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Visit-to-visit glycemic variability is a strong predictor of chronic obstructive pulmonary disease in patients with type 2 diabetes mellitus: Competing risk analysis using a national cohort from the Taiwan diabetes study.
PLoS One. 2017; 12(5):e0177184.Plos

Abstract

BACKGROUND

This study aims to examine the association between visit-to-visit glucose variability, which was measured by coefficient of variation (CV) of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), and risk of chronic obstructive pulmonary disease (COPD) in a large number of patients with type 2 diabetes with an average follow-up of 7.58 years.

METHODS

We conducted a retrospective cohort study on 27,257 patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. Visit-to-visit variability in HbA1c and FPG at baseline and the incidence of COPD were analyzed using a modified Cox proportional hazards model considering competing risks.

RESULTS

A total of 2,346 incident cases of COPD. Patients were grouped into tertiles of FPG-CV and HbA1c-CV. The incidence rates in the first, second, and third tertiles were 9.87, 11.06, and 13.19, respectively, for FPG-CV and 10.2, 11.81, and 12.07, for HbA1c-CV per 1000 person-years. After adjusting for age, gender, diabetes duration, treatment type, smoking, hypertension, hyperlipidemia, baseline FPG and HbA1c levels, and complications, both FPG-CV and HbA1c-CV were independently associated with COPD. The hazard ratios of COPD for the third terile compared with the first tertile of FPG-CV were 1.26 (95% confidence interval [CI]: 1.13-1.40). Moreover, the hazard ratios of COPD for the third and second tertiles compared with the first tertile of HbA1c-CV were 1.13 (1.02-1.25) and 1.13 (1.02-1.26), respectively.

CONCLUSIONS

Patients with FPG-CV higher than 34.6% or HbA1c-CV higher than 8.4% exhibited an increased risk of COPD. This finding confirmed the linear relationship of FPG-CV and HbA1c-CV to COPD. Visit-to-visit variability in FPG and HbA1c levels are strong predictors of COPD in patients with type 2 diabetes. Future studies should focus on lung dysfunction in diabetes, and adequate glucose control strategy in regular clinical practices must be established for COPD prevention.

Authors+Show Affiliations

Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan. Clinical Research Outcome and Training Center, Big Data Center, China Medical University Hospital, Taichung, Taiwan.Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28489885

Citation

Chiu, Hsien-Tsai, et al. "Visit-to-visit Glycemic Variability Is a Strong Predictor of Chronic Obstructive Pulmonary Disease in Patients With Type 2 Diabetes Mellitus: Competing Risk Analysis Using a National Cohort From the Taiwan Diabetes Study." PloS One, vol. 12, no. 5, 2017, pp. e0177184.
Chiu HT, Li TC, Li CI, et al. Visit-to-visit glycemic variability is a strong predictor of chronic obstructive pulmonary disease in patients with type 2 diabetes mellitus: Competing risk analysis using a national cohort from the Taiwan diabetes study. PLoS One. 2017;12(5):e0177184.
Chiu, H. T., Li, T. C., Li, C. I., Liu, C. S., Lin, W. Y., & Lin, C. C. (2017). Visit-to-visit glycemic variability is a strong predictor of chronic obstructive pulmonary disease in patients with type 2 diabetes mellitus: Competing risk analysis using a national cohort from the Taiwan diabetes study. PloS One, 12(5), e0177184. https://doi.org/10.1371/journal.pone.0177184
Chiu HT, et al. Visit-to-visit Glycemic Variability Is a Strong Predictor of Chronic Obstructive Pulmonary Disease in Patients With Type 2 Diabetes Mellitus: Competing Risk Analysis Using a National Cohort From the Taiwan Diabetes Study. PLoS One. 2017;12(5):e0177184. PubMed PMID: 28489885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Visit-to-visit glycemic variability is a strong predictor of chronic obstructive pulmonary disease in patients with type 2 diabetes mellitus: Competing risk analysis using a national cohort from the Taiwan diabetes study. AU - Chiu,Hsien-Tsai, AU - Li,Tsai-Chung, AU - Li,Chia-Ing, AU - Liu,Chiu-Shong, AU - Lin,Wen-Yuan, AU - Lin,Cheng-Chieh, Y1 - 2017/05/10/ PY - 2016/10/23/received PY - 2017/04/23/accepted PY - 2017/5/11/entrez PY - 2017/5/11/pubmed PY - 2017/9/9/medline SP - e0177184 EP - e0177184 JF - PloS one JO - PLoS One VL - 12 IS - 5 N2 - BACKGROUND: This study aims to examine the association between visit-to-visit glucose variability, which was measured by coefficient of variation (CV) of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), and risk of chronic obstructive pulmonary disease (COPD) in a large number of patients with type 2 diabetes with an average follow-up of 7.58 years. METHODS: We conducted a retrospective cohort study on 27,257 patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. Visit-to-visit variability in HbA1c and FPG at baseline and the incidence of COPD were analyzed using a modified Cox proportional hazards model considering competing risks. RESULTS: A total of 2,346 incident cases of COPD. Patients were grouped into tertiles of FPG-CV and HbA1c-CV. The incidence rates in the first, second, and third tertiles were 9.87, 11.06, and 13.19, respectively, for FPG-CV and 10.2, 11.81, and 12.07, for HbA1c-CV per 1000 person-years. After adjusting for age, gender, diabetes duration, treatment type, smoking, hypertension, hyperlipidemia, baseline FPG and HbA1c levels, and complications, both FPG-CV and HbA1c-CV were independently associated with COPD. The hazard ratios of COPD for the third terile compared with the first tertile of FPG-CV were 1.26 (95% confidence interval [CI]: 1.13-1.40). Moreover, the hazard ratios of COPD for the third and second tertiles compared with the first tertile of HbA1c-CV were 1.13 (1.02-1.25) and 1.13 (1.02-1.26), respectively. CONCLUSIONS: Patients with FPG-CV higher than 34.6% or HbA1c-CV higher than 8.4% exhibited an increased risk of COPD. This finding confirmed the linear relationship of FPG-CV and HbA1c-CV to COPD. Visit-to-visit variability in FPG and HbA1c levels are strong predictors of COPD in patients with type 2 diabetes. Future studies should focus on lung dysfunction in diabetes, and adequate glucose control strategy in regular clinical practices must be established for COPD prevention. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/28489885/Visit_to_visit_glycemic_variability_is_a_strong_predictor_of_chronic_obstructive_pulmonary_disease_in_patients_with_type_2_diabetes_mellitus:_Competing_risk_analysis_using_a_national_cohort_from_the_Taiwan_diabetes_study_ L2 - https://dx.plos.org/10.1371/journal.pone.0177184 DB - PRIME DP - Unbound Medicine ER -