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

Hu, Yuming; Zhao, Lihua; Zhang, Xiulin; Cai, Hong-Li; Huang, Haiyan; Xu, Feng; Chen, Tong; Wang, Xueqin; A, Guo; Li, Jianan; Su, Jianbin

doi:10.1007/s12020-018-1546-z

Cited by 45 publications

(54 citation statements)

References 48 publications

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“…Glucose variability has been demonstrated to be an independent risk factor for free radical damage and diabetes complications, yet we did not find that glucose variability was associated with DPN 35 36. There is inconsistency in the relationship between glucose variability and DPN in the literature, and some research indicates that for type 2 DM, glucose variability may be regarded as a marker of beta-cell function rather than direct cause of DPN 37–39…”

Section: Discussioncontrasting

confidence: 69%

Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease

Mayeda

Katz

Ahmad

et al. 2020

BMJ Open Diab Res Care

111

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ObjectiveCompared with hemoglobin A1c (HbA1c), continuous glucose monitoring (CGM) may better capture risk of diabetes complications in patients with chronic kidney disease (CKD), including diabetic peripheral neuropathy (DPN). We hypothesized that glucose time in range (TIR), measured by CGM, is associated with DPN symptoms among participants with type 2 diabetes mellitus (type 2 DM) and moderate-to-severe CKD.Research design and methodsWe enrolled 105 people with type 2 DM treated with insulin or sulfonylurea, 81 participants with CKD (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2) and 24 matched control participants with eGFR ≥60 mL/min/1.73 m2. Each participant wore a CGM for two 6-day periods. Calculated glycemic measures included TIR (glucose 70–180 mg/dL) and glucose management indicator (GMI). DPN symptoms were assessed using the Michigan Neuropathy Screening Instrument (MNSI) questionnaire, with a positive MNSI score defined as ≥2 symptoms.ResultsParticipants with CKD had a mean age of 68 years, diabetes duration 20 years, eGFR 38 mL/min/1.73 m2 and HbA1c 7.8%, 61 mmol/mol. Sixty-two participants reported ≥2 DPN symptoms, 51 (63%) with CKD and 11 (46%) controls. Less TIR and higher GMI were associated with higher risk of MNSI questionnaire score ≥2 (OR 1.25 (95% CI 1.02 to 1.52) per 10% lower TIR, and OR 1.79 (95% CI 1.05 to 3.04) per 1% higher GMI, adjusting for age, gender and race). Similar results were observed when analyses were restricted to participants with CKD. In contrast, there was no significant association of HbA1c with DPN symptoms.ConclusionsSymptoms of DPN were common among participants with long-standing type 2 DM and CKD. Lower TIR and higher GMI were associated with DPN symptoms.

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Section: Discussioncontrasting

confidence: 69%

Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease

Mayeda

Katz

Ahmad

et al. 2020

BMJ Open Diab Res Care

111

View full text Add to dashboard Cite

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“…It is believed that impaired early-phase β-cell function is an important pathogenetic mechanism causing postprandial hyperglycaemia excursions [2][3][4]. Given the relationship between glycemic variability and DPN [6,7], we hypothesized that impaired early-phase β-cell function is positively associated with sudomotor dysfunction in T2DM.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between β-cell Function Indices and Sudomotor Function in Chinese Patients with Type 2 Diabetes

Cao

Yao

et al. 2019

Exp Clin Endocrinol Diabetes.

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Purpose SUDOSCAN, a new non-invasive, quick, sensitive and quantitative technique, has been developed to detect diabetic peripheral neuropathy, and the latter is believed to be correlated with impaired β-cell function. The purpose of the present study was to investigate the associations between β-cell function indices and sudomotor function in Chinese type 2 diabetes. Methods A total of 266 Chinese patients with type 2 diabetes were enrolled. Sudomotor function was assessed using electrochemical skin conductance of hands and feet. Pancreatic β-cell function was determined by homeostasis model assessment of β-cell function index, early-phase β-cell function indices and total β-cell function indices. Pearson correlation analysis and multiple linear stepwise regression analysis were carried out to explore the associations between β-cell function indices and sudomotor function. Results Patients with lower early-phase β-cell function had lower electrochemical skin conductance levels of hands and feet and higher asymmetry ratio of hands and feet. Both Pearson correlation analysis and multiple linear stepwise regression analysis showed significantly positive relationships between early-phase β-cell function and electrochemical skin conductance levels of hands and feet, after controlling for potential confounders (P<0.05). Conclusions Impaired early-phase β-cell function was positively associated with sudomotor dysfunction in Chinese patients with type 2 diabetes. We speculated that impaired early-phase β-cell function may be associated with the incidence of sudomotor dysfunction in patients with T2DM.

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“…The diabetic duration, homeostasis model assessment for insulin resistance, haemoglobin A 1c , and increased glycaemic variability assessed by the mean amplitude of glycaemic excursions are all independent contributors to diabetic peripheral neuropathy in type 2 diabetic (T2D) patients. 3 The pathological mechanisms of diabetic neuropathy are nearly the same as diabetic retinopathy and nephropathy, such as oxidative stress, increased advanced glycation end products and their receptors, activation of the polyol pathway, inducible nitric oxide synthase, and activation of mitogen-activated protein kinases and protein kinase C. Moreover, increased cytokines (eg, nerve growth factor, tumour necrosis factor [TNF] α, and interleukin 6), hypoxia, and ischaemia deficiency are crucial etiologic roles for diabetic neuropathy. 4 Consistent with these findings, dysfunctional metabolic pathways in diabetes result in functional disorder, damage, and cell death, which are inherent to the peripheral nervous system (eg, Schwann cells, dorsal root ganglia neurons, and vasa nervorum).…”

Section: Introductionmentioning

confidence: 99%

Neuropathy and inflammation in diabetic bone marrow

Zhou

Zuo

Qian

2018

Diabetes Metabolism Res

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Summary Diabetes impairs the bone marrow (BM) architecture and function as well as the mobilization of immature cells into the bloodstream and number of potential regenerative cells. Circadian regulation of bone immature cell migration is regulated by β‐adrenergic receptors, which are expressed on haematopoietic stem cells, mesenchymal stem cells, and osteoblasts in the BM. Diabetes is associated with a substantially lower number of sympathetic nerve terminal endings in the BM; thus, diabetic neuropathy plays a critical role in BM dysfunction. Treatment with mesenchymal stem cells, BM mononuclear cells, haematopoietic stem cells, and stromal cells ameliorates the dysfunction of diabetic neuropathy, which occurs, in part, through secreted neurotrophic factors, growth factors, adipokines, and polarizing macrophage M2 cells and inhibiting inflammation. Inflammation may be a therapeutic target for BM stem cells to improve diabetic neuropathy. Given that angiogenic and neurotrophic effects are two major barriers to effective diabetic neuropathy therapy, targeting BM stem cells may provide a novel approach to develop these types of treatments.

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

Abstract: 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.

Cited by 45 publications

References 48 publications

Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease

Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease

The Relationship Between β-cell Function Indices and Sudomotor Function in Chinese Patients with Type 2 Diabetes

Neuropathy and inflammation in diabetic bone marrow

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