Correlation of Glycemic Variability towards Heart Failure Phenotype in Diabetes Mellitus Type 2 Patients

Christian Gunarto, dr. Vita Yanti Anggraeni, M.Sc., Ph.D., Sp.PD., Sp.JP, dr. Vina Yanti Susanti, Ph.D, Sp.PD-KEMD, dr. Imam Manggalya Adhikara Sp.PD, Ph.D

2026 | Skripsi | PENDIDIKAN DOKTER

Latar Belakang: Gagal jantung masih menjadi beban kesehatan global utama, menyebabkan 17,9 juta kematian pada tahun 2019. Gagal jantung diklasifikasikan berdasarkan fraksi ejeksi ventrikel kiri (LVEF) menjadi HFpEF, HFmrEF, dan HFrEF. Diabetes melitus tipe 2 (T2DM) merupakan faktor risiko kuat terjadinya gagal jantung karena dapat meningkatkan risiko hingga lima kali lipat. Baru-baru ini, variabilitas glikemik muncul sebagai prediktor penting luaran kardiovaskular. Namun, hubungannya dengan fenotipe gagal jantung tertentu pada pasien T2DM masih belum jelas. Penelitian ini menyelidiki hubungan antara standar deviasi variabilitas glikemik dan fenotipe gagal jantung pada pasien T2DM.

Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan standar deviasi variabilitas glikemik dengan fenotipe gagal jantung pada pasien diabetes melitus tipe 2.

Metode: Penelitian potong lintang ini menggunakan data rekam medis dari RSUP Dr. Sardjito. Populasi penelitian mencakup pasien diabetes melitus tipe 2 dan gagal jantung pada periode Januari 2021–2024, dengan data glukosa point-of-care (±7 hari) minimal 3 nilai selama 3 hari berturut-turut dan data ekokardiografi. Kriteria eksklusi meliputi terapi pengganti ginjal, keganasan, penyakit hati kronis, dan anemia. Variabilitas glikemik (standar deviasi) dikategorikan menjadi tinggi atau rendah berdasarkan titik potong kurva ROC. Analisis meliputi tabel kontingensi, uji T, dan uji Mann–Whitney U sesuai kebutuhan, dilanjutkan dengan regresi logistik multivariat menggunakan metode backward likelihood ratio dengan variabel yang bermakna pada analisis bivariat. Besar sampel ditentukan menggunakan hipotesis dua proporsi.

Hasil: Sebanyak 231 sampel dianalisis dengan rerata usia 60,74 ± 9,285 tahun dan dominasi laki-laki (70,6%). Analisis multivariat menggunakan regresi logistik menunjukkan bahwa standar deviasi variabilitas glikemik (SDGV) (OR = 3,659; 95% CI: 1.518–8.820; p = 0.004), komorbid hipertensi (OR = 0.071; 95% CI: 0.011–0.448; p = 0.005), CKD (OR = 3,268; 95% CI: 1.362–7.844; p = 0.008), penggunaan ARB (OR = 0.256; 95% CI: 0.102–0.646; p = 0.004), dan statin (OR = 14.815; 95% CI: 5.928–37.028; p < 0>

Kesimpulan: Standar deviasi variabilitas glikemik (SDGV) berhubungan dan dapat memprediksi fenotipe gagal jantung pada pasien diabetes melitus tipe 2. Pasien dengan SDGV tinggi secara signifikan lebih berisiko mengalami fenotipe non-HFpEF (HFmrEF, HFrEF) dibandingkan pasien dengan SDGV rendah.

Background: Heart failure remains a major global health burden, causing 17,9 million deaths in 2019. It is classified with left ventricular ejection fraction (LVEF) into HFpEF, HFmrEF, and HFpEF. Type 2 diabetes mellitus (T2DM) is a strong risk factor for heart failure for it increase heart failure risk up to fivefold. Recently, glycemic variability emerged as an important predictor of cardiovascular outcomes. However, its association with specific heart failure phenotype in T2DM remains unclear. This study investigates the association between standard deviation of glycemic variability and heart failure phenotypes in T2DM patients.

Objective: This study aims to know the association of standard deviation of glycemic variability with heart failure phenotype in patients with diabetes mellitus type 2.

Methods: This cross-sectional study used medical record data from dr. Sardjito General Hospital. The population included in patients with type 2 diabetes mellitus and heart failure from January 2021–2024, with point-of-care glucose data (±7 days) of at least 3 values over 3 consecutive days from echocardiography. Exclusion criteria were kidney replacement therapy, malignancy, chronic liver disease, and anemia. Glycemic variability (standard deviation) was categorized as high or low based on ROC curve cutoff. Analyses included contingency tables, T-test, and Mann–Whitney U as appropriate, followed by multivariate logistic regression using backward likelihood ratio with variables significant in bivariate analysis. Sample size was determined using a two-proportion hypothesis.

Results: A total of 231 samples were included with the mean age of 60.74 ± 9,285 years with male predominant (70,6%). Multivariate analysis using logistic regression showed standard deviation of glycemic variability (SDGV) (OR =3.659; 95% CI: 1.518-8.820; p = 0.004), hypertension comorbid (OR = 0.071; 95% CI: 0.011-0.448; p = 0.005), CKD (OR = 3,268; 95% CI: 1.362–7.844; p = 0.008), ARB use (OR = 0.256; 95% CI: 0.102-0.646; p = 0.004), and Statin (OR = 14.815; 95% CI: 5.928-37.028; p < 0>

Conclusions: Standard deviation of glycemic variability (SDGV) is associated and predict heart failure phenotype in patients with type 2 diabetes mellitus. Patient with high SDGV were significantly more likely to develop non-HFpEF phenotypes (HFmrEF, HFrEF) compared to otherwise. 

Kata Kunci : Glycemic variability, diabetes mellitus, heart failure phenotype, standard deviation