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.

Ankle Brachial Index Screening for Peripheral Arterial Disease in Asymptomatic Diabetic Patients

“…In addition, the prevalence of PAD was significantly higher in patients on oral hypoglycemic drugs than in insulin users due to the majority of participants used 2 or 3 oral hypoglycemic drugs or mixed therapy and were not compliant. This study agrees with Yang et al (16) who showed that PAD was significantly higher in patients on oral hypoglycemic drugs than in insulin users. In contrary, Yeboah et al (17) showed that PAD was more frequent in insulin users due to the effect of insulin resistance on atherosclerosis progression.…”

“…The means of FBS, 2 hrPPBS and HBA1c were significantly higher in PAD group than in non-PAD group. This study agrees with Shaikh et al (9) and Yang et al (16) regarding that FBS and HBA1c levels were higher in patients with PAD. In contrast, Cornejo Del Río et al (21) showed no significant difference between studied groups regarding FBS and 2 hrPPBS.…”

“…Our study showed that there was no significant difference between both groups regarding albuminuria. This agrees with Yang et al (16) but in contrary to Weledji et al (12) who showed that proteinuria was a significant association with PAD.…”

Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

“…The study enrolled 420 T2DM patients and suggested that visit-to-visit HbA1c variability expressed as SD, CV and VIM was independently associated with incidence of in-stent restenosis in patients with T2DM after stent implantation [ 61 ]. Of note, several studies disclosed that long-term GV including both HbA1c and FPG variability (calculated by CV) was associated with peripheral artery disease risk and accelerated progression of coronary atherosclerosis in patients with T2DM [ 62 , 63 ]. These clinical results addressed the essential role of GV in diabetic macrovascular complications (Table 2 ), and paved the way for the research on relevant mechanisms.…”

Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China

“…Bertrand et al demonstrate that HDL-cholesterol, ApoA-I, total cholesterol/HDL-cholesterol ratio or non-HDL-cholesterol were independent factors associated with PAD in patients with type 2 diabetes [13]. Fasting plasma glucose, hemoglobin A(1c), homocysteine levels, age, duration of diabetes, hypertension, cigarette smoking, serum creatinine, estimated glomerular filtration rate, and urinary albumincreatinine ratio history of myocardial infarction and stroke have been also reported to be associated with PAD [14][15][16][17].…”