Implications of fasting plasma glucose variability on the risk of incident peripheral artery disease in a population without diabetes: a nationwide population-based cohort study

Hye Soo Chung, Soon Young Hwang, Jung A. Kim, Eun Roh, Hye Jin Yoo, Sei-Hyun Baik, Nan Hee Kim, Ji A Seo, Sin Gon Kim, Nam Hoon Kim, Kyung Mook Choi

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5 Citations (Scopus)


Background: Diabetes have been known as a traditional risk factor of developing peripheral artery disease (PAD). However, the study evaluating the impact of long-term glycemic variability on the risk of developing PAD is limited, especially in a general population without diabetes. Methods: We included 152,931 individuals without diabetes from the Korean National Health Insurance Service–Health Screening Cohort. Fasting plasma glucose (FPG) variability was measured using coefficient variance (FPG-CV), standard deviation (FPG-SD), and variability independent of the mean (FPG-VIM). Results: A total of 16,863 (11.0%) incident cases of PAD were identified during a median follow-up of 8.3 years. Kaplan–Meier curves showed a progressively increasing risk of PAD in the higher quartile group of FPG variability than in the lowest quartile group (log rank P < 0.001). Multivariable Cox proportional hazard analysis showed the hazard ratio for PAD prevalence as 1.11 (95% CI 1.07–1.16, P < 0.001) in the highest FPG-CV quartile than in the lowest FPG-CV quartile after adjusting for confounding variables, including mean FPG. Similar degree of association was shown in the FPG-SD and FPG-VIM. In sensitivity analysis, the association between FPG variability and the risk of developing PAD persisted even after the participants were excluded based on previously diagnosed diseases, including stroke, coronary artery disease, congestive heart failure, chronic kidney disease, or current smokers or drinkers. Subgroup analysis demonstrated that the effects of FPG variability on the risk of PAD were more powerful in subgroups of younger age, regular exercisers, and those with higher income. Conclusions: Increased long-term glycemic variability may have a significant prognostic effect for incident PAD in individuals without diabetes. GraphicalAbstract: [Figure not available: see fulltext.]

Original languageEnglish
Article number15
JournalCardiovascular diabetology
Issue number1
Publication statusPublished - 2022 Dec

Bibliographical note

Funding Information:
This study was supported in part by Korea University Guro Hospital (Korea Research-Driven Hospital), and a grant funded by Korea University Medicine (K2115701, K.M.C.) and by the National Research Foundation of Korea (NRF- 2018R1D1A1B07049605, H.S.C.).

Funding Information:
This study used data from the National Health Insurance Service-National Health Screening Cohort (NHIS-2021-2-146). The authors thank the staff of the National Health Insurance Sharing Service.

Publisher Copyright:
© 2022, The Author(s).


  • Fasting plasma glucose
  • Glycemic variability
  • Peripheral artery disease

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine


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