Association of glycemic variability assessed by continuous glucose monitoring with subclinical diabetic polyneuropathy in type 2 diabetes patients.

Aims/introduction: Diabetic peripheral neuropathy is a common diabetes-related microvascular complication. The relationship between peripheral nerve function and glucose variability is unclear. We investigated the association of glucose variability with subclinical diabetic polyneuropathy in a large-scale sample of patients with type 2 diabetes.

Materials And Methods: We enrolled 509 individuals with type 2 diabetes who were screened for diabetic peripheral neuropathy and monitored using a continuous glucose monitoring system. Multiple glycemic variability parameters, including the mean amplitude of glycemic excursions, glucose standard deviation (SD ) and glucose coefficient of variation were calculated from 3-day glucose profiles obtained from continuous glucose monitoring. All participants 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 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 nerve conduction velocity (β = -0.124, P = 0.021).

Conclusions: The SD is a significant independent contributor to subclinical diabetic polyneuropathy, in addition to conventional risk factors including diabetes duration and HbA1c.