{
  "abstract": "Introduction In a recent meta-analysis of patients treated with lipid lowering therapies to achieve contemporary targets, 76% of whom had diabetes, high-sensitivity CRP (hsCRP) was a stronger predictor of cardiovascular risk than low-density lipoprotein (LDL) cholesterol. Although, on average, patients with type 2 diabetes (T2D) have higher levels of CRP, little is known about the relationship between the quality of glucose control and hsCRP as a measure of inflammation. We therefore performed continuous glucose monitoring (CGM) on patients presenting with acute coronary syndrome (ACS) with and without T2D to explore this relationship.Methods Patients who were admitted to Oxford University Hospital with ACS were consented to the INFLAMED study. Continuous glucose monitoring (CGM) was performed during admission and/or at home for a median duration of 21 days, using Dexcom G7 glucose sensors. Participants were blinded to the glucose readings. Clinical data including hsCRP during admission were recorded. Peripheral blood was also sampled during hospital admission and PBMCs isolated and stored in liquid nitrogen for future downstream experiments.Results 89 patients were consented to the study, 45 with T2D and 44 without, and of whom 38 had CGM. hsCRP was significantly higher in patients with T2D (4.7 (IQR: 1.80–8.30) vs 2.3 (IQR: 1.00–4.50) mg/L, p-value 0.023) ( table 1) and showed an increasing trend with higher number of vessels with disease that was significant when comparing single versus triple vessel disease (2.0 (IQR: 1.00–4.78) vs 4.5 (IQR: 2.00–10.90) p-value 0.0393) (figure 1A). Different metrics of characterising hyperglycaemia, when separated to high vs low based on median values, showed differences in hsCRP but only ‘Time Above Range (TAR) (%)’, a metric derived from CGM, with a derived median value in this cohort of 4% (IQR: 1–37%), showed a significant difference (1.8(IQR: 0.73–5.88) vs 6.15(IQR: 2.43–12.25) mg/L, p-value 0.0267) (figure 1B). CGM demonstrated heterogeneity of patterns of glycaemia among patients with T2D (figure 2).Conclusion/Implications We demonstrated that hsCRP was associated with increasing extent of coronary artery disease and CGM provided additional characterisation of patterns of glycaemia, one of which showed significant association with hsCRP. We aim to perform these analyses in a larger sample size and characterise the pro-inflammatory state in diabetes at the level of transcription and cytokine secretion in immune cells and investigate how they associate with patterns of glycaemia and complexity of coronary artery disease.Abstract BS14 Table 1Patient characteristics. Values given as mean +/- standard deviation (SD) for normally distributed variables and median (interquartile range) for non-normally distributed variablesBMI: body mass index, HbA1c: glycated haemoglobin, hsCRP: high-sensitivity C-reactive protein, PCI: percutaneous coronary intervention, CABG: coronary artery bypass graftingAbstract BS14 Figure 1[A] hsCRP values in single-vessel disease (1VD), two-vessel disease (2VD) and three-vessel disease (3VD) for the whole cohort [B] hsCRP for participants characterised based on measurements of glucose categorised to low vs high, based on median values of each metric, for patients with CGMAbstract BS14 Figure 2[A] Heatmap of normalised values (0–1) for HbA1c and metrics derived from CGM [B] Representative graphs by Dexcom of interstitial glucose measured over a 24-hour period replicated over the number of days measured. All 4 traces are from patients with T2D",
  "authors": [
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK",
        "Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, UK"
      ],
      "name": "Jason Chai"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK"
      ],
      "name": "Injung Jang"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK",
        "MRC Weatherall Institute of Molecular Medicine"
      ],
      "name": "Charlotte Lees"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK"
      ],
      "name": "Katherine Boden"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, UK"
      ],
      "name": "Andrew Lucking"
    },
    {
      "affiliations": [
        "Oxford Centre for Diabetes, Endocrinology and Metabolism"
      ],
      "name": "Jeremy Tomlinson"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK",
        "Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, UK"
      ],
      "name": "Robin Choudhury"
    }
  ],
  "title": "BS14 Characterisation of patterns of glycaemia in patients with type 2 diabetes presenting with acute coronary syndrome (ACS) and its association with high-sensitivity C-reactive protein (CRP)",
  "uid": "1a234def-9b11-5cd4-8e57-d99f853e02c9"
}