Abstract
BackgroundIt remains unclear whether glycemic variability is related to diabetes microvascular disease, especially diabetes peripheral neuropathy (DPN). We investigated the association between glycemic variability and DPN with type 1 or 2 diabetes.MethodsForty patients (23 males and 17 females; aged 34–79 years) underwent continuous glucose monitoring (CGM) and a nerve conduction study (NCS). Glycemic variability was estimated by mean amplitude of glycemic excursions (MAGE) in CGM. DPN was quantitatively evaluated by NCS in the median, tibial, sural and medial plantar nerves.ResultsMAGE had a significantly positive correlation with disease duration and low-density lipoprotein cholesterol level (r = 0.462, p = 0.003; and r = 0.40, p = 0.011, respectively), and a significantly negative correlation with BMI and medial plantar compound nerve action potential amplitude (r = − 0.39, p = 0.012; and r = − 0.32, p = 0.042, respectively). Multivariate linear regression analysis with adjustment for clinical background showed that MAGE (β = − 0.49, p= 0.007) was independently associated with a higher risk of medial plantar neuropathy.ConclusionsGlycemic variability may be an independent risk factor for DPN.
Highlights
It remains unclear whether glycemic variability is related to diabetes microvascular disease, especially diabetes peripheral neuropathy (DPN)
Six out of 40 patients had macrovascular disease, but no relationship was observed between the existence of macrovascular disease and Hemoglobin A1c (HbA1c) or mean amplitude of glycemic excursions (MAGE)
Eight of 40 patients with severe nonproliferative diabetes retinopathy (DR) or proliferative DR had a tendency toward higher MAGE, but this association was not significant (99.5 ± 42.3 vs 127.5 ± 33.8, p = 0.091)
Summary
It remains unclear whether glycemic variability is related to diabetes microvascular disease, especially diabetes peripheral neuropathy (DPN). We investigated the association between glycemic variability and DPN with type 1 or 2 diabetes. Current treatment strategies for diabetes aim to control glucose levels to prevent the development of diabetesrelated complications. Intensive glucose control led to increased mortality compared with standard therapy in the ACCORD study [2], leading to a review of the strategies for glycemic control. Continuous glucose monitoring (CGM) allows glycemic variability to be evaluated more exactly compared with conventional self-monitoring blood glucose (SMBG). Diabetes peripheral neuropathy (DPN), one of the most common microvascular complications of diabetes, is associated with foot ulceration, amputation and a significant reduction in quality of life [7, 8].
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