Differential impact of short-term and long-term glycemic variability on peripheral nerve function in type 2 diabetes: A 5-year cohort study.

AIMS

Several studies have demonstrated the association between glycemic variability (GV) and diabetic peripheral neuropathy (DPN). However, none has compared the effects of short-term and long-term GV on DPN in a cohort. This study evaluates the association between short-term and long-term GV and peripheral nerve function in a cohort of outpatients with type 2 diabetes.

METHODS

Overall, 230 patients who had continuously attended the outpatient hospital for 5 years were enrolled. Short-term GV was assessed using continuous glucose monitoring (FreeStyle Libre Pro®), focusing on metrics such as the glucose levels'' standard deviation and time in range. Long-term GV was evaluated by using visit-to-visit variability in glycated hemoglobin (HbA1c), including the HbA1c standard deviation and coefficient of variation. Nerve conduction was assessed using DPNCheck™ by measuring sural nerve action potential (SNAP) amplitude and sensory conduction velocity (SCV). Multiple regression models were built to determine independent associations of GV and HbA1c variability metrics with SCV and SNAP amplitude.

RESULTS

Most short-term GV indices were not associated with SNAP amplitude but significantly correlated with SCV; these associations were not evident after adjusting for HbA1c. Long-term GV showed minimal correlation with SCV, while strong associations with SNAP amplitude persisted after adjusting for the 5-year mean HbA1c.

CONCLUSIONS

Our findings demonstrate that short-term and long-term GVs have differential impacts on peripheral nerve function in outpatients with type 2 diabetes; with short-term GV associated with SCV and long-term with SNAP amplitude.