Risk Factor For Diabetic Peripheral Neuropathy Research Articles

The mediating role of HbA1c in the association between elevated low-density lipoprotein cholesterol levels and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus

BackgroundIncreased levels of low-density lipoprotein cholesterol (LDL-C) have been identified as one potential risk factor for diabetic peripheral neuropathy (DPN) in patients. The current study seeks to clarify the link between LDL-C, hyperglycemia, and DPN in patients with type 2 diabetes mellitus (T2DM).MethodsHere, a total of 120 T2DM individuals were recruited. These volunteers with T2DM were divided into 2 groups, based on the presence or absence of peripheral neuropathy. Additionally, their baseline characteristics were compared. Association among LDL-C and glycosylated hemoglobin (HbA1c) levels and DPN, particularly with respect to specific nerve conduction velocity were analyzed. To identify factors influencing DPN, regression was performed. Furthermore, mediation analysis was employed to evaluate the indirect, direct and total effects of LDL-C on specific nerve conduction velocity, with HbA1c serving as a mediator.ResultsCompared to 55 patients without DPN, 65 patients with DPN demonstrated elevated levels of LDL-C and HbA1c. Both LDL-C and HbA1c have been found to be associated with reduced the motor fiber conduction velocities of Ulnar (or the Common peroneal) nerve in diabetic patients. HbA1c is one of the known risk factors for DPN in individuals with T2DM. Further mediation analysis revealed that the effect of LDL-C on the Ulnar (or the Common peroneal) nerve motor fiber conduction velocities are fully mediated by HbA1c in patients with T2DM.ConclusionsThe impact of elevated LDL-C levels upon the Ulnar (or the Common peroneal) nerve motor fiber conduction velocities in patients with T2DM was found to be entirely mediated by increased HbA1c levels.

Serum Uric Acid Levels Are Related to Diabetic Peripheral Neuropathy, Especially for Motor Conduction Velocity of Tibial Nerve in Type 2 Diabetes Mellitus Patients.

Oxidative stress is one of the most critical factors that contribute to the pathogenesis of neuronal damage, including diabetic peripheral neuropathy (DPN). Uric acid is a kind of natural antioxidant that plays a major role in the antioxidant capacity against oxidative stress. Here, we aim to determine the role of serum uric acid (SUA) in the DPN of patients with type 2 diabetes mellitus (T2DM). Patients and Methods. 106 patients with T2DM were recruited and divided into the DPN group and the control group. Clinical parameters, especially for motor nerve fiber conduction velocity and sensory nerve fiber conduction velocity, were collected. Differences between T2DM patients with and without DPN were compared. Correlation and regression analyses were performed to explore the association between SUA and DPN. Compare with 57 patients with DPN, 49 patients without DPN showed lower HbA1c and elevated SUA levels. Additionally, SUA levels are negatively associated with the motor conduction velocity of tibial nerve with or without adjusting for HbA1c. Besides, it is suggested that decreased SUA levels may influence the motor conduction speed of the tibial nerve by multiple linear regression analysis. Moreover, we demonstrated that decreased SUA level is a risk factor for DPN in patients with T2DM by binary logistic regression analysis. Lower SUA is a risk factor for DPN in patients with T2DM. Additionally, decreased SUA may influence the damage of peripheral neuropathy, especially for motor conduction velocity of the tibial nerve.

467-P: The Relationship between Diabetic Peripheral Neuropathy and Metformin Treatment in Type 2 Diabetes Mellitus

Background: Metformin is the first-line therapy for the treatment of Type 2 diabetes mellitus (T2DM) . However, the use of metformin may lead to neuropathy by affecting the absorption of vitamin B12. Our objective was to explore the association between the application of metformin and diabetic peripheral neuropathy (DPN) . Methods: The multicenter randomized cross-sectional study was conducted in 13 hospitals in Beijing from October 2015 to April 2016. T2DM Patients were divided into confirmed DPN group, suspected DPN group and non-DPN group by the five physical examinations (Ankle reflex, acupuncture pain, temperature, vibration, and pressure) . Non-parametric Mann-Whitney test was used for the comparison between non-normally distributed variables between two groups. Chi-square test was used for the comparison of categorical variables. The risk factors of DPN in T2DM Patients were assessed using logistic regression. Results: Compared with patients without metformin, patients taking metformin were more likely to suffer from DPN and suspected DPN (P < 0.0for both) . Similar results were obtained after stratifying the data based on age, BMI, and HbA1c. It was shown that the application of metformin was a risk factor for DPN (OR = 5.06, 95%Cl: 3.90-6.56; P < 0.001) and suspected DPN (OR = 3.58, 95%Cl: 2.78-4.62; P < 0.001) in T2DM patients after the adjustment for age, BMI and HbA1c. In addition, prolonged application of metformin, increased cumulative and single doses would also be associated with the risk of DPN (P < 0.0for all) . Conclusion: The application of metformin was observed relate to DPN in T2DM patients. The vitamin B12 concentration and peripheral nerve function of T2DM patients with the application of metformin should be monitored. Disclosure Q.Pan: None. J.Luo: None. L.Guo: None. Funding National Key R&D Program of China (2020YFC2009006)

IDF21-0260 Prevalence, Characteristics and Factors Associated with Diabetic Peripheral Neuropathy at the Bamenda Regional Hospital

Background: Diabetes and its complications are rapidly becoming the world’s most significant cause of morbidity, disability and mortality. Diabetic peripheral neuropathy (DPN) is a common complication of diabetes and associated with poor quality of life among individuals living with diabetes. There is paucity of data on prevalence and risk factors of DPN among people living with diabetes in Cameroon.

Renal impairment is one of appropriate predictors of future diabetic peripheral neuropathy: a hospital-based 6-year follow-up study

The relationship between renal impairment and diabetic peripheral neuropathy (DPN) remains inconclusive. We aim to investigate the risk factors for the occurrence of DPN in Taiwanese adults with type 2 diabetes mellitus (T2DM) and focus on renal impairment. A hospital-based study was conducted from 2013 to 2019 and 552 Taiwanese people who had T2DM without DPN at baseline were enrolled. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Potential risk factors were recorded, including patient’s sociodemographic factors, current medication usage and biochemical markers. As of 2019, 73 developed DPN and 479 had no DPN. The cumulative incidence during the 6-year period was 13.22%. Multivariable logistic regression analysis revealed that lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.98, p = 0.005), advanced age (OR 1.06, p = 0.001), increased body weight (OR 1.04, p = 0.018), duration of DM (OR 1.05, p = 0.036) and male gender (OR 3.69, p = 0.011) were significantly associated with future DPN. In addition, patients with T2DM under the age of 65 with higher serum creatinine concentration (OR 8.91, p = 0.005) and higher baseline HbA1C (OR 1.71, p < 0.001) revealed significantly associated with future DPN. In conclusion, this is the first large scaled hospital-based study with long term follow-up to investigate risk factors for DPN in Taiwanese. Lower eGFR and higher serum creatinine concentration, particularly in people under the age of 65, are predictors of future DPN in Taiwanese people with T2DM. Other predictors included advanced age, increased body weight, duration of DM, male gender for all ages and HbA1c in enrolled patients under the age of 65. Our study not only confirms the association between renal impairment and future DPN but also provides a commonly available assessment to predict the future DPN.

Association Between Serum Albumin Levels and Diabetic Peripheral Neuropathy Among Patients with Type 2 Diabetes: Effect Modification of Body Mass Index.

BackgroundThe role of serum albumin in the risk of diabetic peripheral neuropathy (DPN) remains unclear. This study aimed to explore the relationship between serum albumin level and DPN, and to examine any possible effect modifiers among patients with type 2 diabetes mellitus.MethodsThis cross-sectional study was conducted in Jiangxi, China, from May 2012 to December 2014. Serum albumin levels were determined in 523 subjects, and the association between serum albumin level and DPN was evaluated using linear regression models (odds ratio [OR] and corresponding 95% confidence interval [CI]).ResultsThere was a significant inverse association between serum albumin level (per 1 g/L increment, OR 0.95 [95% CI 0.92–0.98]) and the risk of DPN. Accordingly, when serum albumin was assessed as quartiles, a significantly lower risk of DPN was found in participants in quartile 4 (OR 0.49 [95% CI 0.25–0.95]), compared with those in quartile 1. Consistently, higher albumin levels (≥35 g/L) were associated with decreased odds for DPN (OR 0.36 [95% CI 0.17–0.74]) compared with lower levels. Furthermore, the albumin–DPN association was significantly stronger in patients with a relatively high body mass index (BMI; ≥24 kg/m2; OR 0.91 [95% CI 0.85–0.98]) than in those with a low BMI (<24 kg/m2; OR 0.99 [95% CI 0.94–1.04]; P for interaction = 0.042).ConclusionThese data suggest that serum albumin level could be a novel risk factor for DPN among patients with type 2 diabetes and relatively high BMI (>24 kg/m2).

Study of Diabetic Peripheral Neuropathy in Adults of Telangana

Background: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported thatprevalence of DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetesmellitus (Type2-M) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosedType2DM.Methods: We prospectively studied 80 consecutive patients over age 30 with a duration of diabetes ≤1 year. Every patientunderwent a clinical and biochemical evaluation and was screened for DPN using TCSS scale (Toronto clinical scoringsystem) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale.Results: The cases had a mean age of 60.28 years and duration of symptoms of DM is &lt;1year prior to presentation. Theoverall prevalence of DPN was 12.5%. The prevalence of DPN showed an increasing trend with FBS (trend chi-square=3.517, P = 0.0304). A logistic regression analysis showed that DPN was independently associated with Fasting Blood Sugar(P = 0.0304), Body mass index (P= 0.0389), HbA1c (P = 0.0451), family history (P= 0.0426) and physical activity (P= 0.0219)but not with age, sex and education.Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with Type2DM, which wasindependently associated with age and duration of symptoms of diabetes prior to the diagnosis. FBS, HbA1c, BMI, werefound to be risk factors for prevalence of Diabetic Neuropathy.

A Study on Peripheral Neuropathy and Its Related Risk Factors Associated With hba1c Levels

Diabetic peripheral neuropathy (DPN) patients frequently feel persistent pain, which is described as painful diabetic peripheral neuropathy (PDPN), which begins in both feet and frequently spreads to the calves, fingers, and hands. PDPN not only causes pain, but also affects patients' sleep, emotions, mental state, and everyday activities, resulting in a low quality of life and a significant financial burden. The goal of this study was to monitor if there was a link between the prevalence, pattern, and related risk factors of diabetic peripheral neuropathy and hemoglobin A1C (HbA1c) levels. In this crosssectional study, 150 type-2 diabetic patients were screened for DPN with PDPN and their HbA1c level was measured in every three months. DPN, PDPN and non-painful DPN were confirmed in patients displaying both clinical manifestations of neuropathy and neurological abnormalities assessment. DPN was detected in 24% (n = 36), while PDPN was found at 15% (n = 23) of the total patients. The prevalence of PDPN is 63.88% (n = 23) and non-painful DPN is 36.11% (n = 13) of total DPN (n = 36). Out of total PDPN (n = 23), the prevalence of symmetrical pain is 65% (n = 15), asymmetrical 35% (n = 8), sensory 26% (n = 6), motor 13% (n = 3), mixed (sensorimotor) 61% (n = 14), lower limb involvement 48% (n = 11), upper limb13% (n = 3) and both limb 39% (n = 9). In comparison to patients without DPN, both PDPN and non-painful DPN, patients had greater HbA1c levels (p&lt;0.05). Furthermore, advanced age and longer diabetes duration were considerable and significant (p&lt;0.05) risk factors for DPN with PDPN and non-painful DPN respectively. Overall, the findings imply that elevated HbA1c levels are closely linked to DPN, PDPN and non-painful DPN in type-2 diabetic patients and that HbA1c might be used as a predictive marker for DPN with PDPN and non-painful DPN in the patients studied. J. Bio-Sci. 29(2): 123-138, 2021 (December)

Clinical study of diabetic peripheral neuropathy screening by retinal vascular geometric parameters

To investigate the relationship between geometrical changes of retinal vessels and diabetic peripheral neuropathy (DPN), and to determine the effectiveness of retinal vascular geometry analysis and vibration perception threshold (VPT) for DPN assessment. Type 2 diabetes patients (n = 242) were categorized by stage of DPN. VPT and fundus photography was performed to obtain retinal vascular geometry parameters. The risk factors for DPN and the correlation between DPN stages were analyzed. The efficiency of the retinal vascular geometric parameters obtained with VPT as a diagnostic tool for DPN was examined. Stages of DPN showed a linear correlation with VPT (r = 0.818), central retinal vein equivalent (CRVE) (r = 0.716), and fractal dimension arterioles (DFa) (r = − 0.769). VPT, CRVE, DFa, and fractal dimension veins (DFv) showed high sensitivity (80%, 55%, 82%, and 67%, respectively) and specificity (92%, 93%, 82%, and 80%, respectively) for DPN diagnosis. Good agreement was observed between combined use of geometric parameters (CRVE, DFa and DFv) and VPT (Kappa value 0.430). The detection rate of DPN with combined use of geometric parameters of retinal vessels (64.88%) was significantly higher than that with use of VPT (47.52%). Retinal vascular geometry changes demonstrated significant correlation with DPN severity. VPT, CRVE, DFa, and DFv may provide insights for understanding DPN.

The relationship between exacerbated diabetic peripheral neuropathy and metformin treatment in type 2 diabetes mellitus

Metformin-treated diabetics (MTD) showed a decrease in cobalamin, a rise in homocysteine, and methylmalonic acid, leading to accentuated diabetic peripheral neuropathy (DPN). This study aimed to determine whether or not metformin is a risk factor for DPN. We compared MTD to non-metformin-treated diabetics (NMTD) clinically using the Toronto Clinical Scoring System (TCSS), laboratory (methylmalonic acid, cobalamin, and homocysteine), and electrophysiological studies. Median homocysteine and methylmalonic acid levels in MTD vs. NMTD were 15.3 vs. 9.6 µmol/l; P < 0.001 and 0.25 vs. 0.13 µmol/l; P = 0.02, respectively with high statistical significance in MTD. There was a significantly lower plasma level of cobalamin in MTD than NMTD. Spearman’s correlation showed a significant negative correlation between cobalamin and increased dose of metformin and a significant positive correlation between TCSS and increased dose of metformin. Logistic regression analysis showed that MTD had significantly longer metformin use duration, higher metformin dose > 2 g, higher TCSS, lower plasma cobalamin, and significant higher homocysteine. Diabetics treated with metformin for prolonged duration and higher doses were associated with lower cobalamin and more severe DPN.

The Correlation between Time in Range and Diabetic Microvascular Complications Utilizing Information Management Platform.

Background In recent years, the time of blood glucose within the target range is a new research hotspot in blood glucose management. TIR is expected to be a novel indicator for evaluating the efficacy of glycemic control and predicting diabetic complications. However, its relationship with diabetic complications has not been fully elucidated. Objective To explore the relationship between time in range (TIR) and glycosylated hemoglobin (HbA1C) through the information big data management platform. Possible association between TIR and diabetic microvascular complications (retinopathy, nephropathy, and neuropathy) was investigated, attempting to provide theoretical basis for the clinical application of TIR and to explore the TIR control scope suitable for diabetic patients. Methods A total of 5,644 type 2 diabetic patients hospitalized in the Department of Endocrinology, the Second Affiliated Hospital of Nanchang University, were selected from April 2017 to June 2020. Fingertip capillary blood glucose monitoring (FCGM) was monitored for a total of 455,664 times, and patients who are nondiabetic, pregnant, or with diabetic ketosis were excluded. Patients with 7 blood glucose points monitored for at least three consecutive days were selected as subjects in the study. 1,895 males and 1,513 females with diabetes were included, with an average age of (59.74 ± 13.40) years old and an average course of disease of 8.28 ± 7.11 years. The proportion of time in range (TIR) (70∼180 mg/dl) within the target range and the correlation between TIR and HbA1C were analyzed, as well as the relationship between TIR and the risk of diabetic complications. Results (1) The average of TIR and HbA1C was 49.65 ± 23.36% and 8.92 ± 2.49%, respectively, and was linearly correlated. With the decrease of TIR, HbA1C increased significantly, and the difference was statistically significant (P < 0.01, R2 = 0.458). The correlation coefficient of mean TIR with mean HbA1C was −0.626. (2) There were 836 patients diagnosed with diabetic nephropathy (DN). The difference of TIR value between DN and non-DN was significant (T = 2.250, P < 0.05). Risk assessment showed the lower the TIR was, the higher the risk of DN was. TIR less than 40% was a risk factor for DN (OR = 1.249, 95% CI: 0.915–1.375). (3) There were 1,296 patients diagnosed with diabetic peripheral neuropathy (DPN). The difference of TIR value between DPN and non-DPN was significant (T = 3.844, P < 0.01). TIR value less than 70% was a risk factor for DPN (OR = 1.030, 95% CI: 0.769–1.379). (4) There were 2,077 patients diagnosed with diabetic retinopathy (DR). The difference of TIR value between DPN and non-DPN was significant (T = 3.608, P < 0.01). TIR value less than 50% was a risk factor for DR (OR = 1.092, 95% CI: 0.898–1.264). Summary. TIR may serve as a reference index for short-term blood glucose control, strongly reflecting the clinical blood glucose regulation and predicting the risk of diabetic microvascular complications.

560-P: The Liver Fibrosis Score Is Associated with Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is interrelated with nonalcoholic fatty liver disease (NAFLD) and liver fibrosis. However, the association between NAFLD and diabetic peripheral neuropathy (DPN) has not been well studied. Methods: We prospectively enrolled subjects with T2DM to evaluate risk factors of DPN and to develop a screening tool of DPN. In this study, we analyzed the data of 127 subjects in whom we could calculate NAFLD and liver fibrosis scores. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Non-invasive markers of NAFLD (hepatic steatosis index, and NAFLD liver fat score) and liver fibrosis (NAFLD fibrosis score, and fibrosis-4 score) were calculated using equations containing several combinations of age, the presence of obesity or metabolic syndrome, liver function test, fasting insulin level, and platelet count. Body composition was measured by bio-impedance analysis. Clinical parameters and various markers were compared according to the presence of DPN. Results: The prevalence of DPN in our study was 39.3%. There was no significant difference in body mass index, diabetes duration, and liver function test between subjects with DPN and those without DPN. Subjects with DPN showed older age, and higher fasting blood glucose level. Hepatic steatosis index and NAFLD liver fat score were comparable between subjects with or without DPN. In contrast, subjects with DPN showed significantly higher NAFLD fibrosis score (-0.7 vs. -1.3, P = 0.004) and fibrosis-4 score (1.6 vs. 1.2, P = 0.014) compared to those without DPN. These two scores were negatively associated with lean body mass. After adjusting lean body mass, the association between liver fibrosis scores and DPN was still significant. Conclusion: The liver fibrosis scores but not NAFLD scores were higher in subjects with DPN compared to those without DPN. Liver fibrosis and DPN might share common pathophysiology. Disclosure K. Kim: None. T. Oh: None. Y. Shin: None. S. Choi: None. H. Jang: Speaker’s Bureau; Self; Daiichi Sankyo, Handok, Pfizer Inc., Takeda Pharmaceutical Company Limited.

Superimposition of hypertension on diabetic peripheral neuropathy affects small unmyelinated sensory nerves in the skin and myelinated tibial and sural nerves in rats with alloxan-induced type 1 diabetes.

Diabetic peripheral neuropathy (DPN) is a major complication of diabetes mellitus, and hypertension is considered to be a risk factor for DPN in patients with type 1 diabetes (T1DM). However, the morphological effects of hypertension on DPN are unclear. In this study, we investigated the effect of hypertension on DPN by investigating the changes in unmyelinated and myelinated nerve fibers in hypertensive rats with alloxan (AL)-induced T1DM. Thirteen-week-old WBN/Kob rats with AL-induced diabetes were allocated to receive tap water only (AL group), tap water containing 0.5% saline (0.5AN group), or tap water containing 0.75% saline (0.75AN group) for 15 weeks. Hyperglycemia was maintained for 15 weeks, and the animals were euthanized at 28 weeks. By 23 weeks of age, the systolic blood pressure was significantly higher in the 0.75AN and 0.5AN groups than in the AL group and was unchanged in all groups at 28 weeks. The number of intraepidermal sensory unmyelinated nerve fibers was significantly smaller in the 0.75AN and 0.5AN groups than in the AL group. The axonal size in the myelinated tibial and sural nerve fibers was significantly smaller in the 0.75AN group than in the AL group. Furthermore, luminal narrowing and endothelial hypertrophy were observed in the endoneurial tibial nerve vessels in the 0.75AN group. These findings suggest that superimposing hypertension on hyperglycemia may accelerate a reduction in the number of small unmyelinated sensory nerve fibers in the skin and induce mild axonal atrophy in myelinated tibial and sural nerve fibers in rats with AL-induced T1DM.

Relationship between peripheral neuropathy and vitamin D in elderly patients with type 2 diabetes

Objective To investigate the levels of vitamin D and the correlation between DPN and vitamin D in elderly patients with diabetic peripheral neuropathy(DPN). Methods A total of 849 patients aged 60 years and over admitted into endocrinology department from June 2016 to September 2017 were enrolled in this retrospective case-control study.According to DPN diagnostic criteria, patients were divided into the non-DPN group(n=542)and the DPN group(n=307). The 25(OH)-vitamin D[25(OH)D]level and blood biochemical parameters were determined and compared between the two groups.The risk factors for DPN were analyzed using logistic regression analysis and plotting receiver operating characteristic(ROC)curves. Results The mean of serum 25(OH)D level in the 849 patients was 43.9±19.4 nmol/L.Serum 25(OH)D level was lower in the DPN patients than in the non-DPN patients[(40.9±20.4)nmol/L vs.(45.7±18.6)nmol/L, P<0.05]. The incidence of 25(OH)D deficiency was higher in the DPN group than in the non-DPN group(72.3% or 222/307 vs. 64.6% or 350/542, P<0.05). Binary logistic regression analysis indicated that 25(OH)D was a protective factor for DPN(OR=0.980, 95% CI: 0.964~0.995, P<0.05)and the disease duration was a risk factor for DPN(OR=1.048, 95% CI: 1.027~1.070, P<0.001). ROC analysis indicated that the diagnostic cut-off value of serum 25(OH)D for predicting DPN was 37.5nmol/L, with a Youden index of 0.17, sensitivity of 0.65 and specificity of 0.52. Conclusions The 25(OH)D level is much lower in diabetic patients, especially in DPN patients.Higher 25(OH)VD level might be a protective factor for DPN, and vitamin D might be one of potential biomarkers for DPN in diabetic patients. Key words: Diabetic neuropathies; Diabetes mellitus, type 2; Vitamin D

Prevalence and Risk Factors of Peripheral Neuropathy among Diabetic Patients in Aden Diabetic Center

AbstractBackground: Diabetic Peripheral Neuropathy (DPN) is an important micro-vascular complication of Diabetes Mellitus (DM), considered as a major contributor to foot ulceration and lower limb amputation among diabetic patients and have remarkable negative effect on patient's quality of life.Aim of Study: This study aimed to estimate the prevalence and possible risk factors of DPN among patients attending diabetic center in Aden governorate, Yemen.Patients and Methods: This cross-sectional retrospective study review prevalence of peripheral neuropathy among patients aged 18-70 years with type 1 and 2 DM (T1D, T2D), were 124 patients assessed by neurosymptoms and neurodis-ability scores (NSS and NDS respectively). Descriptive statistic and logistic regression analysis were done.Results: The prevalence of DPN based on NSS and NDS was 60.48%. Risk factors significantly associated with DPN were age (p 0.015), educational level (p 0.013), type 2 diabetes (p 0.022), and duration of diabetes (p 0.001), dyslipidemia (p 0.009), abdominal obesity (p 0.001), body mass index (p 0.036) and retinopathy (p 0.035). Female gender, hypertension, elevated glycated hemoglobin and the presence of albuminuria were associated with higher frequency of DPN although this relation was statistically non-significant. Logistic regression analysis revealed that Illiteracy (OR 8.75, 95% CI 2.23- 34.33), dyslipidemia (OR 1.97, 95% CI 1.04-24.44), long standing of diabetes (OR 1.14, 95% CI 1.05-1.23), and ab-dominal obesity (OR 1.05, 95% CI 1.01-1.09) were signifi-cantlly associated with DPN.Conclusions: A higher prevalence was observed with illiteracy, dyslipidemia, longer duration of diabetes and abdominal obesity.

322-OR: Risk Factors for Peripheral and Cardiovascular Autonomic Neuropathy in Type 1 Diabetes: Thirty Years of Follow-Up in DCCT/EDIC

The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study reported that intensive glucose control as assessed by hemoglobin A1c (HbA1c) reduced the risk of diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in type 1 diabetes (T1D), with long lasting benefits. We evaluated additional clinical parameters and risk factors that could contribute to the development of DPN and CAN in this cohort. DPN was assessed at three different times and defined as a composite of symptoms, signs, and abnormal nerve conduction studies in ≥2 nerves; CAN was assessed seven different times and defined based on R-R variation, Valsalva maneuver, and postural changes in blood pressure. Generalized estimating equation models were used to evaluate the association of DPN and CAN with individual risk factors over repeated time points spanning 30 years. Among 1,441 DCCT/EDIC participants, 32% developed DPN and 44% developed CAN. Higher mean HbA1c was the most significant risk factor for DPN (OR=1.56 per 1%, 95% CI 1.41,1.72). DPN was also associated with older age (1.43 per 5 years, 95% CI 1.31,1.55), longer duration of T1D, higher albuminuria, β-blocker use, higher mean diastolic blood pressure, and higher HbA1c at DCCT eligibility. CAN was associated (in order) with older age (1.51 per 5 years, 95% CI 1.40,1.63), longer duration of T1D (1.07 per 1 year, 95% CI 1.05,1.10), any sustained microalbuminuria (AER ≥30 mg/24 hour on two consecutive visits), higher mean HbA1c, higher mean and current pulse rate (likely as an indirect measure of CAN), higher mean systolic blood pressure, β-blocker use, any eGFR &amp;lt;60 mL/min/1.73 m2, higher HbA1c at DCCT eligibility, and current cigarette smoking. Higher mean HbA1c was the strongest risk factor for DPN, but not of CAN. These findings help identify patient phenotypes and modifiable risk factors for personalized approaches to neuropathy prevention. Disclosure B. Braffett: None. R. Gubitosi-Klug: None. J.W. Albers: Consultant; Self; Eli Lilly and Company. E.L. Feldman: None. C. Martin: None. N.H. White: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH. M.F. Lopes-Virella: None. P. Raskin: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Gan &amp; Lee Pharmaceuticals, Novo Nordisk A/S. R. Pop-Busui: Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association. Funding Division of Diabetes Endocrinology &amp; Metabolic Diseases (U01DK094176, U01DK094157); National Eye Institute; National Institute of Neurologic Disorders and Stroke; General Clinical Research Centers Program; Clinical Translational Science Center

579-P: Prevalence of and Risk Factors for Peripheral Neuropathy in Chinese Patients with Diabetes: A Multicenter Cross-Sectional Study

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, and its progression significantly worsens the patient’s quality of life. This study investigated the prevalence and risk factors associated with DPN in a large sample of Beijing individuals with type 1 and 2 diabetes, as well as compared the diagnostic methods for DPN. A total of 2,048 diabetic patients from 13 centers in Beijing were assessed for DPN through questionnaires and examination. Patients were divided into DPN group and suspected DPN/non-DPN group. The demographic, clinical and biological characteristics between the two groups were compared. Binary logistic regression analysis was performed to identify potential variables associated with DPN in diabetic patients. The diagnostic methods for DPN were also compared. Among the 2,048 diabetic patients, 73 cases of type 1 diabetes mellitus, 1,975 cases of type 2 diabetes were included in this study. Among them, 714 (34.86%) were identified with DPN, 537 (26.22%) were suspected of having DPN, and 797 (38.92%) were identified without DPN. Patient’s age, duration of diabetes, and diabetic retinopathy were the significant independent risk factor for DPN among patients with type 2 diabetes. The odds ratio (OR) was 1.439 (95% confidence interval (CI): 1.282-1.616, P &amp;lt; 0.001), 1.297 (95% CI: 1.151-1.462, P &amp;lt; 0.001), and 0.637 (95% CI: 0.506-0.802, P &amp;lt; 0.001), respectively. Ankle reflex, temperature sensation plus vibration sensation are the best screening test for patients with type 1 and 2 diabetes. The Youden indexes were 62.2 and 69.8%, respectively. The prevalence rates of DPN in the Chinese patients with type 1 and type 2 diabetes in Beijing were 21.92 and 35.34%, respectively. Patient’s age, duration of diabetes, and diabetic retinopathy are the independent risk factors for DPN. Disclosure Q. Pan: None.

Prevalence and risk factors of diabetic peripheral neuropathy in patients with Type 2 diabetes mellitus

Background: Diabetic peripheral neuropathy (DPN) is common among people with diabetes and can result in foot ulceration and amputation. Objective: The objective of the study is to estimate the prevalence and risk factors of DPN among patients with Type 2 diabetes mellitus (T2DM) at a diabetes clinic in Benghazi Medical Center (BMC), Benghazi, Libya. Patients and Methods: Three hundred and sixty-seven patients with T2DM (127 [34.6%] males and 240 [65.4%] females) were included in this cross-sectional study. The patients aged ≥18 years, and they attended the outpatient diabetes clinics at BMC from May 2015 to October 2016, for routine follow-up. Patients with T1DM, gestational diabetes, and latent autoimmune diabetes in adults were excluded. Data including gender, age, type of DM, duration of DM, history of smoking, history of hypertension, weight, height, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, creatinine, and urea were obtained by a prepared pro forma. Peripheral neuropathy was diagnosed in the presence of numbness, paresthesia, 10-g monofilament examination, and loss of vibration and joint position sensations. The relationship between DPN and its risk factors, in addition to independent predictors of DPN, was explored using multiple forward stepwise logistic regression and presented as an odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of DPN was 30.5% in the studied group. A statistical significant association found between DPN and age (P = 0.014), duration of DM (P &lt; 0.001), macrovascular complications of DM (P &lt; 0.001), diabetic retinopathy (P = 0.001), diabetic nephropathy (P &lt; 0.001), poor glycemic control (high HbA1c) (P &lt; 0.001), hypertension (P = 0.011), uncontrolled blood pressure (≥140/90 mmHg) (P = 0.007), and insulin treatment (P &lt; 0.001). Multiple forward stepwise logistic regression analyses revealed two independent risk factors influencing DPN: diabetic nephropathy (OR = 1.976, 95% CI: 1.289–3.027) (P = 0.009) and insulin treatment (OR = 3.430, 95% CI: 2.021–5.821), (P &lt; 0.001). Conclusions: The overall prevalence rate of DPN in this study was 30.5% among patients with T2DM. It increases with the presence of diabetic nephropathy and insulin treatment.

Serum 25(OH) vitamin D level and its relation to diabetic peripheral neuropathy in Egyptian patients with type 2 diabetes mellitus

BackgroundSome clinical studies demonstrated a significant association between vitamin D deficiency and diabetic peripheral neuropathy (DPN).ObjectiveThis study aims to evaluate the correlation between serum levels of 25(OH) vitamin D and DPN in Egyptian patients with type 2 diabetes mellitus (T2DM).Patients and methodSixty patients were known to have T2DM, which classified into the following: group I included 40 patients with DPN and group II included 20 diabetic patients, without DPN, compared with 30 apparently healthy subjects of matched age and sex as control group. Laboratory investigations including fasting and 2-h postprandial blood glucose levels, serum calcium, phosphorus, glycosylated hemoglobin (HbA1c), lipid profile, serum 25(OH) vitamin D, and nerve conduction studies were carried out for every participant to detect the existence and severity of DPN.ResultsVitamin D deficiency was found in 73.3% of T2DM groups and in 35% of control subjects with statistical significant differences (p < 0.005), and serum level of 25(OH) vitamin D in patients with DPN (21.09 ± 8.38) was less statistically significant than that in patients without DPN (31.12 ± 14.85) (p = 0.001). Mean serum level of 25(OH) vitamin D in patients with painless DPN (10.047 ± 8.12) was less significant than that in patients with painful DPN (18.14 ± 3.85), (p < 0.05). Regression analysis revealed that vitamin D deficiency is one of the independent risk factors of DPN, (OD, 0.914), (p = 0.007).ConclusionVitamin D deficiency has a significant role in the development and severity of DPN in Egyptian patients with T2DM.

Contemporary Prevalence of Diabetic Neuropathy in Type 1 Diabetes (T1D)—Findings from the T1D Exchange

Diabetic peripheral neuropathy (DPN) is a major cause of disability, mortality and poor quality of life in patients with T1D, with prior reported prevalence rates of up to 35%. The contemporary prevalence of DPN in T1D patients was evaluated in T1D Exchange Registry centers throughout the United States. The Michigan Neuropathy Screening Instrument (MNSI), a validated 15-item self-administered questionnaire, was used to assess DPN in adults ≥18 years with ≥ 5 years of T1D duration. A score of ≥4 was used to define DPN. Diabetes-related characteristics and laboratory data were obtained through the most recent clinic update. Chi-square and t-tests were used to compare demographic and diabetes-related characteristics between those with and without DPN. Linear regression was used to determine the effect of DPN on HbA1c, adjusted for possible confounders. In preliminary analyses of 5,058 participants across 62 sites (mean age 39±18 years, T1D duration 22±14 years, 56% female, 88% non-hispanic white, mean HbA1c 8.1±1.6%), the prevalence of DPN was 10%. Those with DPN were older (52±17 vs. 37±18 years), more likely to be female (61% vs. 55%), had longer T1D duration (32±16 vs. 21±13 years), lower annual household income (37% vs. 59% earning ≥$75K), and lower education level (55% vs. 69% with college degree) than those without DPN (all p&amp;lt;0.001). They also had higher systolic blood pressure (126±17 vs. 123±14 mmHg), triglycerides (117±89 vs. 95±62 mg/dL), tobacco use (9% vs. 4%) and prevalence of established CVD (26% vs. 6%), despite higher use of CVD-modifying agents such as statins (64% vs. 31%) and ACE-inhibitors/ARBs (45% vs. 23%) (all p&amp;lt;0.001). Participants with DPN had higher HbA1c (8.4±1.7% vs. 8.1±1.6%), even after adjusting for multiple confounders (p &amp;lt;0.01). The prevalence of DPN in this national T1D cohort is lower than prior published reports, reflecting current clinical care practices, and highlighting other non-glycemic risk factors for DPN including CVD risk factors and socioeconomic status. Disclosure K.R. Mizokami-Stout: None. C.T. Boyle: None. V.N. Shah: None. G. Aleppo: Research Support; Self; AstraZeneca, Novo Nordisk Inc.. Consultant; Self; Dexcom, Inc.. Advisory Panel; Self; Novo Nordisk Inc. J.B. McGill: Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Aegerion Pharmaceuticals. Consultant; Self; Bayer AG, Dexcom, Inc., Intarcia Therapeutics, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., MannKind Corporation. Research Support; Self; Novartis Pharmaceuticals Corporation. Consultant; Self; Novo Nordisk A/S. R. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc.. E. Toschi: None. L. Ang: None. R. Pop-Busui: Research Support; Self; AstraZeneca.