Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
PLoS One. 2019 Jul 29;14(7):e0220175. doi: 10.1371/journal.pone.0220175. eCollection 2019.
The aim of the present study was to investigate the major determinants of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes (T2D), considering the traditional and newly discovered risk factors, including hypoglycaemia and glycemic variability.
This retrospective case-control study was conducted in a tertiary care hospital in Taiwan. A total of 2,837 patients with T2D were recruited, medical history and biochemical data were obtained, and patients were screened for DPN using the Michigan Neuropathy Screening Instrument (MNSI). DPN was defined as an MNSI exam score > 2. A stepwise selection of variables was used based on the Akaike Information Criterion (AIC) and the Schwarz Criterion (SC). Multivariate analysis was performed using the identified variables obtained from the stepwise selection.
Among the recruited patients, 604 (21.3%) were found to have DPN. 275 patients with DPN were selected because of longer follow up period before enrollment and complete data of glycemic parameters, and paired with 351 patients with T2D without DPN and matched for age, gender, and diabetes duration. The results of the stepwise selection showed that the presence of moderately and severely increased albuminuria yielded the lowest values of AIC and SC, which indicate the best predictive performance. Multivariate analysis demonstrated that moderately and severely increased albuminuria and greater long-term glycemic variability significantly increased the risk of DPN, with a corresponding odds ratio of 1.85 and 1.61 (95%confidence intervals of 1.25-2.73and1.02-2.55, respectively), after adjusted for hypoglycaemia and types of diabetes treatment.
Albuminuria is a potent predictor of DPN, and greater long-term glycemic variabilityis clearly associated with DPN in adults with T2D. These findings indicate that, in addition to achieve average blood glucose control, screening for albuminuria and reducing blood glucose fluctuations might be useful for improving diabetic microvascular complications.
本研究旨在探讨 2 型糖尿病（T2D）患者糖尿病周围神经病变（DPN）的主要决定因素，考虑到包括低血糖和血糖变异性在内的传统和新发现的危险因素。
这项回顾性病例对照研究在台湾的一家三级保健医院进行。共招募了 2837 名 T2D 患者，获取了他们的病史和生化数据，并使用密歇根神经病变筛查工具（MNSI）对患者进行 DPN 筛查。DPN 定义为 MNSI 检查评分>2。根据赤池信息量准则（AIC）和施瓦茨准则（SC），采用逐步选择变量。使用逐步选择获得的确定变量进行多变量分析。
在招募的患者中，发现 604 名（21.3%）患有 DPN。由于登记前的随访时间较长且血糖参数的完整数据，选择了 275 名患有 DPN 的患者，并与 351 名无 DPN 的 T2D 患者配对，年龄、性别和糖尿病病程相匹配。逐步选择的结果表明，中度和重度白蛋白尿的存在产生了最低的 AIC 和 SC 值，这表明了最佳的预测性能。多变量分析表明，中度和重度白蛋白尿以及更大的长期血糖变异性显著增加了 DPN 的风险，校正低血糖和糖尿病治疗类型后，相应的比值比分别为 1.85 和 1.61（95%置信区间为 1.25-2.73 和 1.02-2.55）。
白蛋白尿是 DPN 的有力预测指标，在 T2D 成人中，更大的长期血糖变异性与 DPN 明显相关。这些发现表明，除了实现平均血糖控制外，筛查白蛋白尿和降低血糖波动可能有助于改善糖尿病微血管并发症。
