Abstract
BackgroundPlasma 1,5-anhydro-d-glucitol (1,5-AG) may be a easily accessible marker for glycemic variability under mild-to-moderate hyperglycemia. The present study was to investigate the association of 1,5-AG with peripheral nerve function and diabetic peripheral neuropathy (DPN) in patients with T2D and mild-to-moderate hyperglycemia.MethodsWe recruited 574 T2D patients with mild-to-moderate hyperglycemia (HbA1c < 8.0%) for this cross-sectional study, with plasma 1,5-AG synchronously detected. All patients were questioned for neurologic symptoms, examined for neurologic signs and screened for peripheral nerve function. Nerve function included the latency, amplitude and nerve conduction velocity (NCV) of limbs nerves (median, ulnar nerve, common peroneal, superficial peroneal, tibial and sural nerve). Besides, composite Z-score of latency, amplitude and NCV were calculated. DPN was identified as both at least a neurologic symptom/sign and an abnormality of peripheral nerve function.ResultsAmong the recruited patients, 23.9% (n = 137) were identified to be with DPN, and the prevalence of DPN decreased from 36.6%, 24.5%, 21.2%, 13.3% from first (Q1), second (Q2), and third (Q3) to fourth quartile (Q4) of 1,5-AG. Moreover, multivariable linear regression analysis showed 1,5-AG was associated with composite Z-score of nerve latency (β = − 0.18, t = − 3.84, p < 0.001), amplitude(β = 0.26, t = 5.35, p < 0.001) and NCV (β = 0.24, t = 5.61, p < 0.001), respectively. Furthermore, compared to Q4 of 1,5-AG as reference, the adjusted odds ratios and 95% CIs for DPN of Q3, Q2, and Q1 were 1.29(0.59–2.81), 1.85(0.87–3.97), and 2.72(1.16–6.34), respectively. Additionally, receiver operating characteristic analysis revealed that optimal cutoff value of 1,5-AG to indicate DPN was ≤ 30.8 μmol/L, with sensitivity of 56.20% and specificity of 66.36%.ConclusionsLow plasma 1,5-AG is closely associated with impaired peripheral nerve function and DPN in T2D patients under mild-to-moderate hyperglycemia.
Highlights
Plasma 1,5-anhydro-d-glucitol (1,5-AG) may be a accessible marker for glycemic variability under mild-to-moderate hyperglycemia
The inclusion criteria for participants were as follows: (1) aged from 25 to 80 years; (2) diagnosis of type 2 diabetes (T2D) referring to the statement released by the American Diabetes Association in 2015 [19]; (3) presented with mild-to-moderate hyperglycemia, defined as hemoglobin A1c (HbA1c) < 8.0%; (4) consent to participate in the study
Across ascending quartiles of plasma 1,5-AG, age, Body mass index (BMI), DBP and Estimated glomerular filtration rate (eGFR) were significantly increased, while diabetes duration, prevalence of smoking, Uric acid (UA), Homeostasis model assess‐ ment of insulin resistance (HOMA-IR), HbA1c and Urinary albumin-to-creatinine ratio (UACR) were significantly decreased, but ratio of female, SBP, hypertension prevalence, statins treatments, TG, Total cholesterol (TC), Highdensity lipoprotein cholesterol (HDLC), Low-density lipoprotein cholesterol (LDLC) did not show any differences between the quartiles of plasma 1,5-AG
Summary
Plasma 1,5-anhydro-d-glucitol (1,5-AG) may be a accessible marker for glycemic variability under mild-to-moderate hyperglycemia. The present study was to investigate the association of 1,5-AG with peripheral nerve function and diabetic peripheral neuropathy (DPN) in patients with T2D and mild-to-moderate hyperglycemia. Patients with DPN experienced a reduced quality of life and were at a high risk for morbidity and mortality [7, 8]. Classical glycemic variability parameters from continuous glucose monitoring (CGM) system are reported to be contributed to DPN in patients with T2D. Lower time-in-range (TIR) of 3.9–10 mmol/L derived from CGM may independently account for impaired peripheral nerve function in T2D [9]. CGM is time-consuming and costly to assess glycemic variability
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