Coronary inflammation plays crucial role in type 2 diabetes mellitus (T2DM) induced cardiovascular complications. Both glucose-lowering drug interventions (GLDIS) and glycemic control (GC) status potentially correlate coronary inflammation, as indicated by changes in pericoronary adipose tissue (PCAT) attenuation, and thus influence cardiovascular risk. This study evaluated the impact of GLDIS and GC status on PCAT attenuation in T2DM patients. This retrospective study collected clinical data and coronary computed tomography angiography (CCTA) images of 1,342 patients, including 547 T2DM patients and 795 non-T2DM patients in two tertiary hospitals. T2DM patients were subgroup based on two criteria: (1) GC status: well: HbA1c < 7%, moderate: 7 ≤ HbA1c ≤ 9%, and poor: HbA1c > 9%; (2) GLDIS and non-GLDIS. PCAT attenuations of the left anterior descending artery (LAD-PCAT), left circumflex artery (LCX-PCAT), and right coronary artery (RCA-PCAT) were measured. Propensity matching (PSM) was used to cross compare PCAT attenuation of non-T2DM and all subgroups of T2DM patients. Linear regressions were conducted to evaluate the impact of GC status and GLDIS on PCAT attenuation in T2DM patients. Significant differences were observed in RCA-PCAT and LCX-PCAT between poor GC-T2DM and non-T2DM patients (LCX: − 68.75 ± 7.59 HU vs. – 71.93 ± 7.25 HU, p = 0.008; RCA: − 74.37 ± 8.44 HU vs. − 77.2 ± 7.42 HU, p = 0.026). Higher PCAT attenuation was observed in LAD-PCAT, LCX-PCAT, and RCA-PCAT in non-GLDIS T2DM patients compared with GLDIS T2DM patients (LAD: − 78.11 ± 8.01 HU vs. − 75.04 ± 8.26 HU, p = 0.022; LCX: − 71.10 ± 8.13 HU vs. − 68.31 ± 7.90 HU, p = 0.037; RCA: − 78.17 ± 8.64 HU vs. − 73.35 ± 9.32 HU, p = 0.001). In the linear regression, other than sex and duration of diabetes, both metformin and acarbose were found to be significantly associated with lower LAD-PCAT (metformin: β coefficient = − 2.476, p=0.021; acarbose: β coefficient = − 1.841, p = 0.031). Inadequate diabetes management, including poor GC and lack of GLDIS, may be associated with increased coronary artery inflammation in T2DM patients, as indicated by PCAT attenuation on CCTA, leading to increased cardiovascular risk. This finding could help healthcare providers identify T2DM patients with increased cardiovascular risk, develop improved cardiovascular management programs, and reduce subsequent cardiovascular related mortality.

中文翻译：

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基于 2 型糖尿病冠状动脉周围脂肪组织衰减的冠状动脉炎症：糖尿病管理的效果

冠状动脉炎症在 2 型糖尿病 (T2DM) 诱发的心血管并发症中起着至关重要的作用。降糖药物干预 (GLDIS) 和血糖控制 (GC) 状态都可能与冠状动脉炎症相关，如冠状动脉周围脂肪组织 (PCAT) 衰减的变化所示，从而影响心血管风险。本研究评估了 GLDIS 和 GC 状态对 T2DM 患者 PCAT 衰减的影响。这项回顾性研究收集了两家三级医院的 1,342 名患者的临床数据和冠状动脉计算机断层扫描血管造影 (CCTA) 图像，其中包括 547 名 T2DM 患者和 795 名非 T2DM 患者。 T2DM患者根据两个标准进行亚组：（1）GC状态：良好：HbA1c<7%，中度：7≤HbA1c≤9%，差：HbA1c>9%； (2) GLDIS 和非 GLDIS。测量左前降支动脉 (LAD-PCAT)、左旋支动脉 (LCX-PCAT) 和右冠状动脉 (RCA-PCAT) 的 PCAT 衰减。使用倾向匹配 (PSM) 交叉比较非 T2DM 和所有 T2DM 患者亚组的 PCAT 衰减。进行线性回归来评估 GC 状态和 GLDIS 对 T2DM 患者 PCAT 衰减的影响。不良 GC-T2DM 和非 T2DM 患者之间的 RCA-PCAT 和 LCX-PCAT 存在显着差异（LCX：− 68.75 ± 7.59 HU vs. – 71.93 ± 7.25 HU，p = 0.008；RCA：− 74.37 ± 8.44 HU vs. . − 77.2 ± 7.42 HU, p = 0.026)。与 GLDIS T2DM 患者相比，非 GLDIS T2DM 患者的 LAD-PCAT、LCX-PCAT 和 RCA-PCAT 中观察到更高的 PCAT 衰减（LAD：− 78.11 ± 8.01 HU vs. − 75.04 ± 8.26 HU，p = 0.022；LCX ：− 71.10 ± 8.13 HU 对比 − 68.31 ± 7.90 HU，p = 0.037；RCA：− 78.17 ± 8.64 HU 对比 − 73.35 ± 9.32 HU，p = 0.001）。在线性回归中，除性别和糖尿病病程外，发现二甲双胍和阿卡波糖均与较低的 LAD-PCAT 显着相关（二甲双胍：β 系数 = − 2.476，p=0.021；阿卡波糖：β 系数 = − 1.841，p = 0.031）。糖尿病管理不充分，包括 GC 不良和缺乏 GLDIS，可能与 T2DM 患者冠状动脉炎症增加有关，如 CCTA 上 PCAT 衰减所示，导致心血管风险增加。这一发现可以帮助医疗保健提供者识别心血管风险增加的 T2DM 患者，制定改进的心血管管理计划，并降低随后的心血管相关死亡率。