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Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients

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Abstract

Purpose

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.

Methods

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.

Results

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%.

Conclusions

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.

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Abbreviations

BMI:

Body mass index

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

TC:

Total cholesterol

TG:

Triglyceride

HDLC:

High-density lipoprotein cholesterol

LDLC:

Low-density lipoprotein cholesterol

FPG:

Fasting plasma glucose

Serum UA:

Serum uric acid

HOMA-IR:

Insulin resistance estimated by the HOMA model

HbA1c:

Glycosylated hemoglobin A1c

MAGE:

Mean amplitude of glycaemic excursions

MODD:

Mean of daily differences

SD:

Standard deviation of glucose

24-h MG:

24-h Mean glucose

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Funding

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).

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Correspondence to Jian-an Li or Jian-bin Su.

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This study strictly adhered to the principles of the Helsinki Declaration and was approved by the Medical Ethics Committee of Nantong University.

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Informed consent was obtained from all individual participants included in the study.

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Hu, Ym., Zhao, Lh., Zhang, Xl. et al. Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients. Endocrine 60, 292–300 (2018). https://doi.org/10.1007/s12020-018-1546-z

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