Associations of visit-to-visit fasting glucose with risk of mortality: A retrospective cohort study of 48,077 people with type 2 diabetes

Xu, Huilin; Zhang, Y.; Xu, Wanghong; Chen, L.; Zhang, M.; Su, Haiyan; Cheng, Yi; Zhao, Na; Xu, Dongmei; Qin, Guoyou

doi:10.1016/j.diabet.2020.05.003

Cited by 9 publications

(15 citation statements)

References 41 publications

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“…Although we did not calculate the indicators with the same frequency of visits, we adjusted for it in regression analysis to minimize its impact. 18 This method of investigation has proved to be practical and effective in the previous report using the same questionnaire. Finally, because this study was not an intervention or prospective study but a retrospective cohort analysis, causality cannot be determined.…”

Section: Discussionmentioning

confidence: 82%

“…The DMSP was launched as a basic public health service program from 2004 in Minhang District and covered over 1 million residents in Shanghai. 18 , 19 More detailed information can be found in previous literature. A total of 51 970 patients aged between 20 and 80 years were initially included in the study from 2004 to 2015.…”

Section: Methodsmentioning

confidence: 99%

“…After the exclusion, the FBG of each individual was measured 2 to 100 times (median [interquartile range]: 9 [18, 29]). 18

…”

Section: Methodsmentioning

confidence: 99%

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Long‐term fasting glucose variability and risk of cancer in patients with type 2 diabetes mellitus: A retrospective population‐based cohort study in Shanghai

Cui

Yang

et al. 2022

Journal of Diabetes

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Backgrounds Fasting blood glucose (FBG) variability may make an impact on adverse events in patients with diabetes mellitus. However, the association between long‐term changes in FBG and cancer remains unclear. We aimed to investigate this association in a large‐scale longitudinal study. Methods Data were collected from 46 761 patients with type 2 diabetes mellitus aged 20–80 years who participated in the Diabetes Standardized Management Program in Shanghai, China. We adopted four indicators, including standard deviation (SD), coefficient of variation (CV), variation independent of the mean (VIM), and average real variability (ARV) to describe FBG variability. Adjusted multivariable Cox regression analyses and restricted cubic splines were used to investigate the association between long‐term FBG variability and cancer risk. We also determined the interactive effect of FBG variability with hypertension and FBG‐mean with hypertension on cancer risk, respectively. Results In this study, we confirmed 2218 cancer cases (51.1% male) over a median follow‐up of 2.86 years. In the multivariable‐adjusted models, participants in the highest quartile of FBG variability had an increased risk of cancer compared with those in the lowest quartile. The nonlinear association was found when using FBG‐VIM, FBG‐ARV, and FBG‐SD in restricted cubic spline plots. There was a significant interaction effect of FBG variability with hypertension on cancer, whereas the effect of FBG‐mean with hypertension did not attain significance. Conclusions Our retrospective cohort study demonstrated a positive association between the long‐term changes in FBG and cancer risk in patients with type 2 diabetes mellitus. FBG variability may independently predict cancer incidence.

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Section: Discussionmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

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Long‐term fasting glucose variability and risk of cancer in patients with type 2 diabetes mellitus: A retrospective population‐based cohort study in Shanghai

Cui

Yang

et al. 2022

Journal of Diabetes

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“…Most studies found that average glucose levels and adverse outcomes had significant U‐shaped 28,29 and J‐shaped associations 30,31 . A large Korean population‐based prospective study reported a J‐shaped relationship between FBG levels and all‐cause mortality, with a nadir at approximately 4.4 to 5.2 mmol/L 30 .…”

Section: Discussionmentioning

confidence: 99%

“…16 Previous studies have mainly been limited by a relatively small sample size, a wide variation in the interval between visits for glucose assessment (ranging from days to years), and insufficient indicators to describe glycaemic variability. 16,26,27 These factors not only lead to FBG variability but also might impact the strength of the asso- Most studies found that average glucose levels and adverse outcomes had significant U-shaped 28,29 and J-shaped associations. 30,31 A large Korean population-based prospective study reported a J-shaped relationship between FBG levels and all-cause mortality, with a nadir at approximately 4.4 to 5.2 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

Separate and combined effect of visit‐to‐visit glycaemic variability and mean fasting blood glucose level on all‐cause mortality in patients with type 2 diabetes: A population‐based cohort study

Liu

et al. 2022

Diabetes Obesity Metabolism

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Aims: To assess the independent and combined impacts of visit-to-visit fasting blood glucose variability (VVV-FBG) and mean fasting blood glucose level (M-FBG) on allcause mortality. Materials and methods:This prospective cohort study included 48 843 Chinese patients with type 2 diabetes. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the association of VVV-FBG and M-FBG with all-cause mortality. The potential nonlinear associations were examined using restricted cubic splines, and additive interaction was evaluated using relative excess risk due to interaction (RERI). Cox generalized additive models (CGAMs) and bivariate response surface models were further used to assess the combined effects of VVV-FBG and M-FBG.Results: A total of 4087 deaths were observed during a median follow-up of 6.99 years. Compared with patients with values at the 5th percentile of average real variability (ARV) and M-FBG, we observed a 23% and 38% increased risk of premature deaths among those with values at the 95th percentile of ARV (HR 1.23, 95% CI 1.10, 1.37) and M-FBG (HR 1.38, 95% CI 1.26, 1.51), respectively. The interaction between glycaemic variability (ARV) and M-FBG was significant on both the additive scale (RERI 0.80 [0.29, 1.32]) and the multiplicative scale (HR 1.90 [1.10, 3.28]). High VVV-FBG and high M-FBG conferred the highest risk of all-cause mortality (HR 1.89, 95% CI 1.64, 2.17), compared to low VVV-FBG and low M-FBG. The CGAMs showed significant synergistic effects between glycaemic variability and M-FBG (P < 0.05).Moreover, a bivariate surface plot showed that risk of death increased more rapidly in type 2 diabetes patients with lower M-FBG combined with lower VVV-FBG. Conclusions:The coexistence of high glycaemic variability and high glucose level might exacerbate the independent risk of premature mortality in type 2 diabetes Yahang Liu, Huilin Xu and Jun Li: Equal contribution as co-first authors.

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Annual glycemic variations and risk of cancer among Chinese patients with type 2 diabetes mellitus: A population-based cohort study in Shanghai

Zhang

et al. 2021

Diabetes Research and Clinical Practice

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Associations of visit-to-visit fasting glucose with risk of mortality: A retrospective cohort study of 48,077 people with type 2 diabetes

Cited by 9 publications

References 41 publications

Long‐term fasting glucose variability and risk of cancer in patients with type 2 diabetes mellitus: A retrospective population‐based cohort study in Shanghai

Long‐term fasting glucose variability and risk of cancer in patients with type 2 diabetes mellitus: A retrospective population‐based cohort study in Shanghai

Separate and combined effect of visit‐to‐visit glycaemic variability and mean fasting blood glucose level on all‐cause mortality in patients with type 2 diabetes: A population‐based cohort study

Annual glycemic variations and risk of cancer among Chinese patients with type 2 diabetes mellitus: A population-based cohort study in Shanghai

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