Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
Clinical Research Center, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea.
Diabetes Care. 2018 Dec;41(12):2610-2616. doi: 10.2337/dc18-0802. Epub 2018 Sep 25.
Although increasing evidence suggests the association between short-term variability of fasting plasma glucose (FPG) and diabetic complications or mortality, the impact of visit-to-visit variability of FPG on the development of type 2 diabetes (T2D) has not been evaluated.
Our analysis included 131,744 Korean men and women without diabetes using the Korean National Health Insurance System cohort with periodic health examination program. FPG variability was calculated using the coefficient of variation (FPG-CV), SD (FPG-SD), and variability independent of the mean (FPG-VIM).
During the median follow-up time of 8.3 years, Kaplan-Meier curves demonstrated lower disease-free probability in the higher FPG variability group compared with the lower FPG variability group. Multivariable Cox proportional hazards analysis exhibited that the hazard ratio for incident T2D was 1.67 (95% CI 1.58-1.77, < 0.001) in the highest quartile of FPG-CV compared with the lowest quartile of FPG-CV after adjusting for confounding variables, including mean FPG. The association between FPG variability and the risk of T2D was consistent when modeling using FPG-SD and FPG-VIM in both normal and impaired fasting glucose groups. A 1 SD increase in the FPG-CV was associated with a 24% increased risk of T2D in the fully adjusted model.
Increased variability of FPG is associated with the development of T2D independently of diverse risk factors.
虽然越来越多的证据表明空腹血糖（FPG）短期变异性与糖尿病并发症或死亡率之间存在关联，但 FPG 个体间变异性对 2 型糖尿病（T2D）发展的影响尚未得到评估。
我们的分析包括使用韩国国家健康保险系统队列和定期健康检查计划的 131744 名无糖尿病的韩国男性和女性。使用变异系数（FPG-CV）、标准差（FPG-SD）和均值独立变异（FPG-VIM）来计算 FPG 变异性。
在中位随访时间为 8.3 年期间，Kaplan-Meier 曲线显示，FPG 变异性较高组的无病生存概率低于 FPG 变异性较低组。多变量 Cox 比例风险分析显示，与 FPG-CV 最低四分位相比，FPG-CV 最高四分位的 T2D 发生率的风险比为 1.67（95%CI 1.58-1.77，<0.001），在校正了混杂因素，包括平均 FPG 后。当使用 FPG-SD 和 FPG-VIM 在正常和受损空腹血糖组中建模时，FPG 变异性与 T2D 风险之间的关联是一致的。FPG-CV 增加 1SD 与完全调整模型中 T2D 风险增加 24%相关。
FPG 变异性的增加与 T2D 的发生独立于多种危险因素相关。
