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Background  To investigate the effect of visit-to-visit fasting plasma glucose (FPG) variability on the left cardiac structure and function in patients with type 2 diabetes mellitus (T2DM).    Methods  In this prospective cohort study, 455 T2DM patients were included and follow-up for a median of 4.7 years. FPG measured on every hospital visit was collected. FPG variability was calculated by its coefficient of variation (CV-FPG). Left cardiac structure and function were assessed using echocardiography at baseline and after follow-up. Multivariable linear regression analyses were used to estimate the effect of FPG variability on the annualized changes in left cardiac structure and function. Subgroup analysis stratified by mean HbA1c levels (< 7% and ≥ 7%) were also performed.    Result  In multivariable regression analyses, CV-FPG was independently associated with the annualized changes in left ventricle (β = 0.137;  P  = 0.031), interventricular septum (β = 0.215;  P  = 0.001), left ventricular posterior wall thickness (β = 0.129;  P  = 0.048), left ventricular mass index (β = 0.227;  P  < 0.001), and left ventricular ejection fraction (β = − 0.132;  P  = 0.030). After additionally stratified by mean HbA1c levels, CV-FPG was still independently associated with the annualized changes in the above parameters in patients with HbA1c ≥ 7%, while not in patients with HbA1c < 7%.    Conclusions  Visit-to-visit variability in FPG could be a novel risk factor for the long-term adverse changes in left cardiac structure and systolic function in patients with type 2 diabetes.   Trial registration  ClinicalTrials.gov (NCT02587741), October 27, 2015, retrospectively registered.    Electronic supplementary material  The online version of this article (10.1186/s12933-019-0854-9) contains supplementary material, which is available to authorized users.

cardiovascular diabetology

Visit-to-visit fasting plasma glucose variability is an important risk factor for long-term changes in left cardiac structure and function in patients with type 2 diabetes