Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 1
Online Appendix for the following JACC article
TITLE: Impact of Non–Insulin-Dependent Type 2 Diabetes on Carotid Wall 18FFluorodeoxyglucose Positron Emission Tomography Uptake
AUTHORS: Jan Bucerius, MD, Venkatesh Mani, PHD, Colin Moncrieff, James H. F.
Rudd, MD, PHD, Josef Machac, MD, Valentin Fuster, MD, PHD, Michael E. Farkouh, MD,
MSC, Zahi A. Fayad, PHD
APPENDIX
Supplementary Table 2b. Multiple Linear Regression Analyses in the Whole Study
Population Using Uncorrected FDG Uptake Parameters
95%
Uncorrected FDG Uptake
Standardized
Confidence
Adjusted
Parameters
Coefficient 
Interval
R2
Significance
0.104
0.002
meanSUV
p value
BMI ≥ 30 kg/m2
0.277
0.080 - 0.325
0.001
Diabetes
-0.159
-0.242 - 0.005
0.06
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 2
Male
0.162
-0.004 - 0.253
0.058
Hypertension
0.152
-0.010 - 0.234
0.072
meanTBR
0.119
< 0.0001
Smoking
0.267
0.094 - 0.408
0.002
Male
0.216
0.037 - 0.273
0.011
Hypertension
0.166
0.000 - 0.230
0.052
Age > 65 years
0.158
-0.007 - 0.221
0.065
SHS
0.107
0.001
BMI ≥ 30 kg/m2
0.215
0.044 - 0.355
0.012
Smoking
0.212
0.056 - 0.487
0.014
Male
0.194
0.026 - 0.354
0.023
Age > 65 years
0.179
0.011 - 0.318
0.036
Multiple linear regression analyses with backward elimination to identify clinical risk
factors of carotid vessel wall inflammation in the whole study population as depicted by
uncorrected FDG uptake parameters. Mean standardized uptake value (meanSUV), mean
target-to-background ratio (meanTBR), and single hottest segment (SHS), respectively, were
the response variables and the cardiovascular risk factors age >65 years, male sex, body
mass index (BMI) ≥30 kg/m2, statin medication, history of cardiovascular disease,
smoking, alcohol use, exercise, hypertension, diabetes, and family history of cardiovascular
disease were the explanatory variables. Variables were retained in the model when p <
0.10.  is the standardized regression coefficient. In contrast to the glucose-corrected FDG
uptake parameters, diabetes could only be shown to be associated with meanSUV. Male sex
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 3
was the only clinical risk factor to be associated with all of the uncorrected FDG uptake
values.
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 4
Supplementary Table 3b. Multiple Linear Regression Analyses in Subjects With and
Without Diabetic Disease (Uncorrected FDG Uptake Parameters)
95%
Uncorrected FDG
Standardized Confidence
Adjusted
Uptake Parameters
Coefficient 
R2
Significance p value
0.126
0.012
Interval
meanSUV
Diabetic Subjects
Smoking
0.384
0.099 - 0.763
Nondiabetic Subjects
0.012
0.115
0.004
BMI ≥ 30 kg/m2
0.268
0.050 - 0.374
0.011
Hypertension
0.217
0.011 - 0.321
0.036
Exercising
0.178
-0.019 - 0.288
0.085
meanTBR
Diabetic Subjects
0.304
< 0.0001
Smoking
0.587
0.370 - 1.001
< 0.0001
Age > 65 years
0.228
-0.026 - 0.309
0.096
Nondiabetic Subjects
0.098
0.004
Hypertension
0.245
0.029 - 0.309
0.018
Male
0.215
0.009 - 0.301
0.038
SHS
Diabetic Subjects
0.32
< 0.0001
Smoking
0.512
0.455 - 1.417
< 0.0001
BMI ≥ 30 kg/m2
0.235
-0.027 - 0.478
0.079
Type 2 Diabetes and Carotid Wall FDG Uptake
Nondiabetic Subjects
Bucerius et al. 5
0.081
0.01
Male
0.214
0.009 - 0.387
0.040
Hypertension
0.212
0.006 - 0.368
0.043
Multiple linear regression analyses with backward elimination to identify clinical risk
factors of carotid vessel wall inflammation as depicted by uncorrected FDG uptake
parameters in diabetic and nondiabetic subjects. meanSUV, mean target-to-background ratio
(meanTBR) and single hottest segment (SHS), were the response variables and the
cardiovascular risk factors age > 65 years, male sex, body mass index (BMI) ≥ 30 kg/m2,
statin medication, history of cardiovascular disease, smoking, alcohol use, exercise,
hypertension, and family history of cardiovascular disease were the explanatory variables.
Variables were retained in the model when p < 0.05. The best model is shown.  is the
standardized regression coefficient. Similar to the glucose-corrected FDG uptake
parameters, smoking was a clinical risk factor for carotid wall inflammation as depicted by
all uncorrected FDG uptake parameters in diabetic patients. This was the same with
regard to hypertension, which was found to be significantly associated with all uncorrected
FDG uptake parameters as also seen with the glucose-corrected uptake values in
nondiabetic subjects.
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 6
Supplementary Table 4. Clinical Variables Stratified by Tertiles
of meanSUVgluc, meanTBRgluc, and SHSgluc
n = 131
1st Tertile
meanSUVgluc
2nd Tertile 3rd Tertile
0.96 - 2.14 2.15 - 3.34 3.35 - 4.54
n (%)
n (%)
n (%)
p value
40 (30)
78 (60)
13 (10)
Age > 65 years
11 (28)
34 (44)
1 (8)
0.021
Male sex
24 (60)
61 (78)
9 (69)
0.11
BMI ≥ 30 kg/m2
7 (18)
30 (39)
8 (62)
0.007
Smoking
7 (18)
9 (12)
2 (15)
0.66
Alcohol
12 (30)
33 (42)
5 (39)
0.43
Exercise
22 (55)
46 (59)
2 (15)
0.014
History of Cardiovascular Disease
27 (68)
49 (63)
7 (54)
0.67
Family History of Cardiovascular
28 (70)
45 (58)
6 (46)
0.24
Characteristics
Lifestyle
Medical History
Disease
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 7
Hypertension
19 (48)
61 (78)
8 (62)
0.003
Diabetes
7 (18)
26 (33)
9 (69)
0.002
Statin Medication
31 (38)
60 (77)
10 (77)
1.0
meanTBRgluc
0.95 - 2.08 2.09 - 3.22 3.23 - 4.37
n (%)
n (%)
n (%)
p value
51 (39)
72 (55)
8 (6)
Age > 65 years
14 (28)
31 (43)
1 (13)
0.078
Male
32 (63)
57 (79)
5 (63)
0.12
BMI ≥ 30 kg/m2
12 (24)
27 (38)
6 (75)
0.012
Smoking
7 (14)
9 (13)
2 (25)
0.62
Alcohol
16 (31)
30 (42)
4 (50)
0.4
Exercise
28 (55)
40 (56)
2 (25)
0.25
History of Cardiovascular Disease
31 (61)
47 (65)
5 (63)
0.88
Family History of Cardiovascular
37 (73)
39 (54)
3 (38)
0.048
Hypertension
24 (47)
61 (85)
3 (38)
< 0.0001
Diabetes
8 (16)
27 (38)
7 (88)
< 0.0001
Statin Medication
36 (71)
60 (83)
5 (63)
0.15
Characteristics
Lifestyle
Medical History
Disease
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 8
SHSgluc
n (%)
n (%)
n (%)
p value
84 (64)
43 (33)
4 (3)
Age > 65 years
28 (33)
18 (42)
0 (0)
0.21
Male
56 (67)
37 (86)
1 (25)
0.008
BMI ≥ 30 kg/m2
21 (25)
21 (49)
3 (75)
0.006
Smoking
11 (13)
5 (12)
2 (50)
0.1
Alcohol
28 (33)
20 (47)
2 (50)
0.31
Exercise
48 (57)
21 (49)
1 (25)
0.35
History of Cardiovascular Disease
52 (62)
28 (65)
3 (75)
0.83
Family History of Cardiovascular
57 (68)
20 (47)
2 (50)
0.061
Hypertension
52 (62)
33 (77)
3 (75)
0.23
Diabetes
19 (23)
20 (47)
3 (75)
0.004
Statin Medication
63 (75)
35 (81)
3 (75)
0.72
Characteristics
Lifestyle
Medical History
Disease
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 9
Clinical variables stratified by tertiles of glucose-corrected FDG uptake parameters
(meanSUVgluc, meanTBRgluc, and SHSgluc). Data are presented as absolute numbers and
percentages. The p values represent overall differences across the groups. For all FDG
uptake parameters, incidence of diabetes increased with increments of carotid wall
inflammation as depicted by FDG-PET uptake.
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 10
Type 2 Diabetes and Carotid Wall FDG Uptake
Bucerius et al. 11
Figure 4. Mean Standardized Uptake Value (meanSUVgluc [upper panel], Mean Targetto-Background Ratio (meanTBRgluc [middle panel], and Single Hottest Segment (SHSgluc
[lower panel]) in Diabetic Patients Classified According to Fasting Glucose Levels
(mmol/l).
Data are presented as median (bolded line), 25th to 75th percentile (box), and 5th to 95th
percentile (whiskers). Circles represent outliers. A one-way ANOVA was performed to test
for between-group differences. Linear trend across categories was executed by using oneway ANOVA linear contrasts:
meanSUVgluc

Unweighted: p < 0.0001

Weighted:
p < 0.0001
meanTBRgluc

Unweighted: p < 0.0001

Weighted:
p < 0.0001
SHSgluc

Unweighted: p < 0.0001

Weighted:
p < 0.0001
For all FDG uptake parameters in diabetic subjects, increasing values are observed with
increments of fasting pre-scan glucose values.