Abstract
BackgroundThis study aims to examine the association between visit-to-visit glucose variability, which was measured by coefficient of variation (CV) of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), and risk of chronic obstructive pulmonary disease (COPD) in a large number of patients with type 2 diabetes with an average follow-up of 7.58 years.MethodsWe conducted a retrospective cohort study on 27,257 patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. Visit-to-visit variability in HbA1c and FPG at baseline and the incidence of COPD were analyzed using a modified Cox proportional hazards model considering competing risks.ResultsA total of 2,346 incident cases of COPD. Patients were grouped into tertiles of FPG-CV and HbA1c-CV. The incidence rates in the first, second, and third tertiles were 9.87, 11.06, and 13.19, respectively, for FPG-CV and 10.2, 11.81, and 12.07, for HbA1c-CV per 1000 person-years. After adjusting for age, gender, diabetes duration, treatment type, smoking, hypertension, hyperlipidemia, baseline FPG and HbA1c levels, and complications, both FPG-CV and HbA1c-CV were independently associated with COPD. The hazard ratios of COPD for the third terile compared with the first tertile of FPG-CV were 1.26 (95% confidence interval [CI]: 1.13–1.40). Moreover, the hazard ratios of COPD for the third and second tertiles compared with the first tertile of HbA1c-CV were 1.13 (1.02–1.25) and 1.13 (1.02–1.26), respectively.ConclusionsPatients with FPG-CV higher than 34.6% or HbA1c-CV higher than 8.4% exhibited an increased risk of COPD. This finding confirmed the linear relationship of FPG-CV and HbA1c-CV to COPD. Visit-to-visit variability in FPG and HbA1c levels are strong predictors of COPD in patients with type 2 diabetes. Future studies should focus on lung dysfunction in diabetes, and adequate glucose control strategy in regular clinical practices must be established for COPD prevention.
Highlights
Diabetes mellitus (DM), a group of chronic disorders, poses significant public health concern
Patients were grouped into tertiles of fasting plasma glucose (FPG)-coefficient of variation (CV) and hemoglobin A1c (HbA1c)-CV
Patients with FPG-CV higher than 34.6% or HbA1c-CV higher than 8.4% exhibited an increased risk of chronic obstructive pulmonary disease (COPD). This finding confirmed the linear relationship of FPG-CV and HbA1c-CV to COPD
Summary
Diabetes mellitus (DM), a group of chronic disorders, poses significant public health concern. The global incidence of diabetes increased from approximately 176 to 410 million from 1990 to 2013, and the rank of diabetes progressed from the 10th to the 7th top cause of global years lived with disability (YLD) [1]. Type 2 diabetes became a major public health challenge in Asia, including Taiwan [3]. The prevalence and incidence rates of diabetes in Taiwan increased by over 50% and 10%, respectively [4, 5]. This chronic illness is an imperative medical or health issue because of the rapid increase in diabetes incidence worldwide and an emerging social or financial problem that must be addressed by governments. This study aims to examine the association between visit-to-visit glucose variability, which was measured by coefficient of variation (CV) of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), and risk of chronic obstructive pulmonary disease (COPD) in a large number of patients with type 2 diabetes with an average follow-up of 7.58 years
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