Variability of fasting plasma glucose increased risks of diabetic polyneuropathy in T2DM.
OBJECTIVE
To examine whether variations in fasting plasma glucose (FPG), as measured by the coefficient of variation (CV), is a predictor of diabetic polyneuropathy (DPN) risk, considering glycated hemoglobin (HbA1c) and other traditional risk factors.


METHODS
Type 2 diabetic patients enrolled in the National Diabetes Care Management Program were ≥30 years of age and free of DPN (n = 36,152). They were enrolled in 2002-2004 and were monitored until 2011. The related factors were analyzed using Cox proportional hazards regression models.


RESULTS
During an average 7.23 years of follow-up, a total of 7,219 incident cases of DPN were identified, with a crude incidence rate of 27.62/1,000 person-years (25.83 for men and 29.31 for women). After multivariate adjustment, both FPG-CV and HbA1c were significant predictors of DPN, with corresponding hazard ratios of 1.14 (95% confidence interval [CI] 1.05-1.23) and 1.15 (95% CI 1.06-1.24) for FPG-CV in the fourth to fifth quintiles and 1.13 (95% CI 1.07-1.20) for HbA1c ≥7%. This finding maintained consistency after excluding potential confounders in the sensitivity analysis, further validating the results.


CONCLUSIONS
FPG-CV and HbA1c ≥7% were potent predictors of DPN in type 2 diabetic patients. The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments.
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
Chun-Pai
CP
Yang
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
Chia-Ing
CI
Li
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
Chiu-Shong
CS
Liu
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
Wen-Yuan
WY
Lin
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
Kai-Lin
KL
Hwang
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
Sing-Yu
SY
Yang
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan. cclin@mail.cmu.edu.tw tcli@mail.cmu.edu.tw.
Tsai-Chung
TC
Li
From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan. cclin@mail.cmu.edu.tw tcli@mail.cmu.edu.tw.
Cheng-Chieh
CC
Lin
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D018672:Community Health Planning; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D005215:Fasting / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D013624:Taiwan
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human