Abstract
AimsThe aim of the present study was to investigate the major determinants of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes (T2D), considering the traditional and newly discovered risk factors, including hypoglycaemia and glycemic variability.MethodsThis retrospective case-control study was conducted in a tertiary care hospital in Taiwan. A total of 2,837 patients with T2D were recruited, medical history and biochemical data were obtained, and patients were screened for DPN using the Michigan Neuropathy Screening Instrument (MNSI). DPN was defined as an MNSI exam score > 2. A stepwise selection of variables was used based on the Akaike Information Criterion (AIC) and the Schwarz Criterion (SC). Multivariate analysis was performed using the identified variables obtained from the stepwise selection.ResultsAmong the recruited patients, 604 (21.3%) were found to have DPN. 275 patients with DPN were selected because of longer follow up period before enrollment and complete data of glycemic parameters, and paired with 351 patients with T2D without DPN and matched for age, gender, and diabetes duration. The results of the stepwise selection showed that the presence of moderately and severely increased albuminuria yielded the lowest values of AIC and SC, which indicate the best predictive performance. Multivariate analysis demonstrated that moderately and severely increased albuminuria and greater long-term glycemic variability significantly increased the risk of DPN, with a corresponding odds ratio of 1.85 and 1.61 (95%confidence intervals of 1.25–2.73and1.02–2.55, respectively), after adjusted for hypoglycaemia and types of diabetes treatment.ConclusionsAlbuminuria is a potent predictor of DPN, and greater long-term glycemic variabilityis clearly associated with DPN in adults with T2D. These findings indicate that, in addition to achieve average blood glucose control, screening for albuminuria and reducing blood glucose fluctuations might be useful for improving diabetic microvascular complications.
Highlights
Diabetic peripheral neuropathy (DPN) is a common and debilitating microvascular complication of diabetes, affects nearly half of patients with diabetes after 10 years, increases the risk of ulcerations and lower extremities amputations, and has a deleterious impact on quality of life [1]
The results of the stepwise selection showed that the presence of moderately and severely increased albuminuria yielded the lowest values of Akaike Information Criterion (AIC) and Schwarz Criterion (SC), which indicate the best predictive performance
Albuminuria is a potent predictor of DPN, and greater long-term glycemic variabilityis clearly associated with DPN in adults with type 2 diabetes (T2D)
Summary
Diabetic peripheral neuropathy (DPN) is a common and debilitating microvascular complication of diabetes, affects nearly half of patients with diabetes after 10 years, increases the risk of ulcerations and lower extremities amputations, and has a deleterious impact on quality of life [1]. Longer diabetes duration, poor glycemic control, hypertension, and dyslipidemia are well-known risk factors of DPN. Many results from clinical trials and systematic reviews suggest that enhanced sugar control for targeting normal HbA1c levels does not significantly reduce DPN in patients with type 2 diabetes (T2D) but increases the risk of severe hypoglycemic episodes [2]. A number of studies suggested that long-term glycemic variability, as determined by visit-to-visit variations in fasting plasma glucose (FPG) or HbA1c, is a potent indicator in patients with T2D [4, 5]. Recent evidence has shown that previous hypoglycemic events requiring hospitalization or visits to emergency department were associated with an increased risk of DPN, independent of HbA1c levels [6]. The aim of this study was to investigate the major determinants of DPN in a large cohort of adult patients with T2D
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