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Diabetes Care. 2018 May;41(5):1068-1075. doi: 10.2337/dc17-2062. Epub 2018 Feb 27.

Risk Factors for Incident Diabetic Polyneuropathy in a Cohort With Screen-Detected Type 2 Diabetes Followed for 13 Years: ADDITION-Denmark.

Author information

1
Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark sta@ph.au.dk.
2
Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
3
Danish Diabetes Academy, Odense, Denmark.
4
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
5
Department of Medicine I and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.
6
German Center for Diabetes Research, Neuherberg, Germany.
7
Institute for Diabetes and Cancer, Helmholtz Center Munich, Munich, Germany.
8
Joint Heidelberg-Institute for Diabetes and Cancer Translational Diabetes Program, Neuherberg, Germany.
9
Steno Diabetes Center Copenhagen, Gentofte, Denmark.
10
Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
11
Department of Neurology, University of Michigan, Ann Arbor, MI.

Abstract

OBJECTIVE:

To study incident diabetic polyneuropathy (DPN) prospectively during the first 13 years after a screening-based diagnosis of type 2 diabetes and determine the associated risk factors for the development of DPN.

RESEARCH DESIGN AND METHODS:

We assessed DPN longitudinally in the Danish arm of the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) using the Michigan Neuropathy Screening Instrument questionnaire (MNSIQ), defining DPN with scores ≥4. Risk factors present at the diabetes diagnosis associated with the risk of incident DPN were estimated using Cox proportional hazard models adjusted for trial randomization group, sex, and age.

RESULTS:

Of the total cohort of 1,533 people, 1,445 completed the MNSIQ at baseline and 189 (13.1%) had DPN at baseline. The remaining 1,256 without DPN entered this study (median age 60.8 years [interquartile range 55.6; 65.6], 59% of whom were men). The cumulative incidence of DPN was 10% during 13 years of diabetes. Age (hazard ratio [HR] 1.03 [95% CI 1.00; 1.07]) (unit = 1 year), weight (HR 1.09 [95% CI 1.03; 1.16]) (unit = 5 kg), waist circumference (HR 1.14 [95% CI 1.05; 1.24]) (unit = 5 cm), BMI (HR 1.14 [95% CI 1.06; 1.23]) (unit = 2 kg/m2), log2 methylglyoxal (HR 1.45 [95% CI 1.12; 1.89]) (unit = doubling), HDL cholesterol (HR 0.82 [95% CI 0.69; 0.99]) (unit = 0.25 mmol/L), and LDL cholesterol (HR 0.92 [95% CI 0.86; 0.98]) (unit = 0.25 mmol/L) at baseline were significantly associated with the risk of incident DPN.

CONCLUSIONS:

This study provides further epidemiological evidence for obesity as a risk factor for DPN. Moreover, low HDL cholesterol levels and higher levels of methylglyoxal, a marker of dicarbonyl stress, are identified as risk factors for the development of DPN.

PMID:
29487078
DOI:
10.2337/dc17-2062
[Indexed for MEDLINE]

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