Biostatistics Center, George Washington University, Rockville, MD
Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH.
Diabetes. 2020 May;69(5):1000-1010. doi: 10.2337/db19-1046. Epub 2020 Feb 12.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study demonstrated that intensive glucose control reduced the risk of developing diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN). We evaluated multiple risk factors and phenotypes associated with DPN and CAN in this large, well-characterized cohort of participants with type 1 diabetes, followed for >23 years. DPN was defined by symptoms, signs, and nerve conduction study abnormalities in ≥2 nerves; CAN was assessed using standardized cardiovascular reflex tests. Generalized estimating equation models assessed the association of DPN and CAN with individual risk factors measured repeatedly. During DCCT/EDIC, 33% of participants developed DPN and 44% CAN. Higher mean HbA was the most significant risk factor for DPN, followed by older age, longer duration, greater height, macroalbuminuria, higher mean pulse rate, β-blocker use, and sustained albuminuria. The most significant risk factor for CAN was older age, followed by higher mean HbA, sustained albuminuria, longer duration of type 1 diabetes, higher mean pulse rate, higher mean systolic blood pressure, β-blocker use, estimated glomerular filtration rate <60 mL/min/1.73 m, higher most recent pulse rate, and cigarette smoking. These findings identify risk factors and phenotypes of participants with diabetic neuropathy that can be used in the design of new interventional trials and for personalized approaches to neuropathy prevention.
糖尿病控制和并发症试验/糖尿病干预和并发症的流行病学(DCCT/EDIC)研究表明,强化血糖控制降低了发生糖尿病周围神经病变(DPN)和心血管自主神经病变(CAN)的风险。我们在这个大型、特征明确的 1 型糖尿病参与者队列中评估了与 DPN 和 CAN 相关的多种风险因素和表型,随访时间超过 23 年。DPN 通过≥2 条神经的症状、体征和神经传导研究异常来定义;CAN 使用标准化心血管反射测试进行评估。广义估计方程模型评估了 DPN 和 CAN 与个体风险因素之间的关联,这些风险因素是在多次测量中得到的。在 DCCT/EDIC 期间,33%的参与者出现了 DPN,44%出现了 CAN。较高的平均 HbA 是 DPN 的最重要危险因素,其次是年龄较大、病程较长、身高较高、大量白蛋白尿、平均脉搏率较高、β受体阻滞剂使用和持续白蛋白尿。年龄较大是 CAN 的最重要危险因素,其次是较高的平均 HbA、持续白蛋白尿、1 型糖尿病病程较长、平均脉搏率较高、平均收缩压较高、β受体阻滞剂使用、估计肾小球滤过率<60 mL/min/1.73 m、最近的平均脉搏率较高和吸烟。这些发现确定了有糖尿病神经病变的参与者的风险因素和表型,可用于新的干预试验设计和个性化预防神经病变的方法。