Abstract
Previous studies exploring the influence of glycemic variability (GV) on the pathogenesis of distal symmetrical polyneuropathy (DSPN) in type 1 diabetes (T1DM) produced conflicting results. The aim of this study was to assess the relationship between GV and DSPN in T1DM. Adults with T1DM were included in this cross-sectional study and asked to undergo 3-day CGM. GV quantified by coefficient of variation (CV) and mean amplitude of glucose excursions (MAGE) were obtained from CGM. Clinical characteristics and biochemical assessments were collected for analysis. The study comprised 152 T1DM patients (53.9% males) with mean age of 44.2 year. Higher levels of age and duration of diabetes and lower levels of total cholesterol, LDL, fasting C-peptide and postprandial C-peptide were observed in DSPN subjects. DSPN groups displayed a higher blood glucose between 00:00 and 12:59 according to the CGM profile. Higher MAGE and CV were associated with increased risk of DSPN in the fully adjusted model. Meanwhile, a significant association between measurements of hypoglycemia, especially nocturnal hypoglycemia, and DSPN was found after multiple tests. CGM parameters describing the glycemic variability and hypoglycemia were potential risk factors for DSPN in adults with T1DM.
Highlights
Previous studies exploring the influence of glycemic variability (GV) on the pathogenesis of distal symmetrical polyneuropathy (DSPN) in type 1 diabetes (T1DM) produced conflicting results
We found that Continuous glucose monitoring (CGM) parameters describing GV were strongly associated with DSPN in T1DM patients
Only few previous studies questioned the association of GV and DSPN in T1DM and presented conflicting results
Summary
Previous studies exploring the influence of glycemic variability (GV) on the pathogenesis of distal symmetrical polyneuropathy (DSPN) in type 1 diabetes (T1DM) produced conflicting results. Abbreviations DSPN Distal symmetrical polyneuropathy GV Glycemic variability MAGE Mean amplitude of glycemic excursions CV Coefficient of variation AUC Area under the curve OR Odds ratio BMI Body mass index SBP Systolic blood pressure HbA1c Glycated A1c LDL Low-density lipoprotein HDL High-density lipoprotein T2DM Type 2 diabetes T1DM Type 1 diabetes CGM Continuous glucose monitoring FPG Fasting plasma glucose eGFR Estimated glomerular filtration LBGI Low blood glucose index. Increasing clinical and laboratory evidence suggests that GV is associated with DSPN independent of mean glucose in type 2 diabetes (T2DM), by causing Schwann cells apoptosis and oxidative stress[7,8,9,10]. The aim of current study was to explore the relative contribution of each internationally standardized CGM metric to DSPN in T1DM patients
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