Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes

Ponirakis, Georgios; Petropoulos, Ioannis N.; Alam, Uazman; Ferdousi, Maryam; Asghar, Omar; Marshall, Andrew; Azmi, Shazli; Jeziorska, Maria; Mahfoud, Ziyad; Boulton, Andrew J.M.; Efron, Nathan; Nukada, Hitoshi; Malik, Rayaz A.

doi:10.1093/ajh/hpz058

Cited by 55 publications

(43 citation statements)

References 43 publications

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“…However, the UKPDS, VA‐CSDM, and Steno‐2 trial have shown a limited effect of intensive glucose control on DN. This study shows an association of DN with hyperlipidaemia and hypertension, which is consistent with previous studies showing that DN is associated with hypertension, hyperlipidaemia, BMI, cigarette smoking, and physical activity . Indeed, treatment with ACE inhibitors and statins may slow the progression of DN.…”

Section: Discussionsupporting

confidence: 93%

“…Whilst poor glycaemic control is associated with DN, there are conflicting data on the benefits of improved glycaemic control on DN . Studies also suggest that modifiable cardiovascular risk factors including hypertension and hyperlipidaemia are associated with DN and treatment with a angiotensin converting enzyme (ACE) inhibitor may improve neuropathy and statins, and fibrates may reduce amputation.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and management of diabetic neuropathy in secondary care in Qatar

Ponirakis

Elhadd

Chinnaiyan

et al. 2020

Diabetes Metabolism Res

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Aims: Diabetic neuropathy (DN) is a "Cinderella" complication, particularly in the Middle East. A high prevalence of undiagnosed DN and those at risk of diabetic foot ulceration (DFU) is a major concern. We have determined the prevalence of DN and its risk factors, DFU, and those at risk of DFU in patients with type 2 diabetes mellitus (T2DM) in secondary care in Qatar.Materials and methods: Adults with T2DM were randomly selected from the two National Diabetes Centers in Qatar. DN was defined by the presence of neuropathic symptoms and a vibration perception threshold (VPT) ≥ 15 V. Participants with a VPT ≥ 25 V were categorized as high risk for DFU. Painful DN was defined by a DN4 score ≥4. Logistic regression analysis was used to identify predictors of DN.Results: In 1082 adults with T2DM (age 54 ± 11 years, duration of diabetes 10.0 ± 7.7 years, 60.6% males), the prevalence of DN was 23.0% (95% CI, 20.5%-25.5%) of whom 33.7% (95% CI, 27.9%-39.6%) were at high risk of DFU, and 6.3% had DFU; 82.0% of the patients with DN were previously undiagnosed. The prevalence of DN increased with age and duration of diabetes and was associated with poor glycaemic control (HbA 1c ≥ 9%) AOR = 2.1 (95% CI, 1.3-3.2), hyperlipidaemia AOR = 2.7 (95% CI, 1.5-5.0), and hypertension AOR = 2.0 (95% CI, 1.2-3.4). Conclusions:Despite DN affecting 23% of adults with T2DM, 82% had not been previously diagnosed with one-third at high risk for DFU. This argues for annual screening and identification of patients with DN. Furthermore, we identify hyperglycaemia, hyperlipidaemia, and hypertension as predictors of DN. K E Y W O R D S diabetic neuropathy, painful diabetic neuropathy, diabetic foot ulceration, type 2 diabetes mellitus

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Prevalence and management of diabetic neuropathy in secondary care in Qatar

Ponirakis

Elhadd

Chinnaiyan

et al. 2020

Diabetes Metabolism Res

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“…Furthermore, DPN in latent autoimmune diabetes of adults has been shown to be more severe than in matched people with type 2 diabetes, further substantiating the contribution of hypoinsulinaemia to DPN [11]. Thus, whilst hyperglycaemia is a major risk factor for DPN, additional contributors include age, obesity, hypertension [12] and hypertriglyceridaemia [13], and recently a longitudinal analysis of the KORA F4/FF4 cohort showed that general and abdominal obesity and inflammation were associated with incident DPN [14].…”

Section: Pathophysiology and Risk Factors For Diabetic Peripheral Neumentioning

confidence: 86%

Diabetic peripheral neuropathy in people with type 2 diabetes: too little too late

et al. 2019

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Diabetic peripheral neuropathy in people with type 2 diabetes is poorly managed because of its insidious onset, delayed diagnosis and more complex aetiology resulting from the contribution of not only hyperglycaemia, but also ageing, hyperlipidaemia, hypertension and obesity. Because there is no US Food and Drug Adminstration‐approved disease‐modifying therapy for diabetic peripheral neuropathy, the key to ameliorating it in type 2 diabetes has to be through earlier diagnosis and timely multi‐factorial risk factor reduction. The management of painful diabetic peripheral neuropathy also requires a detailed appraisal of the choice of therapy, taking into account efficacy, patient wishes, comorbidities, side effect profile and potential for abuse.

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“…Age, sex, BMI and blood pressure have previously been shown to be associated with systemic inflammation, DSPN susceptibility or both 23‐25 . Furthermore, disease duration is a plausible influencing factor as well, due to the prolonged exposure to hyperglycaemia.…”

Section: Discussionmentioning

confidence: 99%

Increased levels of inflammatory factors are associated with severity of polyneuropathy in type 1 diabetes

Okdahl

Brock

Fløyel

et al. 2020

Clinical Endocrinology

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Objective Distal symmetrical polyneuropathy (DSPN) is a severe common long‐term complication of type 1 diabetes caused by impaired sensory‐motor nerve function. As chronic low‐grade inflammation may be involved in the pathogenesis of DSPN, we investigated the circulating levels of inflammatory markers in individuals with type 1 diabetes with and without DSPN. Furthermore, we determined to what extent these factors correlated with different peripheral sensory nerve functions. Design Cross‐sectional study. Patients The study included 103 individuals with type 1 diabetes with (n = 50) and without DSPN (n = 53) as well as a cohort of healthy controls (n = 21). Measurements Circulating levels of various inflammatory markers (cytokines, chemokines and soluble adhesion molecules) were determined in serum samples by Luminex multiplexing technology. Peripheral sensory nerve testing, for example vibration, tactile and thermal perception, was assessed by standardized procedures. Results The cytokines IL‐1α, IL‐4, IL‐12p70, IL‐13, IL‐17A and TNF‐α; the chemokine MCP‐1; and the adhesion molecule E‐selectin were significantly increased in individuals with type 1 diabetes with DSPN compared to those without DSPN (P < .001). These observations were independent of age, sex, BMI, disease duration and blood pressure. Additionally, higher serum concentrations of cytokines and chemokines were associated with higher vibration and tactile perception thresholds, but not with heat tolerance threshold. Conclusions Individuals with type 1 diabetes and concomitant DSPN display higher serum levels of several inflammatory markers. These findings support that systemic low‐grade inflammation may play a role in the pathogenesis of DSPN.

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Hypertension Contributes to Neuropathy in Patients With Type 1 Diabetes

Cited by 55 publications

References 43 publications

Prevalence and management of diabetic neuropathy in secondary care in Qatar

Prevalence and management of diabetic neuropathy in secondary care in Qatar

Diabetic peripheral neuropathy in people with type 2 diabetes: too little too late

Increased levels of inflammatory factors are associated with severity of polyneuropathy in type 1 diabetes

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