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

Chiang, Jason; Li, Tsai‐Chung; Li, C. I.; Liu, C. S.; Meng, Nai‐Hsin; Lin, Wen‐Yuan; Yang, Sing Yu; Chen, H. J.; Lin, Ching‐Heng

doi:10.1007/s00198-016-3689-1

Cited by 22 publications

(15 citation statements)

References 47 publications

(60 reference statements)

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“…Long-term glycemic variability commonly refers to the glycemic variability over several months or years, which is usually assessed by the annual variability of fasting plasma glucose (FPG) levels, glycated albumin (GA) or HbA1c. Annual FPG variability was found to be a significant risk factor for renal disease [ 17 ], ischaemic stroke [ 18 ], Alzheimer disease [ 19 ], occurrence of cancers [ 20 ], and all-cause and cardiovascular mortality [ 21 ] in type 2 diabetic patients, as well as hip fracture in older type 2 diabetic patients [ 22 ]. Moreover, a higher HbA1c variability was associated with a higher risk of microalbuminuria [ 23 ], diabetic retinopathy, adverse cardiovascular events and mortality [ 24 ] in type 2 diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

HbA1c variability and diabetic peripheral neuropathy in type 2 diabetic patients

Zhao

Zhang

et al. 2018

Cardiovasc Diabetol

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BackgroundDiabetic complications may be associated with impaired time-dependent glycemic control. Therefore, long-term glycemic variability, assessed by variations in haemoglobin A1c (HbA1c), may be a potential risk factor for microvascular complications, such as diabetic peripheral neuropathy (DPN). We investigated the association of HbA1c variability with DPN in patients with type 2 diabetes.MethodsIn this cross-sectional study, 563 type 2 diabetic patients who had been screened for DPN and undergone quarterly HbA1c measurements during the year preceding enrolment were recruited. DPN was confirmed in patients displaying both clinical manifestations of neuropathy and abnormalities in a nerve conduction evaluation. HbA1c variability was assessed by the coefficient of variation of HbA1c (CV-HbA1c), and the mean of HbA1c (M-HbA1c) was calculated. In addition, medical history and clinical data were collected.ResultsAmong the recruited patients, 18.1% (n = 102) were found to have DPN, and these patients also presented with a higher CV-HbA1c than the patients without DPN (p < 0.001). The proportion of patients with DPN increased significantly from 6.9% in the first to 19.1% in the second and 28.5% in the third tertile of CV-HbA1c (p for trend < 0.001). After adjusting for initial HbA1c, M-HbA1c and other clinical factors via multiple logistic regression analysis, the odds ratios (ORs) for DPN in the second and third versus those in the first CV-HbA1c tertile were 3.61 (95% CI 1.62–8.04) and 6.48 (2.86–14.72), respectively. The area under the receiver operating characteristic (ROC) curve of CV-HbA1c was larger than that of M-HbA1c, at 0.711 (95% CI 0.659–0.763) and 0.662 (0.604–0.721), respectively. ROC analysis also revealed that the optimal cutoff value of CV-HbA1c to indicate DPN was 15.15%, and its corresponding sensitivity and specificity were 66.67% and 65.73%, respectively.ConclusionsIncreased HbA1c variability is closely associated with DPN in type 2 diabetic patients and could be considered as a potent indicator for DPN in these patients.

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Section: Discussionmentioning

confidence: 99%

HbA1c variability and diabetic peripheral neuropathy in type 2 diabetic patients

Zhao

Zhang

et al. 2018

Cardiovasc Diabetol

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“…Several studies reported an increase in hip fracture prevalence or incidence with the presence [14,107,110,114,115,118,120,121]. de Liefde et al reported no association between T2DM and hip fracture, although they did observe an increased risk of hip fracture associated with diabetes treated with antidiabetic drugs [123].…”

Section: T2dm and Risk Of Fracturementioning

confidence: 99%

“…N-acetyl cysteine is used widely, although it provides limited benefits in human therapy. Studies concerning monocarriers of antioxidants that act on the mitochondria of activated microglia in neurodegenerative diseases, such as neutral hydroxyl-terminated polyamidoamine (PAMAM) dendrimers, appear to exert a level of control on pro-inflammatory microglial reactions [120]. It may also be possible to use antibodies that block pro-inflammatory substances [117].…”

Section: Microgliamentioning

confidence: 99%

“…Although hyperglycemia appears to be a risk factor for fractures, some studies reported an increased risk of fractures associated with hypoglycemia or with lower levels of HbA1c compared to higher HbA1c levels [119,125,[133][134][135], whereas only two studies reported no deleterious effect of hypoglycemia [120,121]. However, Chiang et al observed that visit-to-visit variation of FPG was a predictor of hip fracture, indicating an effect mediated by increased hypoglycemia risk [120]. Kachroo et al quantified the increased risk associated with hypoglycemia and reported an OR of 2.16 (95% CI 1.74-2.67) for any fracture [134].…”

Section: Bone Health and Hypoglycemiamentioning

confidence: 99%

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2020

OBM Geriatrics

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This special issue entitled "Geriatric Cardiac Diseases" aims to cover the latest and outstanding developments in the field of geriatric cardiac disease, focusing on known-unknowns in the diagnosis and therapeutics of this increasingly frequent pathology. The number of older adults is significant, and practicing cardiologists are encountering increasing numbers of consultations for geriatric patients. The demand for modern therapies has rapidly increased expenditures, while the number of practicing cardiologists is also increasing who treat old cardiac patients. Medical progress has made it possible to treat lethal cardiac conditions in extremely old patients. Geriatric patients are often frail and exhibit several comorbidities. This issue compiles specific characteristics of the elderly cardiac patients, including prevention and the therapy of arterial hypertension, arrhythmias (especially atrial fibrillation), coronary artery syndromes, valve heart diseases, and heart failure. Data regarding the extremely old patients are limited, and it is irrational to directly extrapolate the experience obtained with the young patients to the old. Very old patients with arterial hypertension benefit from antihypertensive treatment, although the therapeutic strategy of one-size-fits-all cannot be applied. Elderly patients often require a cardiac pacemaker. However, with patients with atrioventricular block, the importance of synchronization is debatable. Implantable cardioverter defibrillators are used in extremely old patients, but limited data are available on their benefit.

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“…Although strict glycemic control does not necessarily reduce the risk of fractures, several studies have indicated that poor glycemic control (HbA1c ≥8%–9%) increases fracture risk compared with standard control in T1D and T2D, and that bone accrual following the diagnosis of T1D was impaired in individuals with poor glycemic control . Thus, for patients with diabetes, glycemic control remains a top priority, and the decrease in blood glucose level should be smooth to prevent hypoglycemia and its consequences, including fracture …”

Section: Comprehensive Management Of Fracture Risk In Diabetesmentioning

confidence: 99%