Peripheral Neuropathy and Vasculopathy; Frequency and Associated Risk Factors in Newly Diagnosed Treatment Naive Type 2 Diabetes

Abstract

Background: The prevalence of diabetes in Pakistan is 11.45%. The reported prevalence of diabetic foot ulceration in Pakistan is between 4% and 10%, with the amputation rate of 8%-21%. Peripheral neuropathy and vasculopathy are main underlying cause of diabetic foot ulcers. Methodology: It was a cross-sectional non-interventional cohort study where all newly diagnosed treatment naïve type 2 diabetic patients were enrolled. Peripheral neuropathy and vasculopathy were detected by Michigan neuropathy screening instrument (MNSI) and ankle brachial index (ABI) respectively. Risk factors for peripheral neuropathy and vasculopathy were determined by univariate and multivariate logistic regression analysis. Statistical significance was considered with P value of < 0.05. Result: Fifty seven patients (37.7%) had early neuropathy with MNSI score of 3.3 ± 0.4. Thirty seven patients (20.6%) had vasculopathy with ABI score of 0.76 ± 0.11. Age (Odd ratio 1.07 (1.02-1.11), p 0.003), duration of symptoms (Odd ratio 1.11 95% CI: 1.05-1.17, p ≤ 0.001), high HbA1C % (Odd ratio 1.94 95% CI: 1.54-2.45, P ≤ 0.001), albumin creatinine ratio (Odd ratio 1.01, 95% CI: 1.00-1.01, P ≤ 0.001) and cholesterol level (Odd ratio 1.01 95% CI: 1.01-1.02, p = 0.001) were found as risk factors for early neuropathy and vasculopathy. Conclusion: Peripheral neuropathy and vasculopathy are frequently reported complications among newly diagnosed treatment naïve patients of type 2 DM. Age, duration of symptoms prior to diagnosis, metabolic parameters like raised HbA1C, hyperlipidemia and spot random albumin creatinine ratio are found to be risk factors for both peripheral neuropathy and vasculopathy.

The risk factors for diabetic peripheral neuropathy: A meta-analysis

“…In addition, the currently reported risk factors for diabetes complicated with peripheral neuropathy include vitamin D[41–43] c-peptide[31], hyperlipidemia[42], alcohol intake[44], hyperglycemia[41, 42], LDL-C[29, 35, 36], BUN[22, 33] amongst others, except the duration of diabetes, age, HbA1c, DR, smoking, BMI, TC, TG. These risk factors play an important role in better explaining the causes of diabetes complicated with peripheral neuropathy.…”

Change in Urine Albumin-to-Creatinine Ratio and Risk of Diabetic Peripheral Neuropathy in Type 2 Diabetes: A Retrospective Cohort Study

“…17 A cross-sectional study confirmed that UACR was a risk factor for peripheral neuropathy. 8 This study showed that diabetic neuropathy was associated with DPN but lacked follow-up. Our study first demonstrated that an increase in UACR was also a risk of DPN in non-DPN patients, which complemented the above studies and may provide clues for further clinical exploration of the relationship between UACR and neuropathy in type 2 diabetes.…”

“…6 Diabetic peripheral neuropathy (DPN) can lead to neuropathic pain, which worsens the quality of life. 7 Many studies confirmed that the level of UACR, which represents one of the risk factors of early DPN, 8 was higher in patients with neuropathy as compared those without this condition. 9 The previous research of our team found that even in the normal range, UACR and the risk of DPN showed a positive correlation.…”