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Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes.

ABSTRACT: BACKGROUND:This study investigated whether visit-to-visit fasting plasma glucose (FPG) variability, as measured by the coefficient of variation (CV), increased peripheral artery disease (PAD) risk. METHODS:Individuals with type 2 diabetes from the National Diabetes Care Management Program during the period 2002-2004, ??30 years of age, and free of PAD (n?=?30,932) were included and monitored until 2011. Cox proportional hazards regression models were implemented to analyze related determinants of PAD. RESULTS:A total of 894 incident cases of PAD were identified during an average 8.2 years of follow-up, resulting in a crude incidence rate of 3.53 per 1000 person-years. Both FPG-CV and HbA1c were significantly associated with PAD after multivariate adjustment, with corresponding hazard ratios of 1.24 [95% confidence interval (CI) 1.04-1.47] for FPG-CV in the third tertile and 1.50 (95% CI 1.10-2.04) for HbA1c???10%. The findings of the sensitivity analysis remained consistent after excluding potential confounders, demonstrating the consistency of the results. CONCLUSIONS:The associations between HbA1c, variability in FPG-CV, and PAD suggest a linked pathophysiological mechanism, suggesting the crucial role of glycemic variability in clinical management and therapeutic goals in preventing PAD in type 2 diabetes.

SUBMITTER: Yang CP

PROVIDER: S-EPMC6945758 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes.

Yang Chun-Pai CP Lin Cheng-Chieh CC Li Chia-Ing CI Liu Chiu-Shong CS Lin Chih-Hsueh CH Hwang Kai-Lin KL Yang Shing-Yu SY Li Tsai-Chung TC

Cardiovascular diabetology 20200107 1

<h4>Background</h4>This study investigated whether visit-to-visit fasting plasma glucose (FPG) variability, as measured by the coefficient of variation (CV), increased peripheral artery disease (PAD) risk.<h4>Methods</h4>Individuals with type 2 diabetes from the National Diabetes Care Management Program during the period 2002-2004, ≥ 30 years of age, and free of PAD (n = 30,932) were included and monitored until 2011. Cox proportional hazards regression models were implemented to analyze related ...[more]

PMID: 31910828

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Project description:Introduction: The incidences of diabetes and diabetic retinopathy (DR) in Thai high-risk individuals with prediabetes have not been identified. This study compared diabetes and DR incidences among people at risk with different glycemic levels, using fasting plasma glucose (FPG) and hemoglobin A1C (HbA1c). Materials and methods: A historical cohort study estimating risk of type 2 diabetes and DR was conducted among outpatients, using FPG and HbA1c measurements at recruitment and monitored for ≥5 years. High-risk participants (defined as having metabolic syndrome or atherosclerotic cardiovascular disease) were categorized by glycemic level into 4 groups: 1) impaired fasting glucose (IFG)-/HbA1c- (FPG <110 mg/dl; HbA1c < 6.0%); 2) IFG+/HbA1c- (FPG 110-125 mg/dl; HbA1c < 6.0%); 3) IFG-/HbA1c+ (FPG <110 mg/dl; HbA1c 6.0%-6.4%); and 4) IFG+/HbA1c+ (FPG 110-125 mg/dl; HbA1c 6.0%-6.4%). The incidences of type 2 diabetes mellitus (T2DM) and DR were obtained and estimated using Kaplan-Meier analysis. Cox regression models explored hazard ratios (HRs). Results: We recruited 8,977 people at risk (metabolic syndrome, 89.9%; atherosclerotic cardiovascular disease, 16.9%). The baseline cohort consisted of 1) IFG-/HbA1c- (n = 4,221; 47.0%); 2) IFG+/HbA1c- (n = 1,274; 14.2%); 3) IFG-/HbA1c+ (n = 2,151; 24.0%); and 4) IFG+/HbA1c+ (n = 1,331; 14.8%). Their 5-year T2DM incidences were 16.0%, 26.4%, 30.8%, and 48.5% (p < 0.001). The median DR follow-up was 7.8 years (interquartile range, 7.0-8.4 years). The DR incidences were 0.50, 0.63, 1.44, and 2.68/1,000 person-years (p < 0.001) for IFG-/HbA1c-, IFG+/HbA1c-, IFG-/HbA1c+, and IFG+/HbA1c+, respectively. Compared with IFG-/HbA1c-, the multivariable-adjusted HRs (95% CI) for incident diabetes were 1.94 (1.34-2.80), 2.45 (1.83-3.29), and 4.56 (3.39-6.15) for IFG+/HbA1c-, IFG-/HbA1c+, and IFG+/HbA1c+, respectively. As for incident DR, the corresponding HRs were 0.67 (0.08-5.76), 4.74 (1.69-13.31), and 5.46 (1.82-16.39), respectively. Conclusion: The 5-year incidence of T2DM in Thai high-risk participants with prediabetes was very high. The incidences of diabetes and DR significantly increased with higher degrees of dysglycemia. High-risk people with FPG 110-125 mg/dl and HbA1c 6.0%-6.4% were more likely to develop T2DM and DR. Such individuals should receive priority lifestyle and pharmacological management.

Project description:The prevalence of diabetes in Singapore is high. Screening to facilitate early detection and intervention has been shown to be cost-effective. Current clinical practice guidelines in Singapore recommend screening with fasting plasma glucose (FPG), followed by an oral glucose tolerance test (OGTT) in those with FPG 6.1-6.9?mmol/L. Glycated haemoglobin A1c (HbA1c) has robust stability at ambient temperature, and can be performed on non-fasted capillary blood samples, making it an attractive potential alternative for screening. However, limitations of HbA1c include differential performance in different races, and its performance as a screening test has not been well characterized in Asian populations. This study compares HbA1c and FPG as diabetes screening modalities in 3540 community-dwelling Singapore residents of Chinese, Malay and Indian race to detect diabetes mellitus diagnosed based on blood glucose (FPG???7.0?mmol/L, 2?hr OGTT???11.1?mmol/L). The area under the receiver-operating-characteristic curve (AUC) was higher for FPG compared to HbA1c in the overall population and age, race and age-race strata, but these differences were not statistically significant. HbA1c >?=?7.0% identified 95% of individuals with diabetes mellitus, and the remainder had impaired glucose tolerance (IGT). HbA1c cut-off at 6.1% had better sensitivity (0.825) to FPG at 6.1?mmol/L. The positive predictive value of HbA1c at 6.1% was 40-50% in different age-race combinations with a negative predictive value of about 98%. If follow-up screening with FPG is used, a lower cut-off at 5.6?mmol/L is appropriate in identifying people with pre-diabetes, as about 85% of people with HbA1c 6.1-6.9% and FPG 5.6-6.9?mmol/L had IFG/IGT or diabetes in the study sample. HbA1c is an appropriate alternative to FPG as a first-step screening test, and the combination of Hba1c?>?=?6.1% and FPG?>?=?5.6?mmol/L would improve the identification of individuals with diabetes mellitus and prediabetes.

Dataset Information

Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes.

Publications

Fasting plasma glucose variability and HbA1c are associated with peripheral artery disease risk in type 2 diabetes.

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