Variability in Annual Fasting Glucose and the Risk of Peripheral Artery Disease in Patients with Diabetes Mellitus

Yu-Shan Chang,1,2 Liang-Yi Lee,3 I-Te Lee1,2,4 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan; 2School of Medicine, Chung Shan Medical University, Taichung City, Taiwan; 3Mingdao High School, Taichung City, Taiwan; 4School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanCorrespondence: I-Te LeeDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Taichung City, 40705, TaiwanEmail itlee@vghtc.gov.twPurpose: High glucose concentrations and swings are associated with endothelial dysfunction. We examined the effects of variability in fasting plasma glucose on peripheral artery disease (PAD) in patients with diabetes mellitus (DM).Patients and Methods: In this screening study for the risk factors of PAD, we retrospectively collected data on the ankle-brachial index (ABI) and the percentage of mean arterial pressure (%MAP) at the ankle between August 01, 2016 and July 31, 2017. We defined low ABI ≤ 0.90, high %MAP ≥ 45%, or both as high-risk PAD and others as low-risk PAD. We compared the standard deviation (SD) of the first fasting plasma glucose data available each year after January 01, 2007.Results: In 2577 patients, a higher SD of annual fasting glucose was observed in those with an ABI ≤ 0.90 than in patients with an ABI > 0.90 (2.6 ± 2.1 vs 2.2 ± 2.3, P = 0.009), and in patients with %MAP ≥ 45% than in those with %MAP < 45% (2.4 ± 2.1 vs 2.2 ± 2.3, P = 0.034). A high-risk PAD was significantly associated with the SD (P = 0.032) but not with the mean (P = 0.338) of annual fasting glucose. The former was an independent risk factor for high-risk PAD (odds ratio = 1.424; 95% CI = 1.118‒1.814; P = 0.004).Conclusion: Variability but not mean of annual fasting plasma glucose was significantly associated with a high risk of PAD in patients with DM.Keywords: ankle-brachial index, arterial stiffness, lower extremity arterial disease, percentage of the mean arterial pressure, standard deviation