Variability of fasting plasma glucose increased risks of diabetic polyneuropathy in T2DM

Neurology. 2017 Mar 7;88(10):944-951. doi: 10.1212/WNL.0000000000003682. Epub 2017 Feb 8.


Objective: To examine whether variations in fasting plasma glucose (FPG), as measured by the coefficient of variation (CV), is a predictor of diabetic polyneuropathy (DPN) risk, considering glycated hemoglobin (HbA1c) and other traditional risk factors.

Methods: Type 2 diabetic patients enrolled in the National Diabetes Care Management Program were ≥30 years of age and free of DPN (n = 36,152). They were enrolled in 2002-2004 and were monitored until 2011. The related factors were analyzed using Cox proportional hazards regression models.

Results: During an average 7.23 years of follow-up, a total of 7,219 incident cases of DPN were identified, with a crude incidence rate of 27.62/1,000 person-years (25.83 for men and 29.31 for women). After multivariate adjustment, both FPG-CV and HbA1c were significant predictors of DPN, with corresponding hazard ratios of 1.14 (95% confidence interval [CI] 1.05-1.23) and 1.15 (95% CI 1.06-1.24) for FPG-CV in the fourth to fifth quintiles and 1.13 (95% CI 1.07-1.20) for HbA1c ≥7%. This finding maintained consistency after excluding potential confounders in the sensitivity analysis, further validating the results.

Conclusions: FPG-CV and HbA1c ≥7% were potent predictors of DPN in type 2 diabetic patients. The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments.

MeSH terms

  • Aged
  • Blood Glucose / metabolism*
  • Cohort Studies
  • Community Health Planning
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Neuropathies* / blood
  • Diabetic Neuropathies* / epidemiology
  • Diabetic Neuropathies* / etiology
  • Fasting / blood*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Middle Aged
  • National Health Programs / statistics & numerical data
  • Outcome Assessment, Health Care
  • Risk Factors
  • Taiwan


  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human