Relationship of ankle-brachial index, vibration perception threshold, and current perception threshold to glycemic variability in type 2 diabetes

The association between time in the glucose target range and abnormal ankle-brachial index: a cross-sectional analysis

BACKGROUND

Time in range (TIR), a novel proxy measure of glucose control, is found closely related to diabetic microangiopathy and some other chronic complications, but the correlation between TIR and lower limb angiopathy has not been studied yet. Our purpose is to explore the relationship between TIR and abnormal ankle-brachial index(ABI) in type 2 diabetes.

METHODS

We retrospectively collected patients' information from the database and performed cross-sectional analysis. A total of 405 type 2 diabetes patients were enrolled in this study. ABI was measured and patients were stratified into low, normal, and high groups according to ≤ 0.9, > 0.9 and < 1.3, ≥ 1.3 ABI values. All patients underwent continuous glucose monitoring(CGM), and TIR was defined as the percentage of time in which glucose was in the range of 3.9-10 mmol/L during a 24-h period. Correlations between TIR and abnormal ABI were analyzed using Spearman analysis. And logistic regression was used to explore whether TIR is an independent risk factor for abnormal ABI.

RESULTS

The overall prevalence of abnormal ABI was 20.2% (low 4.9% and high 15.3%). TIR was lower in patients with abnormal ABI values (P = 0.009). The prevalence of abnormal ABI decreased with increasing quartiles of TIR (P = 0.026). Abnormal ABI was negatively correlated with TIR and positively correlated with hypertension, age, diabetes duration, UREA, Scr, ACR, TAR, MBG, and M values (P < 0.05). The logistic regression revealed a significant association between TIR and abnormal ABI, while HbA1C and blood glucose variability measures had no explicit correlation with abnormal ABI. Additionally, there was a significant difference in LDL between the low and high ABI groups (P = 0.009), and in Scr between normal and low groups (P = 0.007). And there were significant differences in TIR (P = 0.003), age (P = 0.023), UREA (P = 0.006), ACR (P = 0.004), TAR (P = 0.015), and MBG (P = 0.014) between normal and high ABI groups, and in diabetes duration between both normal and low (P = 0.023) and normal and high (P = 0.006) groups.

CONCLUSIONS

In type 2 diabetes patients, abnormal ABI is associated with lower TIR, and the correlation is stronger than that with HbA1C. Therefore, the role of TIR should be emphasized in the evaluation of lower limb vascular diseases.

Association of time in range with lower extremity atherosclerotic disease in type 2 diabetes mellitus: a prospective cohort study

PURPOSE

Time in range (TIR) has surfaced as a key continuous glucose monitoring (CGM)-derived metric, which was linked to diabetes-related outcomes. We aimed to investigate the association of TIR with the risk of lower extremity atherosclerotic disease (LEAD) among patients with type 2 diabetes.

METHODS

A total of 1351 adult patients with type 2 diabetes were prospectively recruited from a single center in Shanghai, China. TIR was obtained from CGM data at baseline. LEAD was measured with color Doppler ultrasonography. Cox proportion hazard regression analysis was used to assess the association between TIR and the risk of incident/progressive LEAD.

RESULTS

During a median follow-up of 7.4 years, 450 participants developed incident/progressive LEAD. The multivariable-adjusted hazard ratios (HRs) for incident/progressive LEAD across different levels of TIR ( > 85%, 71~85%, 51~70%, and ≤50%) were 1.00, 1.15 (95% confidence interval [CI] 0.87-1.52), 1.37 (95% CI 1.04-1.80) and 1.46 (95% CI 1.10-1.94) (P for trend = 0.004), respectively. With each 10% decrease in TIR, the multivariable-adjusted risk of incident/progressive LEAD increased by 7% (95% CI 1.02-1.11). Similar results were found in the association between TIR and incident LEAD as the secondary outcome (P for trend < 0.001).

CONCLUSIONS

The current study found an inverse association of TIR with the risk of LEAD among patients with type 2 diabetes.

Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China

Peripheral arterialdisease (PAD) can result in diabetic foot ulcers, gangrene, and even amputation. Since most cases of PAD in diabetic patients are associated with peripheral neuropathy, the symptoms of vascular disease are easily concealed by the symptoms of neuropathy and are ignored by people, so it is critical for health care providers to screen PAD for the diabetes patients. This study was carried out to identify theprevalence and related factors of PAD in diabetes mellitus inpatients. This was a cross-sectional observational study. A total of 855 patients were enrolled in the study from December 2018 to December 2019. The patients were divided into a non-PAD group (ABI = 0.9-1.3) and a PAD group (ABI <0.9). Logistic multivariate regression analysis showed that age, LDL-C, dorsalis pedis artery pulsation (left foot), and sensory-current threshold (right foot) were related factors for peripheral arterial disease. Patients who are older and have a higher LDL-C level, abnormal dorsal foot pulse, and abnormal sensory-current threshold must be vigilant, and receive early screening for PAD diagnosis and treatment to avoid a malignant outcome. In clinical work, medical staff should actively apply PAD screening to diabetic patients, identify risk factors as early as possible, conduct early interventions, reduce the risk of PAD in patients, and avoid the occurrence of adverse outcomes.

Determinants of Diabetic Peripheral Neuropathy and Their Clinical Significance: A Retrospective Cohort Study

BACKGROUND

In this study, we investigated the epidemiological characteristics and predictors of diabetic peripheral neuropathy (DPN) in adult patients with type 2 diabetes mellitus (DM).

METHODS

The study was designed as a retrospective cohort trial at the First Affiliated Hospital of Wenzhou Medical University. From January 2017 to December 2020, a total of 1,262 patients with DM were enrolled to assess the risk factors for DPN. The patients were divided into two groups (DPN group and non-DPN group). The Mann-Whitney U test or t-test, receiver operating characteristic (ROC) analyses, univariate chi-square analyses, and multiple logistic regression analyses were used to analyze the adjusted predictors of DPN.

RESULTS

The overall prevalence of DPN in DM patients was 72.7% (n = 793/1,091). Multivariate analysis revealed that age > 66 years (odds ratio [OR], 2.647; 95% confidence interval [CI] 1.469-4.770; p = 0.002), history of hypertension (OR, 1.829; 95% CI 1.146-2.920; p = 0.011), neutrophil (NE) levels exceeding 4.0 × 10⁹/L (OR 0.256; 95% CI 0.162-0.405; p = 0.001), lymphocyte (LY) levels over 3.0 × 10⁹/L (OR 7.173; 95% CI 4.258-12.086; p = 0.000), HbA1c > 7.7% (OR 3.151; 95% CI 1.959-5.068; p = 0.000), and FT3 > 4.4 pmol/L (OR 0.417; 95% CI 0.263-0.662; p = 0.000) were six significant predictive factors for the prevalence of DPN.

CONCLUSIONS

High levels of LY, HbA1c, history of hypertension, and > 66 years of age increase the risk of DPN in adult patients with DM, while high levels of NE and FT3 were protective factors of DPN. Thus, the prediction of DPN can significantly be improved by identifying older patients over the age of 66 and history of hypertension, as well as establishing the biochemical cutoff values of NE, LY, HbA1c, and FT3.

Greater daily glucose variability and lower time in range assessed with continuous glucose monitoring are associated with greater aortic stiffness: The Maastricht Study

AIMS

CVD is the main cause of morbidity and mortality in individuals with diabetes. It is currently unclear whether daily glucose variability contributes to CVD. Therefore, we investigated whether glucose variability is associated with arterial measures that are considered important in CVD pathogenesis.

METHODS

We included participants of The Maastricht Study, an observational population-based cohort, who underwent at least 48 h of continuous glucose monitoring (CGM) (n = 853; age: 59.9 ± 8.6 years; 49% women, 23% type 2 diabetes). We studied the cross-sectional associations of two glucose variability indices (CGM-assessed SD [SD_CGM] and CGM-assessed CV [CV_CGM]) and time in range (TIR_CGM) with carotid-femoral pulse wave velocity (cf-PWV), carotid distensibility coefficient, carotid intima-media thickness, ankle-brachial index and circumferential wall stress via multiple linear regression.

RESULTS

Higher SD_CGM was associated with higher cf-PWV after adjusting for demographics, cardiovascular risk factors and lifestyle factors (regression coefficient [B] per 1 mmol/l SD_CGM [and corresponding 95% CI]: 0.413 m/s [0.147, 0.679], p = 0.002). In the model additionally adjusted for CGM-assessed mean sensor glucose (MSG_CGM), SD_CGM and MSG_CGM contributed similarly to cf-PWV (respective standardised regression coefficients [st.βs] and 95% CIs of 0.065 [-0.018, 0.167], p = 0.160; and 0.059 [-0.043, 0.164], p = 0.272). In the fully adjusted models, both higher CV_CGM (B [95% CI] per 10% CV_CGM: 0.303 m/s [0.046, 0.559], p = 0.021) and lower TIR_CGM (B [95% CI] per 10% TIR_CGM: -0.145 m/s [-0.252, -0.038] p = 0.008) were statistically significantly associated with higher cf-PWV. Such consistent associations were not observed for the other arterial measures.

CONCLUSIONS

Our findings show that greater daily glucose variability and lower TIR_CGM are associated with greater aortic stiffness (cf-PWV) but not with other arterial measures. If corroborated in prospective studies, these results support the development of therapeutic agents that target both daily glucose variability and TIR_CGM to prevent CVD.

Association of time in range, as assessed by continuous glucose monitoring, with painful diabetic polyneuropathy

AIMS/INTRODUCTION

This study aimed to evaluate the association between time in range (TIR) obtained from continuous glucose monitoring and the prevalence and degree of painful diabetic neuropathy.

MATERIALS AND METHODS

A total of 364 individuals with diabetic peripheral neuropathy were enrolled in this study. Sensor-based flash glucose monitoring systems were used to monitor the participants' glucose levels, and the glycemic variability metrics were calculated, including the TIR, glucose coefficient of variation, standard deviation and the mean amplitude of glycemic excursions. The participants were asked to record any form of pain during the 2 weeks of monitoring, and score the pain every day on a numerical rating scale. Based on the numerical rating scale, the patients were divided into the pain-free group, mild pain group and moderate/severe pain group.

RESULTS

Overall, 51.92% (189/364) of the participants were diagnosed with painful diabetic neuropathy. Compared with the pain-free group, the level of TIR decreased significantly in the mild pain and moderate/severe pain groups (P < 0.05). The prevalence of mild pain and moderate/severe pain decreased with increasing TIR quartiles (all P < 0.05). Multiple linear regression analysis showed that TIR was significantly negatively correlated with the numerical rating scale score after adjustment for glycated hemoglobin, glycemic variability indicators and other risk factors (P < 0.05). Logistic regression analysis showed that a decreasing level of TIR was significantly associated with an increasing risk of any pain and moderate/severe pain (P < 0.05).

CONCLUSIONS

TIR is correlated with painful diabetic neuropathy and is underscored as a valuable clinical evaluation measure.