Abstract
BackgroundDiabetic complications may be associated with impaired time-dependent glycemic control. Therefore, long-term glycemic variability, assessed by variations in haemoglobin A1c (HbA1c), may be a potential risk factor for microvascular complications, such as diabetic peripheral neuropathy (DPN). We investigated the association of HbA1c variability with DPN in patients with type 2 diabetes.MethodsIn this cross-sectional study, 563 type 2 diabetic patients who had been screened for DPN and undergone quarterly HbA1c measurements during the year preceding enrolment were recruited. DPN was confirmed in patients displaying both clinical manifestations of neuropathy and abnormalities in a nerve conduction evaluation. HbA1c variability was assessed by the coefficient of variation of HbA1c (CV-HbA1c), and the mean of HbA1c (M-HbA1c) was calculated. In addition, medical history and clinical data were collected.ResultsAmong the recruited patients, 18.1% (n = 102) were found to have DPN, and these patients also presented with a higher CV-HbA1c than the patients without DPN (p < 0.001). The proportion of patients with DPN increased significantly from 6.9% in the first to 19.1% in the second and 28.5% in the third tertile of CV-HbA1c (p for trend < 0.001). After adjusting for initial HbA1c, M-HbA1c and other clinical factors via multiple logistic regression analysis, the odds ratios (ORs) for DPN in the second and third versus those in the first CV-HbA1c tertile were 3.61 (95% CI 1.62–8.04) and 6.48 (2.86–14.72), respectively. The area under the receiver operating characteristic (ROC) curve of CV-HbA1c was larger than that of M-HbA1c, at 0.711 (95% CI 0.659–0.763) and 0.662 (0.604–0.721), respectively. ROC analysis also revealed that the optimal cutoff value of CV-HbA1c to indicate DPN was 15.15%, and its corresponding sensitivity and specificity were 66.67% and 65.73%, respectively.ConclusionsIncreased HbA1c variability is closely associated with DPN in type 2 diabetic patients and could be considered as a potent indicator for DPN in these patients.
Highlights
Diabetic complications may be associated with impaired time-dependent glycemic control
When compared to the patients without diabetic peripheral neuropathy (DPN), patients with DPN presented with a higher age, diabetic duration, hypertension prevalence, insulin resistance index, initial haemoglobin A1c (HbA1c) and urinary albumin-to-creatinine ratio (UACR)
Proportion and odds ratios (ORs) of DPN according to CV‐HbA1c tertiles The proportion of participants with DPN increased significantly from 6.9% in the first tertile (T1) to 19.1% in the second tertile (T2) and 28.5% in the third tertile (T3) of CV-HbA1c (p for trend < 0.001)
Summary
Diabetic complications may be associated with impaired time-dependent glycemic control. Long-term glycemic variability, assessed by variations in haemoglobin A1c (HbA1c), may be a potential risk factor for microvascular complications, such as diabetic peripheral neuropathy (DPN). We investigated the association of HbA1c variability with DPN in patients with type 2 diabetes. Diabetic peripheral neuropathy (DPN), one of the most common microvascular complications, is closely connected to morbidity and mortality in type 2 diabetic patients [1]. Microvascular complications of diabetes may be associated with impaired time-dependent glycemic control [7]. Long-term glycemic variability assessed by HbA1c variability over the course of several months may be a reliable risk factor for microvascular complications, including diabetic neuropathy. The role of HbA1c variability in DPN is not well known
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