Cardiovascular Risk Factors Increase the Risks of Diabetic Peripheral Neuropathy in Patients With Type 2 Diabetes Mellitus

Abstract

This study aimed to examine whether poor glycemic control, measured by glycated hemoglobin A1C (HbA1c) and other cardiovascular risk factors, can predict diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (DM).Patients aged ≥30 years with type 2 DM, enrolled in the National Diabetes Care Management Program, and free of DPN (n = 37,375) in the period 2002 to 2004 were included and followed up until 2011. The related factors were analyzed using Cox proportional hazards regression models.For an average follow-up of 7.00 years, 8379 cases of DPN were identified, with a crude incidence rate of 32.04/1000 person-years. After multivariate adjustment, patients with HbA1c levels 7 to 8%, 8 to 9%, 9 to 10%, and ≥10% exhibited higher risk of DPN (adjusted HR: 1.11 [1.04–1.20], 1.30 [1.21–1.40], 1.32 [1.22–1.43], and 1.62 [1.51–1.74], respectively) compared with patients with HbA1c level 6 to 7%. There was a significant linear trend in DPN incidence with increasing HbA1c (P < 0.001) and significant HRs of DPN for patients with HbA1c level ≥7%, blood pressure ≥130/85 mm Hg, triglycerides (TG) ≥150 mg/dL, high density of lipoprotein-cholesterol (HDL-C) <40 mg/dL in males and <50 mg/dL in females, low density of lipoprotein-cholesterol (LDL-C) ≥100 mg/dL, and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2.Patients with type 2 DM and HbA1c ≥7.0% exhibit increased risk of DPN, demonstrating a linear relationship. The incidence of DPN is also associated with poor glucose control and cardiovascular risk factors like hypertension, hyper-triglyceridemia, low HDL-C, high LDL-C, and decreased eGFR.

Associations of Demographic, Clinical and Laboratory Profiles of Patients with type II Diabetes Mellitus with its Microvascular Complications in Bangladesh

“…Similarly, microalbuminuria (p=0.0118, OR=1.01), urinary creatinine (p=0.0462, OR=1.00) were found to be significant risk factor where HbA1c (p=0.0077, OR=1.72) was found to be the most significant predicting risk factor for DPN complication of type 2 diabetes in Bangladesh. It is consistent with other finding that age and diabetic duration is insignificant [15,[43][44][45][46][47][48] here since all the patients are more than 40 years of age and the diabetic duration is minimum of 10 years.…”

Mediators of diabetic neuropathy: is hyperglycemia the only culprit?

“…The association of elevated levels of triglycerides with DPN has also been evaluated in subjects with T1DM (40) and T2DM (41, 45, 47, 48). In a study of patients with mild to moderate diabetes, a correlation between the loss of myelinated fiber density and hypertriglyceridemia was observed, independent of disease duration, age, diabetes control, or other variables (49), suggesting an important influence of elevated triglycerides on the progression of DPN.…”

Upregulated 14‑3‑3β aggravates restenosis by promoting cell migration following vascular injury in diabetic rats with elevated levels of free fatty acids

“…In the present study, in vitro and in vivo experiments were performed which demonstrated that YWHAB had a significant role in neointimal hyperplasia by enhancing the migration of VSMCs following carotid artery injury. Patients with T2DM have a high risk for vascular restenosis following endovascular interventional therapy (4,25,26). Imbalanced caloric intake is the major cause of T2dM, and previous data have indicated that excessive plasma FFA levels induced by a high fat intake are responsible for this pathological change (27).…”