Articles

Posted Apr 30 , 2018 03:23 AM

Risk Factors for Incident Diabetic Polyneuropathy in a Cohort with Screen-Detected Type 2 Diabetes Followed for 13 Years: ADDITION-Denmark

Andersen, ST. et al, Diabetes Care 2018; Online February 27th

What were the findings (excerpted from the Abstract)?

The purpose of this study was to follow incident diabetic polyneuropathy (DPN) prospectively during the first 13 years after a screening-based diagnosis of type 2 diabetes and determine the associated risk factors for the development of DPN. The authors assessed DPN longitudinally in the Danish arm of the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) using the Michigan Neuropathy Screening Instrument questionnaire (MNSIQ), defining DPN with scores >4. Risk factors present at diabetes diagnosis associated with the risk of incident DPN were estimated using Cox proportional hazard models adjusted for trial randomization group, sex, and age. Of the total cohort of 1,533 people, 1,445 completed the MNSIQ at baseline and 189 (13.1%) had DPN at baseline. The remaining 1,256 without DPN entered this study (median age 60.8 years; 59% were men). The cumulative incidence of DPN was 10% during 13 years of diabetes. Age, weight, waist circumference, BMI, log2 methylglyoxal, HDL, and LDL cholesterol at baseline were significantly associated with the risk of incident DPN. This study provides further epidemiological evidence for obesity as a risk factor for DPN. Moreover, low HDL cholesterol levels and higher levels of methylglyoxal, a marker of dicarbonyl stress, are identified as risk factors for the development of DPN.

Why is this important?

Many of the variables looked at in this study are longitudinally associated with other (e.g. cardiovascular) complications, which are known to develop or worsen over time in patients with type 2 diabetes. In a previous article (see: Articles-May 16, 2017) we discussed the clear relationship between advanced glycation products, oxidative stress and atherosclerosis. Other reported risk factors for DPN include high blood pressure, smoking, alcohol consumption, hyperlipidemia, and low HDL cholesterol. In the current study, the authors found no support for smoking status or alcohol consumption as risk factors for DPN. The authors concluded that the study provides stronger epidemiological evidence for obesity as a risk factor for DPN, supporting several previous cross-sectional studies. In addition, lower levels of HDL and LDL cholesterol at diabetes diagnosis were associated with higher risk of DPN development, but previous studies reveal conflicting results. Lastly, this study further implicates increased methylglyoxal levels at diabetes diagnosis as a risk factor for DPN, suggesting early tight control (usually associated with lower methylglyoxal levels) will be beneficial to decrease the development of DPN. Additional studies will be needed to confirm this relationship. Do you use special questionnaires or other tools to regularly screen for DPN? Will you now?

Read the Abstract:
http://care.diabetesjournals.org/content/early/2018/02/23/dc17-2062