Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Olot, Girona, Spain.
J Diabetes Complications. 2012 Mar-Apr;26(2):77-82. doi: 10.1016/j.jdiacomp.2012.02.011. Epub 2012 Apr 10.
Identifying patients at risk of developing diabetic peripheral neuropathy (DPN) is of paramount importance in those with type 2 diabetes mellitus (T2DM) to provide and anticipate secondary prevention measures as well as intensify action on risk factors, particularly so in primary care. Noteworthy, the incidence of DPN remains unknown in our environment.
(i) To analyze a single angiotensin-converting enzyme (ACE) gene polymorphism (D/I) as a genetic marker of risk of developing DPN, and (ii) to determine the incidence of DPN in our environment.
Longitudinal study with annual follow-up for 3years involving a group of T2DM (N=283) randomly selected. ACE gene polymorphism distribution (I=insertion; D=deletion) was determined. DPN was diagnosed using clinical and neurophysiology evaluation.
Baseline DPN prevalence was 28.97% (95% CI, 23.65-34.20). ACE polymorphism heterozygous genotype D/I presence was 60.77% (95% CI, 55.05-66.5) and was independently associated with a decreased risk of DPN (RR, 0.51; 95% CI, 0.30-0.86). DPN correlated with age (P<0.001) but not with gender (P=0.466) or time of evolution of T2DM (P=0.555). Regarding end point, DPN prevalence was 36.4% (95% CI, 30.76-42.04), and accumulated incidence was 10.4% 3years thereafter. In the final Poisson regression analysis, the presence of heterozygous genotype remained independently associated with a decreased risk of DPN (RR, 0.71; (95% CI, 0.53-0.96). DPN presence remained correlated with age (P=0.002), but not with gender (P=0.490) or time of evolution (P=0.630).
In our series, heterozygous ACE polymorphism (D/I) stands as a protective factor for DPN development. Accumulated incidence of DPN was relevant. Further prospective studies are warranted.
在 2 型糖尿病（T2DM）患者中，识别发生糖尿病周围神经病变（DPN）风险的患者至关重要，以便提供和预测二级预防措施，并强化对危险因素的干预，尤其是在初级保健中。值得注意的是，我们的环境中 DPN 的发病率尚不清楚。
（i）分析单个血管紧张素转换酶（ACE）基因多态性（D/I）作为 DPN 发病风险的遗传标志物，以及（ii）确定我们环境中的 DPN 发病率。
这是一项纵向研究，对随机选择的 283 例 T2DM 患者进行了为期 3 年的年度随访。确定 ACE 基因多态性（I=插入；D=缺失）分布。使用临床和神经生理学评估诊断 DPN。
基线 DPN 患病率为 28.97%（95%CI，23.65-34.20）。ACE 杂合基因型 D/I 存在率为 60.77%（95%CI，55.05-66.5），与 DPN 风险降低独立相关（RR，0.51；95%CI，0.30-0.86）。DPN 与年龄相关（P<0.001），但与性别（P=0.466）或 T2DM 病程时间无关（P=0.555）。关于终点，DPN 的患病率为 36.4%（95%CI，30.76-42.04），3 年后累积发病率为 10.4%。在最终的泊松回归分析中，杂合基因型的存在与 DPN 风险降低独立相关（RR，0.71；95%CI，0.53-0.96）。DPN 的存在仍与年龄相关（P=0.002），但与性别无关（P=0.490），与病程时间无关（P=0.630）。
在我们的系列中，杂合 ACE 多态性（D/I）是 DPN 发病的保护因素。DPN 的累积发病率是相关的。需要进一步进行前瞻性研究。
