The relationship between glycemic variability and diabetic peripheral neuropathy in type 2 diabetes with well-controlled HbA1c

Abstract

Background: Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications o diabetes. Glycemic variability could be an independent risk factor for diabetes complications in addition to averag glucose. Type 2 diabetes with well-controlled glycosylated hemoglobin A1c (HbA1c) may have different terms o glycemic variability and vascular complication consequences. The aim of the study is to investigate the relationshi between glycemic variability and DPN in type 2 diabetes with well-controlled HbA1c (HbA1c < 7.0%) Methods: 45 type 2 diabetes with well-controlled HbA1c(HbA1c < 7.0%) and with DPN (DM/DPN group) wer recruited in the study, and 45 type 2 diabetes with well-controlled HbA1c and without DPN (DM/-DPN group) wer set as controls. The two groups were also matched for age and diabetic duration. Blood pressure, body mass inde (BMI), insulin sensitivity index (Matsuda index, ISI), total cholesterol (TC), triglyceride (TG), high density lipoprotei cholesterol (HDLC), and low density lipoprotein cholesterol (LDLC) were tested in the two groups. And all patients wer monitored using the continuous glucose monitoring (CGM) system for consecutive 72 hours. The multiple parameter of glycemic variability included the standard deviation of blood glucose (SDBG), mean of daily differences (MODD) an mean amplitude of glycemic excursions (MAGE) Results: The DM/DPN group had a greater SDBG, MODD and MAGE, when compared to the DM/-DPN grou (p < 0.05). BMI, TC, and LDLC of DM/DPN group were lower than those of DM/-DPN group (p < 0.05). The patient with hypoglycemia were comparable between the two groups (p> 0.05). Univariate analysis showed DPN was closel associated with BMI (OR 0.82, CI 0.72-0.94, p = 0.005), TC (OR 0.63, CI 0.42-0.93, p = 0.02), LDLC (OR 0.4, CI 0.20-0.80 p = 0.009), SDBG (OR 2.95, CI 1.55-5.61, p = 0.001), MODD (OR 4.38, CI 1.48-12.93, p = 0.008), MAGE (OR 2.18 CI 1.47-3.24, p < 0.001). Multivariate logistic regression analysis showed that MAGE (OR 2.05, CI 1.36-3.09, p = 0.001 and BMI (OR 0.85, CI 0.73-0.99, p = 0.033) were significantly correlating with DPN. Glycemic variability, evaluated b MAGE, was the most significantly independent risk factor for DPN Conclusions: There was a close relationship between glycemic variability evaluated by MAGE and DPN in type diabetes with well-controlled HbA1c.