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.

中文翻译：

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血糖变异性超过HbA1c在确定高血小板反应性的2型糖尿病患者中的作用，这些患者正在接受经皮冠状动脉介入治疗。

背景技术具有治疗中的高血小板反应性（HPR）的糖尿病患者显示出增加的血栓形成事件的风险。尚不清楚测量糖化血红蛋白（HbA1c）水平和/或血糖变异性（GV）是否有助于确定较高风险的糖尿病患者，应采用定制的抗血小板和/或血糖降低策略。我们旨在调查接受经皮冠状动脉介入治疗（PCI）的2型糖尿病（DM）患者的GV，HbA1c水平与血小板反应性之间的关系。方法采用VerifyNow P2Y12测定法对2型糖尿病患者的血小板反应性进行测定。HPR定义为P2Y12反应单位（PRU）>240。使用iPro™连续葡萄糖记录仪通过血糖波动的平均幅度（MAGE）和变异系数（CV）表示GV。结果纳入了接受氯吡格雷治疗的35例患者（年龄70±9岁，男性86％，平均HbA1c 7.2±1.0％）。HbA1c与HPR独立相关（OR 7.25，95％CI 1.55-33.86，p = 0.012）。此外，当将其纳入模型时，GV指数在确定患有HPR的糖尿病患者中具有独立的（OR 1.094，95％CI 1.007-1.188，p <0.034）和其他的诊断意义（p <0.001）。结论接受氯吡格雷治疗的2型糖尿病患者中糖代谢状态与HPR显着相关。HbA1c可以识别出具有更高血栓形成风险的患者，但结合使用GV和HbA1c可以达到最高的诊断准确性。