High HbA1c variability was independently associated with a significantly increased risk of diabetic peripheral neuropathy in patients with type 2 diabetes (OR 6.48 for the highest vs lowest tertile).
Cross-Sectional (n=563)
No
Is increased HbA1c variability associated with diabetic peripheral neuropathy in patients with type 2 diabetes?
Increased HbA1c variability is strongly associated with diabetic peripheral neuropathy in type 2 diabetic patients, independent of mean HbA1c levels.
Odds Ratio: 6.48 (95% CI 2.86–14.72)
Absolute Event Rate: 28.5% vs 6.9%
p-value: p=<0.001
BACKGROUND: Diabetic complications may be associated with impaired time-dependent glycemic control. Therefore, long-term glycemic variability, assessed by variations in haemoglobin A1c (HbA1c), may be a potential risk factor for microvascular complications, such as diabetic peripheral neuropathy (DPN). We investigated the association of HbA1c variability with DPN in patients with type 2 diabetes. METHODS: In this cross-sectional study, 563 type 2 diabetic patients who had been screened for DPN and undergone quarterly HbA1c measurements during the year preceding enrolment were recruited. DPN was confirmed in patients displaying both clinical manifestations of neuropathy and abnormalities in a nerve conduction evaluation. HbA1c variability was assessed by the coefficient of variation of HbA1c (CV-HbA1c), and the mean of HbA1c (M-HbA1c) was calculated. In addition, medical history and clinical data were collected. RESULTS: Among the recruited patients, 18.1% (n = 102) were found to have DPN, and these patients also presented with a higher CV-HbA1c than the patients without DPN (p < 0.001). The proportion of patients with DPN increased significantly from 6.9% in the first to 19.1% in the second and 28.5% in the third tertile of CV-HbA1c (p for trend < 0.001). After adjusting for initial HbA1c, M-HbA1c and other clinical factors via multiple logistic regression analysis, the odds ratios (ORs) for DPN in the second and third versus those in the first CV-HbA1c tertile were 3.61 (95% CI 1.62-8.04) and 6.48 (2.86-14.72), respectively. The area under the receiver operating characteristic (ROC) curve of CV-HbA1c was larger than that of M-HbA1c, at 0.711 (95% CI 0.659-0.763) and 0.662 (0.604-0.721), respectively. ROC analysis also revealed that the optimal cutoff value of CV-HbA1c to indicate DPN was 15.15%, and its corresponding sensitivity and specificity were 66.67% and 65.73%, respectively. CONCLUSIONS: Increased HbA1c variability is closely associated with DPN in type 2 diabetic patients and could be considered as a potent indicator for DPN in these patients.
Su et al. (Thu,) conducted a cross-sectional in Type 2 diabetes (n=563). High HbA1c variability (highest tertile of CV-HbA1c) vs. Low HbA1c variability (lowest tertile of CV-HbA1c) was evaluated on Diabetic peripheral neuropathy (DPN) (OR 6.48, 95% CI 2.86-14.72, p=<0.001). High HbA1c variability was independently associated with a significantly increased risk of diabetic peripheral neuropathy in patients with type 2 diabetes (OR 6.48 for the highest vs lowest tertile).