Abstract
Diabetic peripheral neuropathy is a frequent and severe complication of diabetes. As Matrix-gla-protein (MGP) is expressed in several components of the nervous system and is involved in some neurological disease, MGP could play a role in peripheral nervous system homeostasis. The aim of this study was to evaluate factors associated with sensitive diabetic neuropathy in Type 2 Diabetes, and, in particular, dephospho-uncarboxylated MGP (dp-ucMGP), the inactive form of MGP. 198 patients with Type 2 Diabetes were included. Presence of sensitive diabetic neuropathy was defined by a neuropathy disability score (NDS) ≥6. Plasma levels of dp-ucMGP were measured by ELISA. In this cohort, the mean age was 64+/-8.4 years old, and 80% of patients were men. Peripheral neuropathy was present in 15.7% of the patients and was significantly associated (r = 0.51, p<0.0001) with dp-ucMGP levels (β = -0.26, p = 0.045) after integrating effects of height (β = -0.38, p = 0.01), insulin treatment (β = 0.42, p = 0.002), retinopathy treated by laser (β = 0.26, p = 0.02), and total cholesterol levels (β = 0.3, p = 0.03) by multivariable analysis. The association between diabetic neuropathy and the inactive form of MGP suggests the existence of new pathophysiological pathways to explore. Further studies are needed to determine if dp-ucMGP may be used as a biomarker of sensitive neuropathy. Since dp-ucMGP is a marker of poor vitamin K status, clinical studies are warranted to explore the potential protective effect of high vitamin K intake on diabetic peripheral neuropathy.
Highlights
Diabetic peripheral neuropathy is a frequent complication of diabetes
Peripheral neuropathy was present in 15.7% of the patients and was significantly associated (r = 0.51, p
The association between diabetic neuropathy and the inactive form of MGP suggests the existence of new pathophysiological pathways to explore
Summary
Diabetic peripheral neuropathy is a frequent complication of diabetes. It affects about 10 to 15% of patients with Type 2 Diabetes at diagnosis and up to 50% after 10 years of disease duration [1]. Diabetic neuropathy is associated with high morbidity and mortality [2], because of increased risk for foot ulceration and amputation [3], and for poor quality of life and depression [4]. The main clinical characteristic of diabetic peripheral neuropathy is a decrease of distal sensitivity that represents the most important risk factor of foot ulceration in patients with diabetes. In 2019, ADA guidelines recommended an annual clinical screening to diagnose sensitive diabetic neuropathy [1]. Electrophysiological testing or referral to a neurologist is not recommended for screening, except in situations where the clinical features are atypical, the diagnosis is unclear, or a different etiology is suspected [1]
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