Pop-Busui Rodica, Lu Jiang, Lopes Neuza, Jones Teresa L Z
Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
J Peripher Nerv Syst. 2009 Mar;14(1):1-13. doi: 10.1111/j.1529-8027.2009.00200.x.
We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15-2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.
在冠状动脉疾病（CAD）的药物和血运重建治疗以及糖尿病的胰岛素增敏与胰岛素补充治疗的“旁路血管成形术血运重建研究2糖尿病（BARI 2D）”试验中，我们评估了基线时血糖治疗与糖尿病周围神经病变（DPN）患病率之间的关联。共评估了2368例2型糖尿病和CAD患者。DPN定义为使用密歇根神经病变筛查工具（MNSI）临床检查评分>2。通过多因素logistic回归评估不同血糖治疗组的DPN比值比，并对包括年龄、性别、糖化血红蛋白（HbA1c）和糖尿病病程在内的多个协变量进行校正。具有有效基线特征和MNSI评分的BARI 2D受试者中，51%患有DPN。校正所有变量后，使用胰岛素与DPN显著相关（OR = 1.57，95%CI：1.15 - 2.13）。使用磺脲类药物（SU）或SU/二甲双胍（Met）/噻唑烷二酮类药物（TZD）联合治疗的患者DPN发生率略高于Met/TZD组。这项对2型糖尿病和CAD患者队列的横断面研究表明，胰岛素使用与较高的DPN患病率相关，且独立于疾病病程、血糖控制和其他特征。在这项横断面研究中无法评估血糖控制策略与DPN之间的因果关系，但在BARI 2D试验中对DPN的持续评估和随机治疗可能会为DPN的发生提供进一步解释。
