Abstract
Variability in HbA1c is associated with a higher risk of cardiovascular disease and microvascular complications in patients with type 2 diabetes. The present study evaluated the severity of somatic nerve dysfunction at different stages of chronic glycemic impairment, and its correlation with different cardio-metabolic parameters. The study was conducted on 223 patients with type 2 diabetes. We calculated the intrapersonal mean, standard deviation (SD), and coefficient of variation of HbA1c for each patient using all measurements obtained for 3 years prior to the study. Patients were divided into quartiles according to the SD of HbA1c, and we constructed composite scores of nerve conduction as the severity of peripheral neuropathy. Linear regression analysis was performed to evaluate the influence of independent variables on mean composite scores. Those with higher SD-HbA1c had a higher body mass index, mean and index HbA1c, triglyceride and uric acid level, urinary albumin excretion and albumin-creatinine ratio, proportion of insulin therapy, and prevalence of hypertension as the underlying diseases, but lower estimate glomerular filtration rate (eGFR). In addition, those with higher SD-HbA1c showed lower amplitudes and reduced motor nerve conduction velocity in tested nerves, and lower sensory nerve conduction velocity in the sural nerve. Furthermore, those with higher SD-HbA1c had higher composite scores of low extremities. Multiple linear regression analysis revealed that diabetes duration, SD-HbA1c, and eGFR were independently associated with mean composite scores. Based on our results, HbA1c variability plus chronic glycemic impairment is strongly associated with the severity of peripheral neuropathy in patients with type 2 diabetes. Aggressively control blood glucose to an acceptable range and avoid blood glucose fluctuations by individualized treatment to prevent further nerve damage.
Highlights
Diabetic peripheral neuropathy (DPN), including autonomic and somatic neuropathy, is a very important microvascular complication of diabetes
Our first analysis revealed that age, diabetes duration, systolic blood pressure (SBP), UA, hs-CRP, mean HbA1c, standard deviation (SD)-HbA1c, and estimate glomerular filtration rate (eGFR) were correlated with composite scores of nerve conduction (Table 4)
Results from the model 1 analysis (Table 5) revealed that diabetes duration, SD-HbA1c, and eGFR were significantly associated with mean composite scores of nerve conduction while there was no association with age, SBP, UA, hs-CRP, and mean HbA1c
Summary
Diabetic peripheral neuropathy (DPN), including autonomic and somatic neuropathy, is a very important microvascular complication of diabetes. By using only amplitudes of motor and sensory nerve conduction, all attributes of nerve conduction were more assessable because conduction velocities and distal latencies were too frequently unmeasurable if peroneal and tibial CMAPs were 0 (Dyck et al, 1997, 2011b; Suanprasert et al, 2014) These values were transformed to normal deviates from percentile values by correcting for age, gender, height, or weight as based on our previous study (Huang et al, 2009). Correlation analysis was used to evaluate the relationship between composite scores of nerve conduction and variables including age, diabetes duration, body mass index (BMI), waist circumstance, systolic and diastolic blood pressure, and peripheral blood studies for vascular risks. All statistical analyses were conducted using the SAS software package, version 9.1 (2002, SAS Statistical Institute, Cary, North Carolina)
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