空腹血糖变异性与 2 型糖尿病患者痛性糖尿病周围神经病变风险的关系。

Variability of fasting plasma glucose and the risk of painful diabetic peripheral neuropathy in patients with type 2 diabetes.

机构信息

Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan.

Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan.

出版信息

Diabetes Metab. 2018 Mar;44(2):129-134. doi: 10.1016/j.diabet.2018.01.015. Epub 2018 Feb 4.

DOI:10.1016/j.diabet.2018.01.015

PMID:29459007

Abstract

AIM

The relationship between glycaemic variability and painful diabetic peripheral neuropathy (PDPN) in patients with type 2 diabetes (T2D) is unclear. The aim of this study was to investigate whether variations in fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), were associated with the risk of PDPN in patients with T2D.

METHODS

This case-control, retrospective study was conducted at a tertiary care hospital in Taiwan. We enrolled adults with T2D from January 1 through October 31, 2013. PDPN was diagnosed using the Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathique 4 (DN4) questionnaire. Variability in FPG was defined as a CV of visit-to-visit FPG for every 3-month interval during follow-up period before enrolment.

RESULTS

A total of 2,773 patients were enrolled. One hundred patients with PDPN were randomly selected and paired with 175 consecutive patients with non-painful diabetic peripheral neuropathy and 351 patients with T2D without diabetic peripheral neuropathy, matched for age, gender, and diabetic duration. After multivariate adjustment, the FPG-CV was significantly associated with a risk of PDPN with a corresponding odds ratio of 4.08 (95% confidence interval [CI] of 1.60-10.42) and 5.49 (95% CI of 2.14-14.06) for FPG-CV in the third and fourth versus first FPG-CV quartiles, respectively, after considering glycated haemoglobin (HbA1c).

CONCLUSION

Long-term variability as evaluated by FPG-CV was associated to the risk of PDPN in adults with T2D. However, further studies are needed to know whether the FPG-CV is not simply a marker of the ambient hyperglycaemia.

摘要

目的

血糖变异性与 2 型糖尿病（T2D）患者痛性糖尿病周围神经病变（PDPN）之间的关系尚不清楚。本研究旨在探讨空腹血糖（FPG）变异，以变异系数（CV）表示，是否与 T2D 患者发生 PDPN 的风险相关。

方法

这是一项在台湾一家三级保健医院进行的病例对照、回顾性研究。我们于 2013 年 1 月 1 日至 10 月 31 日招募 T2D 成年患者。使用密歇根神经病变筛查工具（MNSI）和神经病变疼痛 4 项问卷（DN4）诊断 PDPN。FPG 变异性定义为在登记前随访期间每 3 个月间隔内 FPG 随访到随访的 CV。

结果

共纳入 2773 例患者。随机选择 100 例 PDPN 患者，并与 175 例连续非痛性糖尿病周围神经病变患者和 351 例 T2D 无糖尿病周围神经病变患者配对，配对因素为年龄、性别和糖尿病病程。在多变量调整后，FPG-CV 与 PDPN 风险显著相关，相应的比值比（OR）分别为 4.08（95%置信区间 [CI]为 1.60-10.42）和 5.49（95% CI 为 2.14-14.06），FPG-CV 分别在第三和第四四分位组与第一四分位组相比，在考虑糖化血红蛋白（HbA1c）后。