Impact of visit-to-visit fasting plasma glucose variability on the development of type 2 diabetes: A nationwide population-based cohort study

Jung A. Kim, Ji Sung Lee, Hye Soo Chung, Eun Roh, You Bin Lee, So Hyeon Hong, Nam Hoon Kim, Hye-Jin Yoo, Ji A Seo, Sin Gon Kim, Nan Hee Kim, Sei-Hyun Baik, Kyung Mook Choi

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Abstract

OBJECTIVE Although increasing evidence suggests the association between short-term variability of fasting plasma glucose (FPG) and diabetic complications or mortality, the impact of visit-to-visit variability of FPG on the development of type 2 diabetes (T2D) has not been evaluated. RESEARCH DESIGN AND METHODS Our analysis included 131,744 Korean men and women without diabetes using the Korean National Health Insurance System cohort with periodic health examination program. FPG variability was calculated using the coefficient of variation (FPG-CV), SD (FPG-SD), and variability independent of the mean (FPG-VIM). RESULTS During the median follow-up time of 8.3 years, Kaplan-Meier curves demonstrated lower disease-free probability in the higher FPG variability group compared with the lower FPG variability group. Multivariable Cox proportional hazards analysis exhibited that the hazard ratio for incident T2D was 1.67 (95% CI 1.58-1.77, P < 0.001) in the highest quartile of FPG-CV compared with the lowest quartile of FPG-CV after adjusting for confounding variables, including mean FPG. The association between FPG variability and the risk of T2D was consistent when modeling using FPG-SD and FPG-VIM in both normal and impaired fasting glucose groups. A 1 SD increase in the FPG-CV was associated with a 24% increased risk of T2D in the fully adjusted model. CONCLUSIONS Increased variability of FPG is associated with the development of T2D independently of diverse risk factors.

Original languageEnglish
Pages (from-to)2610-2616
Number of pages7
JournalDiabetes Care
Volume41
Issue number12
DOIs
Publication statusPublished - 2018 Dec 1

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Type 2 Diabetes Mellitus
Fasting
Cohort Studies
Glucose
Population
Confounding Factors (Epidemiology)
National Health Programs
Diabetes Complications

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

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Impact of visit-to-visit fasting plasma glucose variability on the development of type 2 diabetes : A nationwide population-based cohort study. / Kim, Jung A.; Lee, Ji Sung; Chung, Hye Soo; Roh, Eun; Lee, You Bin; Hong, So Hyeon; Kim, Nam Hoon; Yoo, Hye-Jin; Seo, Ji A; Kim, Sin Gon; Kim, Nan Hee; Baik, Sei-Hyun; Choi, Kyung Mook.

In: Diabetes Care, Vol. 41, No. 12, 01.12.2018, p. 2610-2616.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE Although increasing evidence suggests the association between short-term variability of fasting plasma glucose (FPG) and diabetic complications or mortality, the impact of visit-to-visit variability of FPG on the development of type 2 diabetes (T2D) has not been evaluated. RESEARCH DESIGN AND METHODS Our analysis included 131,744 Korean men and women without diabetes using the Korean National Health Insurance System cohort with periodic health examination program. FPG variability was calculated using the coefficient of variation (FPG-CV), SD (FPG-SD), and variability independent of the mean (FPG-VIM). RESULTS During the median follow-up time of 8.3 years, Kaplan-Meier curves demonstrated lower disease-free probability in the higher FPG variability group compared with the lower FPG variability group. Multivariable Cox proportional hazards analysis exhibited that the hazard ratio for incident T2D was 1.67 (95{\%} CI 1.58-1.77, P < 0.001) in the highest quartile of FPG-CV compared with the lowest quartile of FPG-CV after adjusting for confounding variables, including mean FPG. The association between FPG variability and the risk of T2D was consistent when modeling using FPG-SD and FPG-VIM in both normal and impaired fasting glucose groups. A 1 SD increase in the FPG-CV was associated with a 24{\%} increased risk of T2D in the fully adjusted model. CONCLUSIONS Increased variability of FPG is associated with the development of T2D independently of diverse risk factors.",
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T1 - Impact of visit-to-visit fasting plasma glucose variability on the development of type 2 diabetes

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AU - Chung, Hye Soo

AU - Roh, Eun

AU - Lee, You Bin

AU - Hong, So Hyeon

AU - Kim, Nam Hoon

AU - Yoo, Hye-Jin

AU - Seo, Ji A

AU - Kim, Sin Gon

AU - Kim, Nan Hee

AU - Baik, Sei-Hyun

AU - Choi, Kyung Mook

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N2 - OBJECTIVE Although increasing evidence suggests the association between short-term variability of fasting plasma glucose (FPG) and diabetic complications or mortality, the impact of visit-to-visit variability of FPG on the development of type 2 diabetes (T2D) has not been evaluated. RESEARCH DESIGN AND METHODS Our analysis included 131,744 Korean men and women without diabetes using the Korean National Health Insurance System cohort with periodic health examination program. FPG variability was calculated using the coefficient of variation (FPG-CV), SD (FPG-SD), and variability independent of the mean (FPG-VIM). RESULTS During the median follow-up time of 8.3 years, Kaplan-Meier curves demonstrated lower disease-free probability in the higher FPG variability group compared with the lower FPG variability group. Multivariable Cox proportional hazards analysis exhibited that the hazard ratio for incident T2D was 1.67 (95% CI 1.58-1.77, P < 0.001) in the highest quartile of FPG-CV compared with the lowest quartile of FPG-CV after adjusting for confounding variables, including mean FPG. The association between FPG variability and the risk of T2D was consistent when modeling using FPG-SD and FPG-VIM in both normal and impaired fasting glucose groups. A 1 SD increase in the FPG-CV was associated with a 24% increased risk of T2D in the fully adjusted model. CONCLUSIONS Increased variability of FPG is associated with the development of T2D independently of diverse risk factors.

AB - OBJECTIVE Although increasing evidence suggests the association between short-term variability of fasting plasma glucose (FPG) and diabetic complications or mortality, the impact of visit-to-visit variability of FPG on the development of type 2 diabetes (T2D) has not been evaluated. RESEARCH DESIGN AND METHODS Our analysis included 131,744 Korean men and women without diabetes using the Korean National Health Insurance System cohort with periodic health examination program. FPG variability was calculated using the coefficient of variation (FPG-CV), SD (FPG-SD), and variability independent of the mean (FPG-VIM). RESULTS During the median follow-up time of 8.3 years, Kaplan-Meier curves demonstrated lower disease-free probability in the higher FPG variability group compared with the lower FPG variability group. Multivariable Cox proportional hazards analysis exhibited that the hazard ratio for incident T2D was 1.67 (95% CI 1.58-1.77, P < 0.001) in the highest quartile of FPG-CV compared with the lowest quartile of FPG-CV after adjusting for confounding variables, including mean FPG. The association between FPG variability and the risk of T2D was consistent when modeling using FPG-SD and FPG-VIM in both normal and impaired fasting glucose groups. A 1 SD increase in the FPG-CV was associated with a 24% increased risk of T2D in the fully adjusted model. CONCLUSIONS Increased variability of FPG is associated with the development of T2D independently of diverse risk factors.

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