Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients
Diabetic peripheral neuropathy (DPN), a common microvascular complication of diabetes, is linked to glycaemic derangements. Glycaemic variability, as a pattern of glycaemic derangements, is a key risk factor for diabetic complications. We investigated the association of glycaemic variability with DPN in a large-scale sample of type 2 diabetic patients.
In this cross-sectional study, we enrolled 982 type 2 diabetic patients who were screened for DPN and monitored by a continuous glucose monitoring (CGM) system between February 2011 and January 2017. Multiple glycaemic variability parameters, including the mean amplitude of glycaemic excursions (MAGE), mean of daily differences (MODD), standard deviation of glucose (SD), and 24-h mean glucose (24-h MG), were calculated from glucose profiles obtained from CGM. Other possible risks for DPN were also examined.
Of the recruited type 2 diabetic patients, 20.1% (n = 197) presented with DPN, and these patients also had a higher MAGE, MODD, SD, and 24-h MG than patients without DPN (p < 0.001). Using univariate and multiple logistic regression analyses, MAGE and conventional risks including diabetic duration, HOMA-IR, and hemoglobin A1c (HbA1c) were found to be independent contributors to DPN, and the corresponding odds ratios (95% confidence interval) were 4.57 (3.48–6.01), 1.10 (1.03–1.17), 1.24 (1.09–1.41), and 1.33 (1.15–1.53), respectively. Receiver operating characteristic analysis indicated that the optimal MAGE cutoff value for predicting DPN was 4.60 mmol/L; the corresponding sensitivity was 64.47%, and the specificity was 75.54%.
In addition to conventional risks including diabetic duration, HOMA-IR and HbA1c, increased glycaemic variability assessed by MAGE is a significant independent contributor to DPN in type 2 diabetic patients.
KeywordsType 2 diabetes Risk factor Glycaemic variability Diabetic peripheral neuropathy
Body mass index
Systolic blood pressure
Diastolic blood pressure
High-density lipoprotein cholesterol
Low-density lipoprotein cholesterol
Fasting plasma glucose
- Serum UA
Serum uric acid
Insulin resistance estimated by the HOMA model
Glycosylated hemoglobin A1c
Mean amplitude of glycaemic excursions
Mean of daily differences
Standard deviation of glucose
- 24-h MG
24-h Mean glucose
The study was funded by the Scientific Research Program of Nantong (HS2012028 and MS22015065), the Scientific Research Program of Health and Planning Commission of Jiangsu (H201553) and the Scientific and Educational Program for Prosperity of Health Care of Jiangsu (QNRC2016408).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study strictly adhered to the principles of the Helsinki Declaration and was approved by the Medical Ethics Committee of Nantong University.
Informed consent was obtained from all individual participants included in the study.
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