HbA1C Variability Is Strongly Associated With the Severity of Cardiovascular Autonomic Neuropathy in Patients With Type 2 Diabetes After Longer Diabetes Duration

• Published in: Frontiers in neuroscience Vol. 13; p. 458
• Main Authors: Lai, Yun-Ru, Huang, Chih-Cheng, Chiu, Wen-Chan, Liu, Rue-Tsuan, Tsai, Nai-Wen, Wang, Hung-Chen, Lin, Wei-Che, Cheng, Ben-Chung, Su, Yu-Jih, Su, Chih-Min, Hsiao, Sheng-Yuan, Wang, Pei-Wen, Chen, Jung-Fu, Lu, Cheng-Hsien
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 14.05.2019; Frontiers Media S.A
• Subjects: Autonomic nervous system; cardiovascular autonomic neuropathy; Cardiovascular disease; composite autonomic scoring scale; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetic neuropathy; Diabetic retinopathy; Family medical history; Glucose; HbA1c variability; Heart rate; Hemoglobin; High density lipoprotein; Hospitals; Hypertension; Laboratories; long diabetes duration; Low density lipoprotein; Medical schools; Medicine; Microvasculature; Nervous system; Neuroscience; Patients; Retinopathy; Risk factors; type 2 diabetes; University colleges; United States > US; Taiwan; long diabetes duration; HbA1c variability; type 2 diabetes; composite autonomic scoring scale; cardiovascular autonomic neuropathy
• ISSN: 1662-4548; 1662-453X; 1662-453X
• DOI: 10.3389/fnins.2019.00458

Variability in the glycated hemoglobin (HbA1c) level is associated with a higher risk of microvascular complications in patients with type 2 diabetes. We tested the hypothesis that HbA1c variability is not only strongly associated with the presence but also the degree of severity of cardiovascular autonomic neuropathy (CAN) in patients with long diabetes durations (more than 10 years). For each patient, the intrapersonal mean, standard deviation (SD), and coefficient of variation (CV) for HbA1c were calculated using all measurements obtained 3 years before the study. We constructed the composite autonomic scoring scale (CASS) as a measure of the severity of cardiovascular autonomic functions. Stepwise logistic regression and linear regression analyses were performed to evaluate the presence of CAN and the influence of independent variables on the mean CASS, respectively. Those with CAN had a higher mean age, a higher low-density lipoprotein cholesterol (LDL-C), HbA1c-SD, HbA1c-CV, mean HbA1c, and index HbA1c, higher prevalence of retinopathy as the underlying disease, and lower high-density lipoprotein (HDL) levels. Stepwise logistic regression showed that HbA1c-SD and retinopathy were risk factors that were independently associated with the presence of CAN. Mean HbA1c, HbA1c-CV, HbA1c-SD, and index HbA1c were positively correlated with mean CASS, and a multiple linear regression analysis revealed that HbA1c-SD was independently associated with the mean CASS. HbA1c variability is strongly associated with not only the presence but also the degree of severity of CAN. A longitudinal study is required to confirm whether controlling blood glucose level is effective in reducing CAN progression.