Determination of Peripheral Neuropathy Prevalence and Associated Factors in Chinese Subjects with Diabetes and Pre-Diabetes – ShangHai Diabetic neuRopathy Epidemiology and Molecular Genetics Study (SH-DREAMS)

Abstract

ObjectiveThis study determined the prevalence and factors associated with peripheral neuropathy (PN) in subjects with diabetes mellitus, impaired glucose regulation (IGR), and normal glucose tolerance (NGT) in a community-based Chinese population.Research Design and MethodsA total of 2035 subjects in Shanghai were classified as having NGT, IGR, or diabetes. All subjects underwent complete foot examination. PN was assessed according to the neuropathy symptom and neuropathy disability scores. Binary logistic regression was performed to analyze the contributions of factors to PN.ResultsThe prevalence of PN was 8.4%, 2.8%, and 1.5% in diabetes mellitus, IGR, and NGT subjects, respectively (P<0.05 for diabetes vs. NGT, and IGR). The subjects with known diabetes had the highest frequency of PN (13.1%). Among the subjects without diabetes, those with PN were older, had a higher waist circumference and 2-h postprandial plasma glucose levels, and were more likely to be hypertensive. Among the IGR subjects, other than age, the 2-h postprandial plasma glucose level was an independent factor significantly associated with PN. Meanwhile, among the subjects with diabetes, PN was associated with fasting plasma glucose, duration of diabetes, and decreased estimated glomerular filtration rate.ConclusionsThe prevalence of PN is slightly higher in individuals with IGR than that in individuals with NGT, but small fibre damage in IGR as the earliest nerve fibre deficit may be underestimated in our study. As an independent risk factor, postprandial plasma glucose level may be an important target for strategies to prevent or improve PN in IGR subjects.

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

“…Including this study, five recent investigations reveal that obesity is significantly associated with peripheral neuropathy in multivariable analyses 22, 23, 24, 31. Our results are comparable to those found in 2035 Han Chinese subjects in Shanghai 24.…”

“…The mean (SD) age was 51.6 (11.8) and 51.0% were male. Normoglycemic participants accounted for 37.2% of the population, prediabetes 44.0%, and diabetes 18.9%, which is comparable to the distribution in a previous large Chinese cohort study 24. The MetS was present in 38.0%.…”

“…Participants with prediabetes also have a higher prevalence of peripheral neuropathy, but the association does not meet statistical significance in multivariable models. These results are comparable to findings in other populations including those in the United States,22, 23 another region in China,24, 25 and the Netherlands 31. Now that the evidence supporting these specific metabolic drivers of nerve injury is increasingly robust, efforts should turn to interventional studies aimed at weight loss and/or exercise in populations at high risk of peripheral neuropathy.…”

“…Including this study, five recent investigations reveal that obesity is significantly associated with peripheral neuropathy in multivariable analyses 22, 23, 24, 31. Our results are comparable to those found in 2035 Han Chinese subjects in Shanghai 24. Importantly, we were able to address important limitations of the previous study including addressing the effects of interactions between metabolic components and glycemic status, focusing the analysis on metabolic factors, and avoiding collinearity in the multivariable models.…”

“…Another group has performed similar studies in Shanghai, China. They found that patients with diabetes and prediabetes had a higher prevalence of peripheral neuropathy compared to patients with normoglycemia 24. Waist circumference and fasting glucose were the main metabolic factors associated with peripheral neuropathy.…”