Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary.
Royal Hallamshire Hospital, Sheffield, UK.
J Diabetes Res. 2021 May 28;2021:6662159. doi: 10.1155/2021/6662159. eCollection 2021.
People with diabetic cardiovascular autonomic neuropathy (CAN) have increased cardiovascular mortality. However, the association between distal symmetric polyneuropathy (DSPN) or CAN with all-cause mortality is much less investigated. Thus, we set out to examine the effect of CAN and DSPN on all-cause mortality in a well-phenotyped cohort.
All diabetes cases ( = 1,347) from the catchment area of a secondary diabetes care centre who had medical examination including neuropathy assessment between 1997 and 2016 were followed up for all-cause mortality in the NHS Hungary reimbursement database until 2018. We investigated the association of CAN (Ewing tests) and DSPN (Neurometer) with all-cause mortality using Cox models stratified by diabetes type.
Altogether, = 131/1,011 persons with type 1/type 2 diabetes were included. Of the participants, 53%/43% were male, mean age was 46 ± 12/64 ± 10 years, diabetes duration was 13 ± 10/7 ± 8 years, 42%/29% had CAN, and 39%/37% had DSPN. During the 9 ± 5/8 ± 5-year follow-up, = 28/494 participants died. In fully adjusted models, participants with type 1 diabetes patients with versus without DSPN had an increased mortality (HR 2.99, 95% CI 1.4-8.63), while no association with CAN was observed. In type 2 diabetes, both DSPN and CAN independently increased mortality (HR 1.32, 95% CI: 1.07-1.64, and HR 1.44, 95% CI: 1.17-1.76).
Our results are compatible with an increased risk of mortality in people with type 1 diabetes and DSPN. Furthermore, we report a similarly strong association between DSPN and CAN and all-cause mortality in type 2 diabetes mellitus.
患有糖尿病心血管自主神经病变（CAN）的人心血管死亡率增加。然而，远端对称性多发性神经病（DSPN）或 CAN 与全因死亡率之间的关联研究较少。因此，我们着手研究在一个表现良好的队列中 CAN 和 DSPN 对全因死亡率的影响。
1997 年至 2016 年期间，在二级糖尿病护理中心进行体检并包括神经病变评估的所有糖尿病患者（=1347 人）均在匈牙利国民保健服务报销数据库中进行了全因死亡率的随访，随访至 2018 年。我们使用 Cox 模型按糖尿病类型分层，研究 CAN（Ewing 检验）和 DSPN（神经计）与全因死亡率的关系。
共有=131/1011 例 1/2 型糖尿病患者入选。参与者中，53%/43%为男性，平均年龄为 46±12/64±10 岁，糖尿病病程为 13±10/7±8 年，42%/29%患有 CAN，39%/37%患有 DSPN。在 9±5/8±5 年的随访期间，=28/494 名参与者死亡。在完全调整的模型中，与无 DSPN 的患者相比，1 型糖尿病患者伴有 DSPN 死亡率增加（HR 2.99，95%CI 1.4-8.63），而与 CAN 无关。在 2 型糖尿病中，DSPN 和 CAN 均独立增加死亡率（HR 1.32，95%CI：1.07-1.64 和 HR 1.44，95%CI：1.17-1.76）。
我们的结果与 1 型糖尿病和 DSPN 患者死亡风险增加一致。此外，我们报告了 2 型糖尿病中 DSPN 和 CAN 与全因死亡率之间同样强烈的关联。
