Visit-to-visit variability of fasting plasma glucose as predictor of ischemic stroke: competing risk analysis in a national cohort of Taiwan Diabetes Study

BMC Medicine

Tsai-Chung Li¹  Sing-Yu Yang⁴  Kai-Lin Hwang⁶  Wen-Yuan Lin²  Ching-Chu Chen³  Chiu-Shong Liu²  Chia-Ing Li²  Chun-Pai Yang⁵  Cheng-Chieh Lin² 

[1] 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;School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan;Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan;Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan;Department of Public Health, Chung Shan Medical University, Taichung, Taiwan

关键词: Type 2 diabetes;    Ischemic stroke;    Glucose variation;   

Others  :  1121427
DOI  :  10.1186/s12916-014-0165-7

 received in 2014-05-22, accepted in 2014-08-29,  发布年份 2014

【 摘 要 】

Background

Glycemic variation as an independent predictor of ischemic stroke in type 2 diabetic patients remains unclear. This study examined visit-to-visit variations in fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), for predicting ischemic stroke independently, regardless of glycated hemoglobin (HbA₁c) and other conventional risk factors in such patients.

Methods

Type 2 diabetic patients enrolled in the National Diabetes Care Management Program, ≥30 years old and free of ischemic stroke (n = 28,354) in 2002 to 2004 were included, and related factors were analyzed with extended Cox proportional hazards regression models of competing risk data on stroke incidence.

Results

After an average 7.5 years of follow-up, there were 2,250 incident cases of ischemic stroke, giving a crude incidence rate of 10.56/1,000 person-years (11.64 for men, 9.63 for women). After multivariate adjustment, hazard ratios for the second, third and fourth versus first FPG-CV quartile were 1.11 (0.98, 1.25), 1.22 (1.08, 1.38) and 1.27 (1.12, 1.43), respectively, without considering HbA₁c, and 1.09 (0.96, 1.23), 1.16 (1.03, 1.31) and 1.17 (1.03, 1.32), respectively, after considering HbA₁c.

Conclusions

Besides HbA₁c, FPG-CV was a potent predictor of ischemic stroke in type 2 diabetic patients, suggesting that different therapeutic strategies now in use be rated for their potential to (1) minimize glucose fluctuations and (2) reduce HbA₁c level in type 2 diabetic patients to prevent ischemic stroke.

【 授权许可】

   
2014 Lin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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