The effect of continuous glucose monitoring-guided glycemic control on progression of coronary atherosclerosis in type 2 diabetic patients with coronary artery disease: The OPTIMAL randomized clinical trial

• DOI: 10.1016/j.jdiacomp.2023.108592
• Publication Date: 2023-08-23T23:54:04Z
• Authors: Yu Kataoka; Satoshi Kitahara; Sayaka Funabashi; Hisashi Makino; Masaki Matsubara; Miki Matsuo; Yoko Omura-Ohata; Ryo Koezuka; Mayu Tochiya; Tamiko Tamanaha; Tsutomu Tomita; Kyoko Honda-Kohmo; Michio Noguchi; Maki Maruki; Emi Kanai; Kota Murai; Takamasa Iwai; Kenichiro Sawada; Hideo Matama; Satoshi Honda; Masashi Fujino; Syuichi Yoneda; Kensuke Takagi; Fumiyuki Otsuka; Yasuhide Asaumi; Kiminori Hosoda; Stephen J. Nicholls; Satoshi Yasuda; Teruo Noguchi
• Keywords: Clinical endpoint; Post-hoc analysis

Continuous glucose monitoring (CGM) improves glycemic fluctuation and reduces hypoglycemic risk. Whether CGM-guided control favorably modulates coronary atherosclerosis in patients with type 2 diabetes (T2DM) remains unknown.The OPTIMAL trial was a prospective, randomized, single-center which 94 T2DM CAD were randomized to CGM- or HbA1c-guided for 48 weeks (jRCT1052180152). The primary endpoint the nominal change total atheroma volume (TAV) measured by serial IVUS. secondary efficacy measure maxLCBI4mm on near-infrared spectroscopy imaging.Among patients, 82 had evaluable images at weeks. Compared control, achieved greater reduction %coefficient of variation [-0.1 % (-1.8 1.6) vs. -3.3 (-5.1 -1.5), p = 0.01] increase duration between 70 180 mg/dL [-1.5 (-6.0 2.9) 6.7 (1.9 11.5), 0.02]. TAV increased 0.11 ± 1.9 mm3 group decreased -3.29 2.00 [difference -3.4 (95%CI: -8.9 2.0 mm3), 0.22]. MaxLCBI4mm, 90.1 25.6 50.6 (difference -45.6 -118.1 26.7) 0.21]. A post-hoc exploratory analysis showed regression 20.4 (95%CI:1.3 39.5 %), 0.03].CGM-guided did not slow disease progression CAD. lipidic plaque under requires further investigation.