Objective:

Our study aimed to assess glycemic variability by calculating the coefficients of variation (CV) for fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) and investigate their association with painful DPN in adult patients with T2D.

Background:

The relationship between glycemic variability and painful diabetic peripheral neuropathy (DPN) remains uncertain among patients diagnosed with type 2 diabetes (T2D). 

Design/Methods:

We conducted a prospective hospital-based 6-year follow-up study involving patients with T2D at a tertiary medical center. Patients without DPN in 2013 were enrolled, and they were re-evaluated in 2019. DPN was identified using the Michigan Neuropathy Screening Instrument (MNSI), and painful DPN was evaluated using the Taiwan version of the Douleur Neuropathique 4 (DN4-T) questionnaire. FPG-CV and HbA1c-CV were calculated based on visit-to-visit variations in FPG and HbA1c levels during the follow-up period from 2013 to 2019.

Results:

Among 622 enrolled patients, 267 had DPN. After matching by age and gender, we identified 210 patients without DPN and 210 patients with DPN, comprising 184 with non-painful DPN and 26 with painful DPN. The patients were stratified into tertiles according to their FPG-CV and HbA1c-CV. We revealed a significant association between the highest tertile of FPG-CV and an increased risk of painful DPN, compared to the lowest tertile, with an adjusted odds ratio of 2.82 (95% confidence interval 1.04-7.64). However, no significant association was observed between HbA1c-CV and the risk of painful DPN.

Conclusions:

In our study, FPG-CV is associated with painful DPN, suggesting glycemic variability may contribute to the occurrence of painful DPN.