Is visit-to-visit fasting glucose variability associated with occurrence of hypoglycemia hospitalization in adult type 2 diabetic patients? A single-center population study in Chiangrai Prachanukroh Hospital, Thailand.
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Abstract
Background: Hospitalizations due to hypoglycemia is an important potential complication in the treatment of type 2 diabetes mellitus. Although, Thai Diabetes Association guideline did not mention measuring the glycemic variability, whereas American Diabetes Association (ADA) in 2022, mentioned that its influence on hypoglycemia events and made a glycemic target recommendation based on percent coefficient of variation (%CV) from continuous glucose monitoring (CGM) devices. Suspecting that visit-to-visit fasting glucose variation which reflects long-term glycemic variability might have a prognostic value on the incidences of hypoglycemia hospitalization, we investigate their association.
Objective: To ascertain the association between visit-to-visit fasting glucose variability and the incidences of hypoglycemia hospitalization.
Methods: A population-based retrospective observational cohort study was conducted. Medical records of 15,039 adult type 2 diabetic patients having a visit at Chiangrai Prachanukroh Hospital from 2019 to 2021 were reviewed, of which 9,239 patients were analyzed after exclusion. Measuring the visit-to-visit fasting glucose variation coefficient of variation (CV-FBS) calculated from three values of fasting glucose randomly selected by a computer program once per year for three years. Patients were divided into 4 groups according to quartiles of CV-FBS. Kaplan-Meier curves, Log-rank test and Cox proportional hazard regression were then calculated.
Results: The first quartile has CV-FBS 0.00 - 0.06 or 0.00% - 5.89%, the second quartile 0.06 - 0.11 or 5.89% - 10.54%, the third quartile 0.11 - 0.18 or 10.54% - 18.35%, and the fourth quartile 0.18 - 0.89 or 18.37% - 89.37%. Kaplan-Meier curves were calculated showing higher event probability in the higher quartiles. Log-rank test yielded p-value <0.001. Compared to the first quartile, the second quartile had a hazard ratio of 1.36 (p-value 0.229; 95%CI 0.82 - 2.25); the third quartile had a hazard ratio of 1.87 (p-value 0.008; 95%CI 1.17 - 2.97); and the fourth quartile with had a hazard ratio of 2.82 (p-value <0.001; 95%CI 1.78 - 4.46). Thus, the impact of visit-to-visit fasting glucose variability on the risk of hypoglycemia hospitalization is statistically significant in the third and fourth quartiles.
Conclusions and Recommendations: Visit-to-visit fasting glucose variation is associated with occurrence of hypoglycemia hospitalizations. High CV-FBS ≥ 0.11 or 10.54% should be considered a risk factor of hypoglycemia hospitalizations.
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