Vascular Risk Factors and Diabetic Neuropathy

Abstract

backgroundOther than glycemic control, there are no treatments for diabetic neuropathy. Thus, identifying potentially modifiable risk factors for neuropathy is crucial. We studied risk factors for the development of distal symmetric neuropathy in 1172 patients with type 1 diabetes mellitus from 31 centers participating in the European Diabetes (EURODIAB) Prospective Complications Study. methodsNeuropathy was assessed at baseline (1989 to 1991) and at follow-up (1997 to 1999), with a mean (±SD) follow-up of 7.3±0.6 years. A standardized protocol included clinical evaluation, quantitative sensory testing, and autonomic-function tests. Serum lipids and lipoproteins, glycosylated hemoglobin, and the urinary albumin excretion rate were measured in a central laboratory. resultsAt follow-up, neuropathy had developed in 276 of 1172 patients without neuropathy at baseline (23.5 percent). The cumulative incidence of neuropathy was related to the glycosylated hemoglobin value and the duration of diabetes. After adjustment for these factors, we found that higher levels of total and low-density lipoprotein cholesterol and triglycerides, a higher body-mass index, higher von Willebrand factor levels and urinary albumin excretion rate, hypertension, and smoking were all significantly associated with the cumulative incidence of neuropathy. After adjustment for other risk factors and diabetic complications, we found that duration of diabetes, current glycosylated hemoglobin value, change in glycosylated hemoglobin value during the follow-up period, body-mass index, and smoking remained independently associated with the incidence of neuropathy. Cardiovascular disease at baseline was associated with double the risk of neuropathy, independent of cardiovascular risk factors. conclusionsThis prospective study indicates that, apart from glycemic control, the incidence of neuropathy is associated with potentially modifiable cardiovascular risk factors, including a raised triglyceride level, body-mass index, smoking, and hypertension.

Association between serum cystatin C and diabetic peripheral neuropathy: a cross-sectional study of a Chinese type 2 diabetic population

“…Although the pathogenesis of DPN still has not been elucidated, several risk factors including hyperglycemia, dyslipidemia, smoking, etc. have been identified (2). Moreover, vascular diseases including cardiovascular disease, peripheral vascular disease, diabetic nephropathy, and diabetic retinopathy were all found to be risk factors of DPN (2,3).…”

“…have been identified (2). Moreover, vascular diseases including cardiovascular disease, peripheral vascular disease, diabetic nephropathy, and diabetic retinopathy were all found to be risk factors of DPN (2,3). A population-based study of type 2 diabetic patients in Sweden showed that the prevalence of peripheral sensory neuropathy increased with the severity of retinopathy and overt nephropathy, indicating that peripheral sensory neuropathy was associated with micro-or macro-angiopathy in type 2 diabetes (4).…”

Diabetes and obesity are the main metabolic drivers of peripheral neuropathy

“…However, studies that have investigated the contributions of the individual components have revealed mixed results 15, 16, 17, 18, 19, 20, 21. We have recently shown that diabetes, prediabetes, and obesity are the main metabolic components associated with peripheral neuropathy in a United States obese population 22.…”

A genome‐wide association study suggests an association of Chr8p21.3 (GFRA2) with diabetic neuropathic pain

“…Additional risk factors for diabetic neuropathic pain have been proposed, including smoking, hypertension, obesity, hypercholesterolaemia and duration of diabetes (Tesfaye et al., 2005; Jensen et al., 2006). Epidemiological studies can identify risk factors and effective preventive strategies in parallel with the search for the underlying causative biological mechanisms, such as genetic pathways (Smith et al., 2007).…”