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Association of glycemic variability assessed by continuous glucose monitoring with subclinical diabetic polyneuropathy in type 2 diabetes
Jiemin Pan, Xinfeng Yan, Fengwen Li, Yinan Zhang, Lan Jiang, Congrong Wang,et al.
PMID: 34455710 DOI: 10.1111/jdi.13652
Abstract:
Aims: Diabetic peripheral neuropathy (DPN) is a common diabetes-related microvascular complication. The relationship between peripheral nerve function and glucose variability (GV) is unclear. We investigated the association of GV with subclinical diabetic polyneuropathy in a large- scale sample of patients with type 2 diabetes. 
Materials and methods: We enrolled 509 subjects with type 2 diabetes who were screened for DPN and monitored using a continuous glucose monitoring (CGM) system. Multiple glycemic variability parameters, including the mean amplitude of glycemic excursions (MAGE), glucose standard deviation (SD ), and glucose coefficient of variation were calculated from 3-day glucose profiles obtained from CGM. All subjects underwent nerve conduction studies, and the composite Z-scores for nerve conduction parameters were calculated. 
Results: Multivariate logistic regression analyses showed that SD and the conventional risk factor hemoglobin A1c (HbA1c) were independently associated with abnormal nerve function, and the corresponding odds ratios (95% confidence interval) were 1.198 (1.027-1.397, SD ) and 1.182 (1.061-1.316, HbA1c), respectively. The composite Z-score of nerve conduction velocity (NCV) and response amplitude obviously decreased with greater SD , and the composite Z- score of distal latency significantly increased with increasing tertiles of SD (all P trend < 0.05). After adjusting for age, sex, body mass index, diabetes duration, and HbA1c, SD was independently associated with NCV (β = -0.124, P = 0.021). 
Conclusion: The SD is a significant independent contributor to subclinical diabetic polyneuropathy, in addition to conventional risk factors including diabetes duration and HbA1c. 
Keywords: continuous glucose monitoring; diabetic peripheral neuropathy; glycemic variability; type 2 diabetes.

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