The relationship between glycemic variability and diabetic peripheral neuropathy in type 2 diabetes with well-controlled HbA1c.

Feng Xu,Gang Wu,Xiao-Hua Wang,Li-Hua Zhao,Jian-Bin Su,Xue-Qin Wang,Yan Jin,Tong Chen,Jin-Feng Chen

doi:10.1186/1758-5996-6-139

Abstract

BackgroundDiabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes. Glycemic variability could be an independent risk factor for diabetes complications in addition to average glucose. Type 2 diabetes with well-controlled glycosylated hemoglobin A1c (HbA1c) may have different terms of glycemic variability and vascular complication consequences. The aim of the study is to investigate the relationship between glycemic variability and DPN in type 2 diabetes with well-controlled HbA1c (HbA1c < 7.0%).Methods45 type 2 diabetes with well-controlled HbA1c(HbA1c < 7.0%) and with DPN (DM/DPN group) were recruited in the study, and 45 type 2 diabetes with well-controlled HbA1c and without DPN (DM/–DPN group) were set as controls. The two groups were also matched for age and diabetic duration. Blood pressure, body mass index(BMI), insulin sensitivity index (Matsuda index, ISI), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDLC), and low density lipoprotein cholesterol (LDLC) were tested in the two groups. And all patients were monitored using the continuous glucose monitoring (CGM) system for consecutive 72 hours. The multiple parameters of glycemic variability included the standard deviation of blood glucose (SDBG), mean of daily differences (MODD) and mean amplitude of glycemic excursions (MAGE).ResultsThe DM/DPN group had a greater SDBG, MODD and MAGE, when compared to the DM/–DPN group (p < 0.05). BMI, TC, and LDLC of DM/DPN group were lower than those of DM/–DPN group (p < 0.05). The patients with hypoglycemia were comparable between the two groups (p > 0.05). Univariate analysis showed DPN was closely associated with BMI (OR 0.82, CI 0.72–0.94, p = 0.005), TC (OR 0.63, CI 0.42–0.93, p = 0.02), LDLC (OR 0.4, CI 0.20–0.80, p = 0.009), SDBG (OR 2.95, CI 1.55–5.61, p = 0.001), MODD (OR 4.38, CI 1.48–12.93, p = 0.008), MAGE (OR 2.18, CI 1.47–3.24, p < 0.001). Multivariate logistic regression analysis showed that MAGE (OR 2.05, CI 1.36–3.09, p = 0.001) and BMI (OR 0.85, CI 0.73–0.99, p = 0.033) were significantly correlating with DPN. Glycemic variability, evaluated by MAGE, was the most significantly independent risk factor for DPN.ConclusionsThere was a close relationship between glycemic variability evaluated by MAGE and DPN in type 2 diabetes with well-controlled HbA1c.

Highlights

Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes
Signs were revealed through physical examination with tools: touch sensation was tested with a 10-g monofilament on four sites per foot, pain sensation was tested with a pin, reflexes were tested with a tendon hammer, and vibration sensation was tested with a standard 128-Hz tuning fork
Glomerular filtration rate(GFR) was estimated by using the Baseline characteristics in the subjects As shown in Table 1, age, sex distribution, diabetic duration, Systolic blood pressure (SBP), diastolic blood pressure (DBP), TG, high density lipoprotein cholesterol (HDLC), Estimated glomerular filtration rate (eGFR), hemoglobin A1c (HbA1c), and Matsuda insulin sensitivity index (ISI) were comparable between DM/–DPN and DM/DPN groups (p > 0.05). 22.2% (n = 10) treated with insulin, 51.1% (n = 23) treated with oral hypoglycaemic agents, and 26.7% (n = 12) was on lifestyle intervention in DM/–DPN group; 37.8% (n = 17) treated with insulin, 51.1% (n = 23) treated with oral hypoglycaemic agents, and 11.1% (n = 12) was on lifestyle intervention in DM/DPN group

Summary

Introduction

Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes. Glycemic variability could be an independent risk factor for diabetes complications in addition to average glucose. Type 2 diabetes with well-controlled glycosylated hemoglobin A1c (HbA1c) may have different terms of glycemic variability and vascular complication consequences. The potential mechanisms are associated with a number of modifiable and nonmodifiable risk factors, including the degree of hyperglycemia, lipid disorders, high blood pressure, cigarette smoking, alcohol consumption, diabetes duration, height, and so on [5,6,7]. Current diabetic treatments are aimed to control fasting and postprandial glucose levels close to the target in order to prevent the development of diabetes-related complications, with glycosylated hemoglobin A1c (HbA1c) being the gold-standard assessment of long-term overall glycemic control. Diabetic patients with target value of HbA1c may have different terms of glycemic variability and vascular complication consequences

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