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Medicine (Baltimore). 2015 Nov;94(44):e1804. doi: 10.1097/MD.0000000000001804.

Visit-to-Visit Glucose Variability Predicts the Development of End-Stage Renal Disease in Type 2 Diabetes: 10-Year Follow-Up of Taiwan Diabetes Study.

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From the Division of Nephrology (Y-FY, C-CH), China Medical University Hospital; School of Medicine (Y-FY, C-IL, C-SL, W-YL, C-CH, C-CL), College of Medicine, China Medical University; Department of Public Health (Y-FY, F-CS), China Medical University; Institute of Biostatistics (T-CL, S-YY), College of Public Health, China Medical University; Department of Healthcare Administration (T-CL), College of Medical and Health Science, Asia University; Department of Medical Research (C-IL, C-SL, C-CL), China Medical University Hospital; Department of Family Medicine (C-SL, W-YL, C-CL), China Medical University Hospital; Management Office for Health Data (J-HC, F-CS), China Medical University Hospital; and Research Center for Chinese Medicine & Accupuncture (J-HC), China Medical University, Taichung, Taiwan.


The purpose of this study was to examine the association of glucose variability using coefficient of variation of fasting plasma glucose (FPG-CV) and coefficient of variation of glycated hemoglobin (HbA1c-CV) to end-stage renal disease (ESRD) in 31,841 Chinese patients with type 2 diabetes.Patients with type 2 diabetes enrolled in National Diabetes Care Management Program, aged ≧30 years, and free of ESRD (n = 31,841) in January 1, 2002 to December 31, 2004 were included. Extended Cox proportional hazards regression models with competing risk of all-cause mortality were used to evaluate risk factors on ESRD incidence. Patients were followed till 2012.After a median follow-up period of 8.23 years, 1642 patients developed ESRD, giving a crude incidence rate of 6.27/1000 person-years (6.36 for men, 6.19 for women). After the multivariate adjustment, both FPG-CV and HbA1c-CV were independent predictors of ESRD with corresponding hazard ratios of 1.20 (95% confidence interval [CI] 1.01, 1.41), 1.24 (95% CI 1.05, 1.46) in HbA1c-CV from fourth to fifth quintile and 1.23 (95% CI 1.03, 1.47) in FPG-CV from fifth quintile.One-year visit-to-visit glucose variability expressed by FPG-CV and HbA1c-CV predicted development of ESRD in patients with type 2 diabetes, suggesting therapeutic strategies toward a goal to minimize glucose fluctuation.

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