Visit-to-visit variability of fasting plasma glucose as predictor of ischemic stroke: competing risk analysis in a national cohort of Taiwan Diabetes Study

Abstract

BackgroundGlycemic variation as an independent predictor of ischemic stroke in type 2 diabetic patients remains unclear. This study examined visit-to-visit variations in fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), for predicting ischemic stroke independently, regardless of glycated hemoglobin (HbA1c) and other conventional risk factors in such patients.MethodsType 2 diabetic patients enrolled in the National Diabetes Care Management Program, ≥30 years old and free of ischemic stroke (n = 28,354) in 2002 to 2004 were included, and related factors were analyzed with extended Cox proportional hazards regression models of competing risk data on stroke incidence.ResultsAfter an average 7.5 years of follow-up, there were 2,250 incident cases of ischemic stroke, giving a crude incidence rate of 10.56/1,000 person-years (11.64 for men, 9.63 for women). After multivariate adjustment, hazard ratios for the second, third and fourth versus first FPG-CV quartile were 1.11 (0.98, 1.25), 1.22 (1.08, 1.38) and 1.27 (1.12, 1.43), respectively, without considering HbA1c, and 1.09 (0.96, 1.23), 1.16 (1.03, 1.31) and 1.17 (1.03, 1.32), respectively, after considering HbA1c.ConclusionsBesides HbA1c, FPG-CV was a potent predictor of ischemic stroke in type 2 diabetic patients, suggesting that different therapeutic strategies now in use be rated for their potential to (1) minimize glucose fluctuations and (2) reduce HbA1c level in type 2 diabetic patients to prevent ischemic stroke.

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

“…Recent studies and a systematic review have shown that glycemic variability might play an important role in the pathogenesis of atherosclerosis, and may be an independent risk factor for ischemic stroke8 and all‐cause mortality in those with type 2 diabetes mellitus 9, 10. However, these previous studies on glycemic variability were all short‐term within 1 year or less and investigated in patients with type 2 diabetes mellitus.…”

Glycemic Variability: Clinical and Prognostic Significance

“…The patients were grouped into four quartiles according to FPG-CV measurements. 19 The results revealed that compared to patients with the first quartile, higher associated risk of developing ischemic stroke in patients who fell into second, third, and fourth FPG-CV quartile, independent of HbA1c level.…”

“…However, in the Taiwan Diabetes Study, FPG-CV still showed links with incidence of ischemic stroke after excluding patients with hypoglycemia in sensitivity analysis; this association cannot be explained by hypoglycemia in patients with high glucose variability. 19 Further studies need to investigate the effects of glycemic variability whether co-existence of hypoglycemia or not for diabetic complications.…”

Visit-to-visit variation of fasting plasma glucose is a predictor of hip fracture in older persons with type 2 diabetes: the Taiwan Diabetes Study

“…Thus, FPG might be a sensitive indicator for capturing variation of glucose due to overindulgence in diet given that HbA 1c is a mean over the previous 3 months prior to the measurement. Visit-tovisit FPG-CV as a marker for glucose variability has provided longer observation spectrum and good prediction power to further survival [15,16], cardiovascular events [15], stroke [17], and DM nephropathy [18]. Previous studies suggested type 2 diabetes was associated with increased risk of hip fracture [5].…”