Chun-Pai Yang1, Chia-Ing Li1, Chiu-Shong Liu1, Wen-Yuan Lin1, Kai-Lin Hwang1, Sing-Yu Yang1, Tsai-Chung Li2, Cheng-Chieh Lin2. 1. From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan. 2. From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan. cclin@mail.cmu.edu.tw tcli@mail.cmu.edu.tw.
Abstract
OBJECTIVE: To examine whether variations in fasting plasma glucose (FPG), as measured by the coefficient of variation (CV), is a predictor of diabetic polyneuropathy (DPN) risk, considering glycated hemoglobin (HbA1c) and other traditional risk factors. METHODS: Type 2 diabetic patients enrolled in the National Diabetes Care Management Program were ≥30 years of age and free of DPN (n = 36,152). They were enrolled in 2002-2004 and were monitored until 2011. The related factors were analyzed using Cox proportional hazards regression models. RESULTS: During an average 7.23 years of follow-up, a total of 7,219 incident cases of DPN were identified, with a crude incidence rate of 27.62/1,000 person-years (25.83 for men and 29.31 for women). After multivariate adjustment, both FPG-CV and HbA1c were significant predictors of DPN, with corresponding hazard ratios of 1.14 (95% confidence interval [CI] 1.05-1.23) and 1.15 (95% CI 1.06-1.24) for FPG-CV in the fourth to fifth quintiles and 1.13 (95% CI 1.07-1.20) for HbA1c ≥7%. This finding maintained consistency after excluding potential confounders in the sensitivity analysis, further validating the results. CONCLUSIONS: FPG-CV and HbA1c ≥7% were potent predictors of DPN in type 2 diabetic patients. The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments.
OBJECTIVE: To examine whether variations in fasting plasma glucose (FPG), as measured by the coefficient of variation (CV), is a predictor of diabetic polyneuropathy (DPN) risk, considering glycated hemoglobin (HbA1c) and other traditional risk factors. METHODS: Type 2 diabeticpatients enrolled in the National Diabetes Care Management Program were ≥30 years of age and free of DPN (n = 36,152). They were enrolled in 2002-2004 and were monitored until 2011. The related factors were analyzed using Cox proportional hazards regression models. RESULTS: During an average 7.23 years of follow-up, a total of 7,219 incident cases of DPN were identified, with a crude incidence rate of 27.62/1,000 person-years (25.83 for men and 29.31 for women). After multivariate adjustment, both FPG-CV and HbA1c were significant predictors of DPN, with corresponding hazard ratios of 1.14 (95% confidence interval [CI] 1.05-1.23) and 1.15 (95% CI 1.06-1.24) for FPG-CV in the fourth to fifth quintiles and 1.13 (95% CI 1.07-1.20) for HbA1c ≥7%. This finding maintained consistency after excluding potential confounders in the sensitivity analysis, further validating the results. CONCLUSIONS: FPG-CV and HbA1c ≥7% were potent predictors of DPN in type 2 diabeticpatients. The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments.
Authors: Roderick C Slieker; Amber A W H van der Heijden; Giel Nijpels; Petra J M Elders; Leen M 't Hart; Joline W J Beulens Journal: Cardiovasc Diabetol Date: 2019-12-12 Impact factor: 9.951