Visit‐to‐Visit Variability of Fasting Plasma Glucose and the Risk of Cardiovascular Disease and All‐Cause Mortality in the General Population

Abstract

BackgroundThe association of short‐term variability of fasting plasma glucose (FPG) and mortality has been well investigated. However, the relationships between visit‐to‐visit variability of FPG over longer periods of follow‐up and cardiovascular disease (CVD) and all‐cause mortality are unclear. This study aimed to investigate these relationships.Methods and ResultsThe current analysis included 53 607 Chinese participants (mean age, 49.10 years) who were free of CVD in the Kailuan study. Participants were divided into 4 categories by quartiles of visit‐to‐visit variability of FPG. Visit‐to‐visit variability of FPG was defined as the coefficient of variation of 3 values of FPG that were measured from the examination periods of 2006 to 2007, 2008 to 2009, and 2010 to 2011. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for CVD and all‐cause mortality. After a mean follow‐up of 4.93 years, 4261 individuals developed CVD and 1545 individuals died. The incidence of CVD and all‐cause mortality was 5.04 and 5.85 per 1000 person‐years, respectively. After adjusting for mean FPG and other potential confounders, individuals in the highest quartile of variability of FPG compared with participants in the lowest quartile showed a 26% greater risk of developing CVD (hazard ratio, 1.26; 95% confidence interval, 1.08–1.47) and a 46% greater risk for all‐cause mortality (hazard ratio, 1.46; 95% confidence interval, 1.25–1.70).ConclusionsIndependent of mean FPG and other baseline parameters, elevated visit‐to‐visit variability of FPG significantly increases the risk of CVD and all‐cause mortality in the general population. Measuring long‐term visit‐to‐visit variability of FPG is helpful for predicting the risk for CVD and all‐cause mortality.

Impact of Visit-to-Visit Fasting Plasma Glucose Variability on the Development of Type 2 Diabetes: A Nationwide Population-Based Cohort Study

“…However, previous studies examining the prognostic significance of long-term glycemic variability in individuals without diabetes are scarce. In the general population, elevated visit-to-visit FPG variability predicted the risk of CVD and all-cause mortality independent of mean FPG and other baseline variables in 53,607 Chinese participants during a mean follow-up time of 4.9 years (22). Our study demonstrated the consistent association between glycemic variability and the development of type 2 diabetes in both normal and IFG groups after adjusting for confounding factors.…”

The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

“…To minimize the bias caused by a single measurement of fasting glucose level, we used the mean fasting glucose level measured in both 2009-2010 and 2011-2012. Furthermore, glycemic variability, a strong predictor of CV events [27][28][29][30], could not be assessed because of the limited instance of fasting glucose measurements, in the present study. Third, the controlled fasting glucose levels during the future follow-up period could not be predicted.…”

Glycaemic variability in diabetes: clinical and therapeutic implications

“…79 More recently, GV has also been associated with higher risk of mortality in the general population. 80 Interestingly, increased GV has been found to be strongly associated with mortality in ICU in persons without diabetes, but less so in those with diabetes. 81 Similarly, a poorer 30-day functional outcome following acute intracerebral hemorrhage was observed in those without diabetes and increased GV.…”