Neuropathy Among the Diabetes Control and Complications Trial Cohort 8 Years After Trial Completion

Martin, Catherine L.; Albers, James W.; Herman, William H.; Cleary, Patricia A.; Waberski, Barbara H.; Greene, Douglas A.; Stevens, Martin J.; Feldman, Eva L.

doi:10.2337/diacare.29.02.06.dc05-1549

Cited by 305 publications

(188 citation statements)

References 16 publications

Supporting

Mentioning

167

Contrasting

Unclassified

Order By: Relevance

“…The neuropathy definition was based on standardized examination and questionnaires, but not on a neurologist's history and examination or confirmatory measures (nerve conduction studies or skin biopsies). On the other hand, the MNSI questionnaire and examination are validated measures of neuropathy and have been used successfully in both type 1 and type 2 diabetic cohorts 28, 38, 39, 40. While the MNSI instruments have not been validated in Asian populations, the prevalence of neuropathy was comparable to a previous large Chinese cohort study using a different neuropathy definition 24.…”

Section: Discussionmentioning

confidence: 83%

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Callaghan

Gao

Li³

et al. 2018

Ann Clin Transl Neurol

Self Cite

131

View full text Add to dashboard Cite

ObjectiveTo determine the associations between individual metabolic syndrome (MetS) components and peripheral neuropathy in a large population‐based cohort from Pinggu, China.MethodsA cross‐sectional, randomly selected, population‐based survey of participants from Pinggu, China was performed. Metabolic phenotyping and neuropathy outcomes were performed by trained personnel. Glycemic status was defined according to the American Diabetes Association criteria, and the MetS using modified consensus criteria (body mass index instead of waist circumference). The primary peripheral neuropathy outcome was the Michigan Neuropathy Screening Instrument (MNSI) examination. Secondary outcomes were the MNSI questionnaire and monofilament testing. Multivariable models were used to assess for associations between individual MetS components and peripheral neuropathy. Tree‐based methods were used to construct a classifier for peripheral neuropathy using demographics and MetS components.ResultsThe mean (SD) age of the 4002 participants was 51.6 (11.8) and 51.0% were male; 37.2% of the population had normoglycemia, 44.0% prediabetes, and 18.9% diabetes. The prevalence of peripheral neuropathy increased with worsening glycemic status (3.25% in normoglycemia, 6.29% in prediabetes, and 15.12% in diabetes, P < 0.0001). Diabetes (odds ratio [OR] 2.60, 95% CI 1.77–3.80) and weight (OR 1.09, 95% CI 1.02–1.18) were significantly associated with peripheral neuropathy. Age, diabetes, and weight were the primary splitters in the classification tree for peripheral neuropathy.InterpretationSimilar to previous studies, diabetes and obesity are the main metabolic drivers of peripheral neuropathy. The consistency of these results reinforces the urgent need for effective interventions that target these metabolic factors to prevent and/or treat peripheral neuropathy.

show abstract

Section: Discussionmentioning

confidence: 83%

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Callaghan

Gao

Li³

et al. 2018

Ann Clin Transl Neurol

Self Cite

131

View full text Add to dashboard Cite

show abstract

“…Therefore, insulin signaling appears to provide neurotrophic actions in the retina, and retinopathy may result in part from neurotrophin deficiency, as shown for peripheral neuropathy (102,103). In this light, the persistent benefit of initial intensive control in DCCT/ EDIC (Epidemiology of Diabetes Interventions and Complications) patients despite subsequent deterioration of A1C values (104,105) could result from enhanced neurotrophic input from insulin on retinal and peripheral nerve cells.…”

Section: Reduced Insulin Action Leads To Neurodegenerationmentioning

confidence: 99%

Diabetic Retinopathy

et al. 2006

View full text Add to dashboard Cite

Diabetic retinopathy remains a frightening prospect to patients and frustrates physicians. Destruction of damaged retina by photocoagulation remains the primary treatment nearly 50 years after its introduction. The diabetes pandemic requires new approaches to understand the pathophysiology and improve the detection, prevention, and treatment of retinopathy. This perspective considers how the unique anatomy and physiology of the retina may predispose it to the metabolic stresses of diabetes. The roles of neural retinal alterations and impaired retinal insulin action in the pathogenesis of early retinopathy and the mechanisms of vision loss are emphasized. Potential means to overcome limitations of current animal models and diagnostic testing are also presented with the goal of accelerating therapies to manage retinopathy in the face of ongoing diabetes. Diabetes 55:2401-2411, 2006 D espite years of clinical and laboratory investigation, diabetic retinopathy remains the leading cause of vision impairment and blindness among working-age adults, yet the fundamental cause(s) remains uncertain. Retinal photocoagulation to reduce neovascularization and macular edema was developed in the 1950s and is still the standard of care (1). The number of people worldwide at risk of developing vision loss from diabetes is predicted to double over the next 30 years (2), so it is imperative to develop better means to identify, prevent, and treat retinopathy in its earliest stages rather than wait for the onset of vision-threatening lesions. Progress in these areas requires a new perspective on the problem that includes the roles of the neural retina, impaired insulin action, and inflammation. In this way, established neurobiological principles can inform us how diabetes impairs vision, and knowledge of metabolism, inflammation, and regenerative medicine may lead to new treatments.This perspective will discuss how the unique anatomy and physiology of the retina may render it vulnerable to the metabolic derangements of diabetes and lead to impaired vision. The intent of this unconventional approach is to encourage consideration of new opportunities for investigations that will advance the field. NORMAL RETINAL STRUCTURE AND PHYSIOLOGY Topographic and cellular organization of the retina.It is instructive to consider the functional organization of the retina (literally a network) to better understand the impact of diabetes (http://webvision.med.utah.edu). The retina is a transparent layer of neural tissue between the retinal pigmented epithelium and the vitreous body. Normal vision depends on intact cell-cell communication among the neuronal, glial, microglial, vascular, and pigmented epithelial cells of the retina. The fundamental functions of the retina are to capture photons, convert the photochemical energy into electrical energy, integrate the resulting action potentials, and transmit them to the occipital lobe of the brain, where they are deciphered and interpreted into recognizable images. The retina is partitioned from the syst...

show abstract

“…The beneficial effect of intensive treatment, proven by the diabetes control and complications trial (DCCT) and the UK Prospective Diabetes Study, has been confirmed by new data in the recent years. During the follow-up of the DCCT cohort as part of the Epidemiology of Diabetes Intervention and Complications study, every type 1 diabetic patient was encouraged to apply intensive insulin treatment (81). It was clearly shown that the beneficial effect of 6.5 years of intensive therapy on the development and progression of the neuropathy persisted for at least 8 years after completion of the DCCT as the prevalence of neuropathy then still differed in the different groups despite the similar intensive treatment during the follow-up period.…”

Section: Therapeutic Approaches Preventionmentioning

confidence: 99%

New insights in diabetic autonomic neuropathy in children and adolescents

Verrotti

Loiacono

Mohn

et al. 2009

European Journal of Endocrinology

View full text Add to dashboard Cite

Diabetic autonomic neuropathy (DAN) represents a major complication of diabetes mellitus but there is considerable uncertainty about its incidence, prevalence, pathogenesis, diagnosis, and prognosis. There are conflicting opinions about the pathogenesis of DAN: the 'classical hypothesis' has been supplemented by some new insights. Clinical symptoms of autonomic neuropathy do not generally occur until long after the onset of diabetes. DAN seems to be detectable even in asymptomatic children and adolescents with diabetes and is associated with the most serious consequences, such as cardiovascular dysfunction. Because of its association with a variety of adverse outcomes, including cardiovascular deaths, cardiovascular autonomic neuropathy is the most clinically important and well-studied form of DAN. No form of therapy in DAN has been identified that provides unequivocal, safe, and effective stabilization or reversal of the condition, just a near normal control of blood glucose in the early years after the onset of diabetes that may delay the development of clinically significant nerve impairment. This article reviews recent developments in knowledge of epidemiology, pathogenesis, clinical symptoms, diagnosis, and therapy of DAN.

show abstract

Neuropathy Among the Diabetes Control and Complications Trial Cohort 8 Years After Trial Completion

Cited by 305 publications

References 16 publications

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

Diabetic Retinopathy

New insights in diabetic autonomic neuropathy in children and adolescents

Contact Info

Product

Resources

About