The impact of glucose control on coronary plaque composition in patients with diabetes mellitus

Background: Patients with diabetes mellitus (DM) are known to have large necrotic core in their coronary plaque compared to non-DM patients. We assessed coronary plaque composition in patients with angina and with/without DM according to glucose control. Methods: Study subjects consisted of 114 non-DM patients, 14 well-controlled DM patients (hemoglobin A1c [HbA1c] <7.0%), and 37 poorly controlled DM patients (HbA1c ≥7%) who underwent virtual histology intravascular ultrasound (VH-IVUS) examinations of culprit lesions. Results: The DM patients had longer lesion length (20.2 ± 7.8 mm vs 17.0 ± 7.3 mm; P≤.013) than non-DM patients. The plaque volume was highest in the poorly-controlled DM patients (188.9 ± 92.6 mm) compared with the non-DM patients (144.1 ± 92.3 mm; P≤.011) and the well-controlled DM patients (151.7 ± 82.4 mm; P≤.194). The well-controlled DM patients had less dense calcium (0.33 ± 0.14 mm/mm vs 0.71 ± 0.60 mm/mm; P≤.020) and less necrotic core (0.71 ± 0.48 mm/mm vs 1.30 ± 0.94 mm/mm; P≤.029) than the poorly-controlled DM patients and had similar amounts of dense calcium and necrotic core with non-DM patients, whereas fibrous and fibro-fatty volume showed no significant differences among the groups. Conclusion: Coronary plaque composition and plaque volume in well-controlled DM patients are similar to those in non-DM patients and both groups had less dense calcium and necrotic core volume than the poorly-controlled DM patients. These findings suggest hyperglycemia control is important in DM patients with angina.