Chia-Ing Li1,2, Hui-Man Cheng3,4, Chiu-Shong Liu1,2,5, Chih-Hsueh Lin1,5, Wen-Yuan Lin1,5, Mu-Cyun Wang1,5, Shing-Yu Yang6, Tsai-Chung Li7,8, Cheng-Chieh Lin9,10,11. 1. School of Medicine, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. 2. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. 3. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan. 4. Department of Integration of Traditional Chinese and Western Medicine, China Medical University Hospital, Taichung, Taiwan. 5. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. 6. Department of Public Health, College of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. 7. Department of Public Health, College of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. tcli@mail.cmu.edu.tw. 8. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. tcli@mail.cmu.edu.tw. 9. School of Medicine, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. cclin@mail.cmuh.org.tw. 10. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. cclin@mail.cmuh.org.tw. 11. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. cclin@mail.cmuh.org.tw.
Abstract
AIMS/HYPOTHESIS: Elevated glucose level is one of the risk factors for lower extremity amputation (LEA), but whether glycaemic variability confers independent risks of LEA remains to be elucidated. This study aimed to investigate the association between visit-to-visit glycaemic variability and minor and major LEA risks during 8 years of follow-up in type 2 diabetic individuals aged 50 years and older. METHODS: This retrospective cohort study included 27,574 ethnic Chinese type 2 diabetic individuals aged ≥50 years from the National Diabetes Care Management Program in Taiwan. Glycaemic variability measures were presented as the CVs of fasting plasma glucose (FPG-CV) and of HbA1c (A1c-CV). The effect of glycaemic variability on the incidence of LEA events was analysed using Cox proportional hazards models. RESULTS: After a median follow-up of 8.9 years, 541 incident cases of LEA with a crude incidence density rate of 2.4 per 1000 person-years were observed. After multivariate adjustment, FPG-CV and A1c-CV were found to be significantly associated with minor LEA, with corresponding HRs of 1.53 (95% CI 1.15, 2.04) and 1.34 (95% CI 1.02, 1.77) for the third tertiles of FPG-CV and A1c-CV, respectively. In addition, these associations were stronger amongst older adults with longer diabetes duration (≥3 years) than amongst those with shorter duration (<3 years) (pinteraction < 0.01). CONCLUSIONS/ INTERPRETATION: Our study suggests that visit-to-visit variations in HbA1c and FPG are important predictors of minor LEA amongst older adults with type 2 diabetes, particularly for those with more than 3 years of diabetes duration.
AIMS/HYPOTHESIS: Elevated glucose level is one of the risk factors for lower extremity amputation (LEA), but whether glycaemic variability confers independent risks of LEA remains to be elucidated. This study aimed to investigate the association between visit-to-visit glycaemic variability and minor and major LEA risks during 8 years of follow-up in type 2 diabetic individuals aged 50 years and older. METHODS: This retrospective cohort study included 27,574 ethnic Chinese type 2 diabetic individuals aged ≥50 years from the National Diabetes Care Management Program in Taiwan. Glycaemic variability measures were presented as the CVs of fasting plasma glucose (FPG-CV) and of HbA1c (A1c-CV). The effect of glycaemic variability on the incidence of LEA events was analysed using Cox proportional hazards models. RESULTS: After a median follow-up of 8.9 years, 541 incident cases of LEA with a crude incidence density rate of 2.4 per 1000 person-years were observed. After multivariate adjustment, FPG-CV and A1c-CV were found to be significantly associated with minor LEA, with corresponding HRs of 1.53 (95% CI 1.15, 2.04) and 1.34 (95% CI 1.02, 1.77) for the third tertiles of FPG-CV and A1c-CV, respectively. In addition, these associations were stronger amongst older adults with longer diabetes duration (≥3 years) than amongst those with shorter duration (<3 years) (pinteraction < 0.01). CONCLUSIONS/ INTERPRETATION: Our study suggests that visit-to-visit variations in HbA1c and FPG are important predictors of minor LEA amongst older adults with type 2 diabetes, particularly for those with more than 3 years of diabetes duration.
Entities:
Keywords:
Glycaemic variability; Lower extremity amputation; Type 2 diabetes
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