Visit-to-Visit Glucose Variability Predicts the Development of End-Stage Renal Disease in Type 2 Diabetes

Abstract

The purpose of this study was to examine the association of glucose variability using coefficient of variation of fasting plasma glucose (FPG-CV) and coefficient of variation of glycated hemoglobin (HbA1c-CV) to end-stage renal disease (ESRD) in 31,841 Chinese patients with type 2 diabetes.Patients with type 2 diabetes enrolled in National Diabetes Care Management Program, aged ≧30 years, and free of ESRD (n = 31,841) in January 1, 2002 to December 31, 2004 were included. Extended Cox proportional hazards regression models with competing risk of all-cause mortality were used to evaluate risk factors on ESRD incidence. Patients were followed till 2012.After a median follow-up period of 8.23 years, 1642 patients developed ESRD, giving a crude incidence rate of 6.27/1000 person-years (6.36 for men, 6.19 for women). After the multivariate adjustment, both FPG-CV and HbA1c-CV were independent predictors of ESRD with corresponding hazard ratios of 1.20 (95% confidence interval [CI] 1.01, 1.41), 1.24 (95% CI 1.05, 1.46) in HbA1c-CV from fourth to fifth quintile and 1.23 (95% CI 1.03, 1.47) in FPG-CV from fifth quintile.One-year visit-to-visit glucose variability expressed by FPG-CV and HbA1c-CV predicted development of ESRD in patients with type 2 diabetes, suggesting therapeutic strategies toward a goal to minimize glucose fluctuation.

Association of Dietary Patterns With Testicular Function in Young Danish Men

“…Previous work focused on intake of specific nutrients suggests that the associations observed herein could be explained by differences in intake of long-chain ω-3 fatty acids, [35][36][37] carotenoids, vitamins C and B, 38,39 and possibly differences in carbohydrate quality, including intake of added sugars. [40][41][42] The interpretation of the hormone findings is less straightforward. Men with the highest adherence to the Western pattern had higher testosterone levels, assessed as total and free testosterone, compared with men with less adherence.…”

Glycaemic variability in diabetes: clinical and therapeutic implications

“…58 Similarly, long-term GV (HbA1c) in T2D has been associated with the risk of developing diabetic nephropathy. 59,60 Also an association between long-term GV (HbA1c) and diabetic retinopathy has been demonstrated in some studies with T1D. 61,62 GV causes inner retinal sensory neuropathy in persons with T1D.…”

<p>Nomogram for the Risk of Diabetic Nephropathy or Diabetic Retinopathy Among Patients with Type 2 Diabetes Mellitus Based on Questionnaire and Biochemical Indicators: A Cross-Sectional Study</p>

“…55 Among T2DM studies, glucose variability showed a positive association with the progression of DR. 54 A ten-year survey follow-up of diabetes patients in Taiwan showed that visit-to-visit glucose variations in both FPG-CV and HbA1c-CV independently predicted ESRD in patients with T2DM duration >30 years. 56 Some data show that glucose variability, namely, fasting plasma glucose variability, and retinopathy in T2DM patients have a possible connection. 57 To reduce the risk of long-term complications such as DR and DN, maintaining an HbA1c concentration of 7.0% or less is recommended for all patients with diabetes.…”