Abstract
ObjectivesLong-term glycemic variability has been related to increased risk of vascular complication in patients with diabetes. However, the association between parameters of long-term glycemic variability and risk of stroke remains not fully determined. We performed a meta-analysis to systematically evaluate the above association.MethodsMedline, Embase, and Web of Science databases were searched for longitudinal follow-up studies comparing the incidence of stroke in diabetic patients with higher or lower long-term glycemic variability. A random-effect model incorporating the potential heterogeneity among the included studies were used to pool the results.ResultsSeven follow-up studies with 725,784 diabetic patients were included, and 98% of them were with type 2 diabetes mellitus (T2DM). The mean follow-up duration was 7.7 years. Pooled results showed that compared to those with lowest category of glycemic variability, diabetic patients with the highest patients had significantly increased risk of stroke, as evidenced by glycemic variability analyzed by fasting plasma glucose coefficient of variation (FPG-CV: risk ratio [RR] = 1.24, 95% confidence interval [CI] 1.11 to 1.39, P < 0.001; I2 = 53%), standard deviation of FPG (FPG-SD: RR = 1.16, 95% CI 1.02 to 1.31, P = 0.02; I2 = 74%), HbA1c coefficient of variation (HbA1c-CV: RR = 1.88, 95% CI 1.61 to 2.19 P < 0.001; I2 = 0%), and standard deviation of HbA1c (HbA1c-SD: RR = 1.73, 95% CI 1.49 to 2.00, P < 0.001; I2 = 0%).ConclusionsLong-term glycemic variability is associated with higher risk of stroke in T2DM patients.
Highlights
People with diabetes are vulnerable to cardiovascular complications, which have become a major determinant for the prognosis of these patients [1, 2]
Patients with diabetes may have multiple concurrent risk factors and comorbidities which may affect the risk of stroke in this population, such as aging, male sex, smoking, dyslipidemia, hypertension, and glycemic control status characterized by mean Glycated hemoglobin (HbA1c) etc
Publication bias for the association between fasting plasma glucose (FPG)-standard deviation (SD) and stroke risk could not be determined because only two studies were available for the outcome. In this meta-analysis, by pooling the results of seven longitudinal follow-up studies, we found that increased long-term glycemic variability in patients with type 2 diabetes mellitus (T2DM) was significantly associated with higher risk of stroke, as evidenced by analyses with four commonly used metrics for long-term glycemic variability including fasting plasma glucose coefficient of variation (FPG-coefficient of variation (CV)), FPG-SD, HbA1c-CV, and HbA1c-SD
Summary
People with diabetes are vulnerable to cardiovascular complications, which have become a major determinant for the prognosis of these patients [1, 2]. Different parameters for long-term glycemic variability were applied among these studies, three with FPG-CV [15, 17, 19], two with FPG-SD [17, 19], four with HbA1c-CV [18,19,20,21], and the other four with [16, 18, 19, 21]. It is important to determine whether the possible association between long-term glycemic variability and stroke was independent of these risk factors. We performed a meta-analysis to systematically evaluate the possible independent association between long-term glycemic variability measured by different metrics and the risk of stroke in people with diabetes
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