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Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study.
Diabetes Care. 2017 09; 40(9):1210-1217.DC

Abstract

OBJECTIVE

The relationship between glycemic variability and the incidence of Alzheimer disease (AD) in patients with type 2 diabetes mellitus (T2DM) is unclear. The aim of this study was to examine visit-to-visit variations in fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) represented by the coefficient of variation (CV) and to determine whether they were independently associated with AD, irrespective of HbA1c and other traditional risk factors in such patients.

RESEARCH DESIGN AND METHODS

Patients with T2DM enrolled in the National Diabetes Care Management Program, age ≥60 years, and without diagnosis of AD (n = 16,706) were included in the study. Potential risk factors were analyzed using extended Cox proportional hazards regression models for competing risk of mortality on AD incidence.

RESULTS

During a median follow-up of 8.88 years, 831 incident cases of AD were identified, with a crude incidence rate of 3.5/1,000 person-years. After adjustment for sociodemographic factors, lifestyle behaviors, diabetes-related variables, FPG and HbA1c, drug-related variables, and comorbidities, both FPG CV and HbA1c CV were found to be significant predictors of AD, with corresponding hazard ratios of 1.27 (95% CI 1.06-1.52) for the third tertile in FPG CV and 1.32 (95% CI 1.11-1.58) for the third tertile in HbA1c CV.

CONCLUSIONS

FPG CV and HbA1c CV are independently associated with AD. The associations between glycemic variability and AD demonstrated in this study suggest a linked pathophysiological mechanism, which is worthy of further investigation. Further research is required to confirm our results and to evaluate whether FPG CV and HbA1c CV can be valuable therapeutic targets for patients with T2DM at risk.

Authors+Show Affiliations

Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan. Department of Nutrition, Hungkuang University, Taichung, Taiwan.Department of Food and Nutrition, Providence University, Taichung, Taiwan. Department of Endocrinology and Metabolism, Kuang Tien General Hospital, 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. 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 Family Medicine, China Medical University Hospital, Taichung, Taiwan.Department of Public Health, Chung Shan Medical University, Taichung, Taiwan.Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.Department of Medical Research, China Medical University Hospital, Taichung, Taiwan cclin@mail.cmuh.org.tw. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28705834

Citation

Li, Tsai-Chung, et al. "Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study." Diabetes Care, vol. 40, no. 9, 2017, pp. 1210-1217.
Li TC, Yang CP, Tseng ST, et al. Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study. Diabetes Care. 2017;40(9):1210-1217.
Li, T. C., Yang, C. P., Tseng, S. T., Li, C. I., Liu, C. S., Lin, W. Y., Hwang, K. L., Yang, S. Y., Chiang, J. H., & Lin, C. C. (2017). Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study. Diabetes Care, 40(9), 1210-1217. https://doi.org/10.2337/dc16-2238
Li TC, et al. Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study. Diabetes Care. 2017;40(9):1210-1217. PubMed PMID: 28705834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Visit-to-Visit Variations in Fasting Plasma Glucose and HbA1c Associated With an Increased Risk of Alzheimer Disease: Taiwan Diabetes Study. AU - Li,Tsai-Chung, AU - Yang,Chun-Pai, AU - Tseng,Shih-Ting, AU - Li,Chia-Ing, AU - Liu,Chiu-Shong, AU - Lin,Wen-Yuan, AU - Hwang,Kai-Lin, AU - Yang,Sing-Yu, AU - Chiang,Jen-Huai, AU - Lin,Cheng-Chieh, Y1 - 2017/07/13/ PY - 2016/10/18/received PY - 2017/06/19/accepted PY - 2017/7/15/pubmed PY - 2018/3/2/medline PY - 2017/7/15/entrez SP - 1210 EP - 1217 JF - Diabetes care JO - Diabetes Care VL - 40 IS - 9 N2 - OBJECTIVE: The relationship between glycemic variability and the incidence of Alzheimer disease (AD) in patients with type 2 diabetes mellitus (T2DM) is unclear. The aim of this study was to examine visit-to-visit variations in fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) represented by the coefficient of variation (CV) and to determine whether they were independently associated with AD, irrespective of HbA1c and other traditional risk factors in such patients. RESEARCH DESIGN AND METHODS: Patients with T2DM enrolled in the National Diabetes Care Management Program, age ≥60 years, and without diagnosis of AD (n = 16,706) were included in the study. Potential risk factors were analyzed using extended Cox proportional hazards regression models for competing risk of mortality on AD incidence. RESULTS: During a median follow-up of 8.88 years, 831 incident cases of AD were identified, with a crude incidence rate of 3.5/1,000 person-years. After adjustment for sociodemographic factors, lifestyle behaviors, diabetes-related variables, FPG and HbA1c, drug-related variables, and comorbidities, both FPG CV and HbA1c CV were found to be significant predictors of AD, with corresponding hazard ratios of 1.27 (95% CI 1.06-1.52) for the third tertile in FPG CV and 1.32 (95% CI 1.11-1.58) for the third tertile in HbA1c CV. CONCLUSIONS: FPG CV and HbA1c CV are independently associated with AD. The associations between glycemic variability and AD demonstrated in this study suggest a linked pathophysiological mechanism, which is worthy of further investigation. Further research is required to confirm our results and to evaluate whether FPG CV and HbA1c CV can be valuable therapeutic targets for patients with T2DM at risk. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/28705834/Visit_to_Visit_Variations_in_Fasting_Plasma_Glucose_and_HbA1c_Associated_With_an_Increased_Risk_of_Alzheimer_Disease:_Taiwan_Diabetes_Study_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=28705834 DB - PRIME DP - Unbound Medicine ER -