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Observational Study
. 2024 Mar;15(3):326-335.
doi: 10.1111/jdi.14131. Epub 2024 Jan 3.

Prognostic value of longitudinal HbA1c variability in predicting the development of diabetic sensorimotor polyneuropathy among patients with type 2 diabetes mellitus: A prospective cohort observational study

Yun-Ru Lai  1   2 , Wen-Chan Chiu  3 , Chih-Cheng Huang  1 , Ben-Chung Cheng  3 , I-Hsun Yu  1 , Chia-Te Kung  4 , Ting Yin Lin  5 , Hui Ching Chiang  1 , Chun-En Aurea Kuo  6 , Cheng-Hsien Lu  1   7   8
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Observational Study

Prognostic value of longitudinal HbA1c variability in predicting the development of diabetic sensorimotor polyneuropathy among patients with type 2 diabetes mellitus: A prospective cohort observational study

Yun-Ru Lai et al. J Diabetes Investig. 2024 Mar.

Abstract

Aims/introduction: This prospective cohort study aims to identify the optimal measure of glycated hemoglobin (HbA1c) variability and to explore its relationship with the development of new diabetic sensorimotor polyneuropathy (DSPN) in individuals with type 2 diabetes mellitus, building upon previous cross-sectional studies that highlighted a significant association between HbA1c visit-to-visit variability and DSPN.

Materials and methods: In a prospective study, 321 participants diagnosed with type 2 diabetes mellitus underwent comprehensive clinical assessments, neurophysiologic studies, and laboratory evaluations at enrollment and follow-up. Various indices, including HbA1c standard deviation (HbA1c SD), coefficient of variation (HbA1c CV), HbA1c change score (HbA1c HVS), and average real variability (HbA1c ARV), were employed to calculate the visit-to-visit variability HbA1c based on 3 month intervals. The investigation focused on examining the associations between these indices and the development of new DSPN.

Results: The average follow-up duration was 16.9 ± 6.9 months. The Cox proportional hazards model identified age (P = 0.001), diabetes duration (P = 0.024), and HbA1C ARV (P = 0.031) as the sole factors associated with the development of new DSPN. Furthermore, the cumulative risk of developing DSPN over 1 year demonstrated a significant association with HbA1C ARV (P = 0.03, log-rank test).

Conclusions: Apart from age and diabetes duration, HbA1c variability emerged as a robust predictor for the occurrence of new DSPN. Among the various measures of HbA1c variability evaluated, HbA1c ARV demonstrated the highest potential as a reliable indicator for anticipating the onset of new DSPN.

Keywords: Diabetic sensorimotor polyneuropathy; HbA1c variability; average real variability.

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Figures

Figure 1
Figure 1
Enrollment of patients.
Figure 2
Figure 2
The cumulative risk of development of diabetic sensorimotor polyneuropathy in patients with type 2 diabetes mellitus.
Figure 3
Figure 3
Sensitivity, specificity, and area under the curve using receiver operating characteristic curve analysis for age, diabetes duration, HbA1c ARV, and their combination in predicting the development of diabetic sensorimotor polyneuropathy.
See this image and copyright information in PMC

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References

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