD: \u03b2 = \u20130.176, p &lt; 0.001; MAGE: \u03b2 = \u20130.284, p &lt; 0.001). Age showed significant positive associations with SDBG (\u03b2 = 0.020, p &lt; 0.001), log(CV) (\u03b2 = 0.009, p &lt; 0.001), and MODD (\u03b2 = 0.027, p &lt; 0.001). Diabetes duration was significantly positively associated with SDBG (\u03b2 = 0.028, p &lt; 0.001), log(CV) (\u03b2 = 0.011, p &lt; 0.001), and MODD (\u03b2 = 0.029, p &lt; 0.001). Glycated hemoglobin (HbA1c) was significantly positively associated with SDBG (\u03b2 = 0.062, p = 0.002), MODD (\u03b2 = 0.125, p &lt; 0.001), and MAGE (\u03b2 = 0.196, p &lt; 0.001). Log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) (log(NT-proBNP)) was significantly positively associated with all GV indices (SDBG: \u03b2 = 0.085, p = 0.002; log(CV): \u03b2 = 0.046, p = 0.002; MODD: \u03b2 = 0.090, p = 0.009; MAGE: \u03b2 = 0.162, p = 0.003). Additionally, family history of diabetes was positively associated with SDBG (\u03b2 = 0.184, p = 0.001), log(CV) (\u03b2 = 0.088, p = 0.004), and MODD (\u03b2 = 0.175, p = 0.012). A history of cardiovascular disease was positively associated with MAGE (\u03b2 = 0.265, p = 0.024). Body mass index (BMI) was negatively associated with MODD (\u03b2 = \u20130.036, p &lt; 0.001) but positively associated with MAGE (\u03b2 = 0.037, p = 0.007). The regression models explained 34.9% to 49.6% of the variance across the different GV indices. Conclusion: Glycemic variability in hospitalized patients with T2DM and HF is influenced by multiple clinical and metabolic factors. C-peptide level, age, diabetes duration, HF severity (reflected by NT-proBNP), and overall glycemic control are primary factors associated with GV. These findings suggest that clinical management should adopt individualized strategies that account for the heterogeneity and distinct characteristics of different GV indices.<\/jats:p>","DOI":"10.31083\/bjhm54062","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:09:42Z","timestamp":1780128582000},"source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated With Glycemic Variability in Hospitalized Patients With Type 2 Diabetes Mellitus and Heart Failure"],"prefix":"10.31083","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1697-1181","authenticated-orcid":true,"given":"Yang","family":"Jiao","sequence":"first","affiliation":[{"name":"Department of Cardiology (Clinical), People\u2019s Hospital of Baishan, 134300 Baishan, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9506-6980","authenticated-orcid":true,"given":"Jingbo","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Cardiology (Clinical), People\u2019s Hospital of Baishan, 134300 Baishan, Jilin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, et al. Type 2 Diabetes Mellitus and Heart Failure, A Scientific Statement From the American Heart Association and Heart Failure Society of America. Journal of Cardiac Failure. 2019; 25: 584\u2013619.","DOI":"10.1016\/j.cardfail.2019.05.007"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Seferovi\u0107 PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2018; 20: 853\u2013872.","DOI":"10.1002\/ejhf.1170"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Dei Cas A, Khan SS, Butler J, Mentz RJ, Bonow RO, Avogaro A, et al. Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure. JACC. Heart Failure. 2015; 3: 136\u2013145.","DOI":"10.1016\/j.jchf.2014.08.004"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Sun B, Luo Z, Zhou J. Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications. Cardiovascular Diabetology. 2021; 20: 9.","DOI":"10.1186\/s12933-020-01200-7"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Cardoso CRL, Leite NC, Moram CBM, Salles GF. Long-term visit-to-visit glycemic variability as predictor of micro- and macrovascular complications in patients with type 2 diabetes: The Rio de Janeiro Type 2 Diabetes Cohort Study. Cardiovascular Diabetology. 2018; 17: 33.","DOI":"10.1186\/s12933-018-0677-0"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Paolillo S, Marsico F, Prastaro M, Renga F, Esposito L, De Martino F, et al. Diabetic Cardiomyopathy: Definition, Diagnosis, and Therapeutic Implications. Heart Failure Clinics. 2019; 15: 341\u2013347.","DOI":"10.1016\/j.hfc.2019.02.003"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Ceriello A, Esposito K, Piconi L, Ihnat MA, Thorpe JE, Testa R, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008; 57: 1349\u20131354.","DOI":"10.2337\/db08-0063"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"McMurray JJV, Gerstein HC, Holman RR, Pfeffer MA. Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored. The Lancet. Diabetes & Endocrinology. 2014; 2: 843\u2013851.","DOI":"10.1016\/S2213-8587(14)70031-2"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019; 42: 1593\u20131603.","DOI":"10.2337\/dci19-0028"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Rodbard D. Glucose Variability: A Review of Clinical Applications and Research Developments. Diabetes Technology & Therapeutics. 2018; 20: S25\u2013S215.","DOI":"10.1089\/dia.2018.0092"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"American Diabetes Association Professional Practice Committee. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022; 45: S83\u2013S96.","DOI":"10.2337\/dc22-S006"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024; 47: S20\u2013S42.","DOI":"10.2337\/dc24-S002"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021; 42: 3599\u20133726.","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145: e895\u2013e1032.","DOI":"10.1161\/CIR.0000000000001063"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JGF, Kozhuharov N, et al. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. European Journal of Heart Failure. 2019; 21: 715\u2013731.","DOI":"10.1002\/ejhf.1494"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"DeVries JH. Glucose variability: where it is important and how to measure it. Diabetes. 2013; 62: 1405\u20131408.","DOI":"10.2337\/db12-1610"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Handelsman Y, Mechanick JI, Blonde L, Grunberger G, Bloomgarden ZT, Bray GA, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocrine Practice. 2011; 17: 1\u201353.","DOI":"10.4158\/ep.17.s2.1"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Garber AJ, Handelsman Y, Grunberger G, Einhorn D, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm\u20132020 executive summary. Endocrine Practice. 2020; 26: 107\u2013139.","DOI":"10.4158\/CS-2019-0472"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Molnar GD, Taylor WF, Ho MM. Day-to-day variation of continuously monitored glycaemia: a further measure of diabetic instability. Diabetologia. 1972; 8: 342\u2013348.","DOI":"10.1007\/BF01218495"},{"key":"ref20","unstructured":"Team RC. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2016. Available at: http:\/\/www.R-project.org\/ (Accessed: 15 March 2022)."},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Melenovsky V, Benes J, Franekova J, Kovar J, Borlaug BA, Segetova M, et al. Glucose Homeostasis, Pancreatic Endocrine Function, and Outcomes in Advanced Heart Failure. Journal of the American Heart Association. 2017; 6: e005290.","DOI":"10.1161\/JAHA.116.005290"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Wang L, Gao P, Zhang M, Huang Z, Zhang D, Deng Q, et al. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. JAMA. 2017; 317: 2515\u20132523.","DOI":"10.1001\/jama.2017.7596"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Xiang Q, Li Y, Lip GYH, Cuthbertson DJ, Huang W, Zhong Z, et al. Joint trajectories of skeletal muscle and fat mass in relation to glucose homeostasis: 6-Year findings from adults aged \u226550\u2009years. Diabetes, Obesity & Metabolism. 2025; 27: 7133\u20137145.","DOI":"10.1111\/dom.70113"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, et al. Treatment of Diabetes in Older Adults: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 2019; 104: 1520\u20131574.","DOI":"10.1210\/jc.2019-00198"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Ceriello A, Monnier L, Owens D. Glycaemic variability in diabetes: clinical and therapeutic implications. The Lancet. Diabetes & Endocrinology. 2019; 7: 221\u2013230.","DOI":"10.1016\/S2213-8587(18)30136-0"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Ceriello A, Rizvi AA, Rizzo M. Glycemic Variability, Glycated Hemoglobin, and Cardiovascular Complications: Still a Dilemma in Clinical Practice. Advances in Therapy. 2022; 39: 1\u20134.","DOI":"10.1007\/s12325-021-01942-0"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Berezin AA, Obradovic Z, Fushtey IM, Berezina TA, Novikov EV, Schmidbauer L, et al. The Impact of SGLT2 Inhibitor Dapagliflozin on Adropin Serum Levels in Men and Women with Type 2 Diabetes Mellitus and Chronic Heart Failure. Biomedicines. 2023; 11: 457.","DOI":"10.3390\/biomedicines11020457"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Lovren F, Pan Y, Quan A, Singh KK, Shukla PC, Gupta M, et al. Adropin is a novel regulator of endothelial function. Circulation. 2010; 122: S185\u2013S192.","DOI":"10.1161\/CIRCULATIONAHA.109.931782"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Butler AA, Tam CS, Stanhope KL, Wolfe BM, Ali MR, O\u2019Keeffe M, et al. Low circulating adropin concentrations with obesity and aging correlate with risk factors for metabolic disease and increase after gastric bypass surgery in humans. The Journal of Clinical Endocrinology and Metabolism. 2012; 97: 3783\u20133791.","DOI":"10.1210\/jc.2012-2194"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Alebna PL, Mehta A, Yehya A, daSilva-deAbreu A, Lavie CJ, Carbone S. Update on obesity, the obesity paradox, and obesity management in heart failure. Progress in Cardiovascular Diseases. 2024; 82: 34\u201342.","DOI":"10.1016\/j.pcad.2024.01.003"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Monnier L, Colette C, Owens DR. Glycemic variability: the third component of the dysglycemia in diabetes. Is it important? How to measure it? Journal of Diabetes Science and Technology. 2008; 2: 1094\u20131100.","DOI":"10.1177\/193229680800200618"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Carbone S, Canada JM, Billingsley HE, Siddiqui MS, Elagizi A, Lavie CJ. Obesity paradox in cardiovascular disease: where do we stand? Vascular Health and Risk Management. 2019; 15: 89\u2013100.","DOI":"10.2147\/VHRM.S168946"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Su G, Mi S, Tao H, Li Z, Yang H, Zheng H, et al. Association of glycemic variability and the presence and severity of coronary artery disease in patients with type 2 diabetes. Cardiovascular Diabetology. 2011; 10: 19.","DOI":"10.1186\/1475-2840-10-19"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Sarafidis PA, Tsapas A. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. The New England Journal of Medicine. 2016; 374: 1092.","DOI":"10.1056\/NEJMc1600827"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Monnier L, Colette C, Boegner C, Pham TC, Lapinski H, Boniface H. Continuous glucose monitoring in patients with type 2 diabetes: Why? When? Whom? Diabetes & Metabolism. 2007; 33: 247\u2013252.","DOI":"10.1016\/j.diabet.2006.11.007"}],"container-title":["British Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/5\/10.31083\/BJHM54062","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:10:17Z","timestamp":1780128617000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/5\/10.31083\/BJHM54062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1750-8460(26)02841-0"],"URL":"https:\/\/doi.org\/10.31083\/bjhm54062","relation":{},"ISSN":["1750-8460","1759-7390"],"issn-type":[{"value":"1750-8460","type":"print"},{"value":"1759-7390","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"article-number":"54062"}}