Three components of glucose dynamics - value, variability, and autocorrelation - are independently associated with coronary plaque vulnerability

Impaired glucose homeostasis leads to numerous complications, with coronary artery disease (CAD) being a major contributor to healthcare costs worldwide. Given the limited efficacy of current CAD screening methods, we investigated the association between glucose dynamics and a predictor of coronary events measured by virtual histology-intravascular ultrasound (%NC), with the aim of predicting CAD using easy-to-measure indices. We found that continuous glucose monitoring (CGM)-derived indices, particularly average daily risk ratio (ADRR) and AC_Var, exhibited stronger predictive capabilities for %NC compared to commonly used indices such as fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and plasma glucose level at 120 min during oral glucose tolerance tests (PG120). Factor analysis identified three distinct components underlying glucose dynamics - mean, variance, and autocorrelation - each independently associated with %NC. ADRR was influenced by the first two components and AC_Var by the third. FBG, HbA1c, and PG120 were influenced only by the mean component, making them insufficient for %NC prediction. Our results were validated using data sets from Japan (n=64), America (n=53), and China (n=100). CGM-derived indices reflecting the three components of glucose dynamics can serve as more effective screening tools for CAD risk assessment, complementing or possibly replacing traditional diabetes diagnostic methods.