title: Visit-to-visit variability of fasting plasma glucose as predictor of ischemic stroke: competing risk analysis in a national cohort of Taiwan Diabetes Study.
abstract: BACKGROUND
  Glycemic variation as an independent predictor of ischemic stroke in type 2 diabetic patients remains unclear. This study examined visit-to-visit variations in fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), for predicting ischemic stroke independently, regardless of glycated hemoglobin (HbA1c) and other conventional risk factors in such patients.
  
  
  METHODS
  Type 2 diabetic patients enrolled in the National Diabetes Care Management Program, ≥30 years old and free of ischemic stroke (n = 28,354) in 2002 to 2004 were included, and related factors were analyzed with extended Cox proportional hazards regression models of competing risk data on stroke incidence.
  
  
  RESULTS
  After an average 7.5 years of follow-up, there were 2,250 incident cases of ischemic stroke, giving a crude incidence rate of 10.56/1,000 person-years (11.64 for men, 9.63 for women). After multivariate adjustment, hazard ratios for the second, third and fourth versus first FPG-CV quartile were 1.11 (0.98, 1.25), 1.22 (1.08, 1.38) and 1.27 (1.12, 1.43), respectively, without considering HbA1c, and 1.09 (0.96, 1.23), 1.16 (1.03, 1.31) and 1.17 (1.03, 1.32), respectively, after considering HbA1c.
  
  
  CONCLUSIONS
  Besides HbA1c, FPG-CV was a potent predictor of ischemic stroke in type 2 diabetic patients, suggesting that different therapeutic strategies now in use be rated for their potential to (1) minimize glucose fluctuations and (2) reduce HbA1c level in type 2 diabetic patients to prevent ischemic stroke.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.forename: Chun-Pai
authors.initials: CP
authors.lastname: Yang
authors.forename: Chia-Ing
authors.initials: CI
authors.lastname: Li
authors.forename: Chiu-Shong
authors.initials: CS
authors.lastname: Liu
authors.forename: Ching-Chu
authors.initials: CC
authors.lastname: Chen
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lin
authors.forename: Kai-Lin
authors.initials: KL
authors.lastname: Hwang
authors.forename: Sing-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
mesh_terms: D000328:Adult; D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin