Relationship of ankle-brachial index, vibration perception threshold, and current perception threshold to glycemic variability in type 2 diabetes

Abstract

To explore the relationship of glycemic variability with lower extremity arterial disease (LEAD) and diabetic peripheral neuropathy (DPN). Seventy-eight patients with type 2 diabetes were enrolled. All patients underwent 72-hour dynamic blood glucose monitoring and obtained mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), standard deviation of blood glucose (SD), largest amplitude of glycemic excursion (LAGE), mean blood glucose (MBG), T≥10.0 (percentage of time for blood glucose levels ≥10.0 mmol/L), T≤3.9 (percentage of time for blood glucose levels ≤3.9 mmol/L), and other glycemic variability parameters. In the meanwhile, in order to explore the correlation of glycemic variability parameters with ankle-brachial index (ABI), vibration perception threshold (VPT), and current perception threshold (CPT), all patients underwent quantitative diabetic foot screening, including ABI for quantitative assessment of lower extremity arterial lesions and VPT and CPT for quantitative assessment of peripheral neuropathy. Patients were divided into abnormal CPT group (n = 21) and normal CPT group (n = 57) according to the CPT values. Compared with the normal CPT group, abnormal CPT group showed significantly higher levels of HbA1c, longer duration of diabetes, and higher levels of T≤3.9 (P < .05). However, there was no significant difference of MAGE, SD, LAGE, MODD, and other glycemic variability parameters between abnormal CPT group and normal CPT group (P > .05). Pearson correlation analysis or Spearman correlation analysis showed that ABI negatively correlated with MBG, T≥10.0, SD, LAGE, and MAGE (P < .05), but no correlation of ABI with T≤3.9 and MODD (P > .05) was shown. VPT showed a positive correlation with T≥10.0 (P < .05), but no correlation with other glycemic variability parameters (P > .05). There was no correlation between the other CPT values and the glycemic variability parameters (P > .05), except that the left and right 250 Hz CPT values were positively correlated with T≤3.9 (P > .05). The higher the blood glucose levels, the severer the degree of LEAD and DPN lesions; the higher the incidence of hypoglycemia, the severer the degree of DPN lesions; the greater the fluctuation of blood glucose, the severer the degree of LEAD lesions. However, the glycemic variability was not significantly correlated with DPN.

The measurement and consequences of daily glucose variability

“…Generally, our findings are in line with the few studies on the associations of CGMbased daily GV with arterial stiffness 105 , cIMT 106 , and ABI 107 . Since we observed a moderately strong correlation between CGM-assessed GV and the 1-hour OGTT value (Chapter 2), the studies that link the latter metric to arterial stiffness 108,109 and CVD 110 could be considered further support for daily GV as a determinant of CVD.…”

Association of time in range, as assessed by continuous glucose monitoring, with painful diabetic polyneuropathy

“…One study found that increasing MAGE was a significant independent contributor to DPN in type 2 diabetes mellitus patients 27 . In contrast, another study showed that MAGE and SD were not associated with DPN 29 . The conflicting results might be attributable to the different diagnostic criteria of DPN and different types of diabetes assessed.…”

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

“…ABI is the ratio of the systolic blood pressure of the ankle artery (posterior-tibial or dorsal-foot artery) to the ipsilateral brachial artery [20]. All patients in this study had ABI tested by professionally trained medical staff, and the pressures in the bilateral upper limb brachial artery, lower limb dorsalis pedis artery, and posterior tibial artery were measured using an ultrasonic Doppler blood flow detector (VistaAVS, Summit Doppler Systems, USA).…”