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.

Additional causes for distal sensory polyneuropathy in diabetic patients

“…20 21 Indeed a recent study suggested that modification of lipid abnormalities may influence progression of diabetic neuropathy. 22 Vitamin B1 and B6 levels are not measured routinely in patients with neuropathy primarily because such deficiencies have been linked to readily identified conditions, notably alcoholism, malabsorption syndromes, or malnutrition. 19 However, others have documented low B1 and B6 levels in the absence of these conditions.…”

Diabetic neuropathy

“…In this study 23.5% developed neuropathy, which apart from the glycaemic control was related to potentially modifiable cardiovascular risk factors including raised serum triglyceride, body mass index, smoking, and hypertension. 34 A stepwise progressive study of treatment of type II diabetic patients with hypotensive drugs, angiotensin converting enzyme inhibitors, calcium channel blockers, hypoglycaemic agents, aspirin, hypolipidaemic agents, and antioxidants. This study argues for the multifactorial nature of neuropathy and need for managing multiple metabolic abnormalities.…”

Postural orthostatic tachycardia syndrome

“…Autonomic neuropathy is found to be present in over 20% of patients with type 1 diabetes when assessed 7 years after diagnosis 1. In healthy subjects, there is a rapid early rise in heart rate upon standing which falls over approximately 30 beats to relative bradycardia.…”