Glucose variability and the risks of stroke, myocardial infarction, and all-cause mortality in individuals with diabetes
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ORIGINAL INVESTIGATION
Cardiovascular Diabetology Open Access
Glucose variability and the risks of stroke, myocardial infarction, and all‑cause mortality in individuals with diabetes: retrospective cohort study Da Young Lee1†, Kyungdo Han2†, Sanghyun Park2, Ji Hee Yu1, Ji A. Seo1, Nam Hoon Kim1, Hye Jin Yoo1, Sin Gon Kim1, Kyung Mook Choi1, Sei Hyun Baik1, Yong Gyu Park2* and Nan Hee Kim1,3*
Abstract Background: Previous research regarding long-term glucose variability over several years which is an emerging indicator of glycemic control in diabetes showed several limitations. We investigated whether variability in long-term fasting plasma glucose (FG) can predict the development of stroke, myocardial infarction (MI), and all-cause mortality in patients with diabetes. Methods: This is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. A total of 624,237 Koreans ≥ 20 years old with diabetes who had undergone health examinations at least twice from 2005 to 2008 and simultaneously more than once from 2009 to 2010 (baseline) without previous histories of stroke or MI. As a parameter of variability of FG, variability independent of mean (VIM) was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31, 2017. Results: During follow-up, 25,038 cases of stroke, 15,832 cases of MI, and 44,716 deaths were identified. As the quartile of FG VIM increased, the risk of clinical outcomes serially increased after adjustment for confounding factors including duration and medications of diabetes and the mean FG. Adjusted hazard ratios (95% confidence intervals) of FG VIM quartile 4 compared with quartile 1 were 1.20 (1.16–1.24), 1.20 (1.15–1.25), and 1.32 (1.29–1.36) for stroke, MI and all-cause mortality, respectively. The impact of FG variability was higher in the elderly and those with a longer duration of diabetes and lower FG levels. Conclusions: In diabetes, long-term glucose variability showed a dose–response relationship with the risk of stroke, MI, and all-cause mortality in this nationwide observational study. Keywords: Diabetes mellitus Glucose variability, Cardiovascular disease, Stroke, All-cause mortality, The Korean National Health Insurance Corporation *Correspondence: [email protected]; [email protected] † Da Young Lee and Kyungdo Han contributed equally to this article 2 Department of Biostatics, College of Medicine, The Catholic University of Korea, 222, Banpo‑daero, Seocho‑gu, Seoul 06591, Republic of Korea 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Danwon‑gu, Ansan‑si, Gyeonggi‑do 15355, Republic of Korea Full list of author information is available at the end of the article © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptatio
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