Diabetes Care. 2021 Oct 29;45(5):1065-72. doi: 10.2337/dc21-1074.
Data related to diabetic neuropathy in youth with type 2 diabetes are limited. We examined the relationship of glycemic control, sex, race/ethnicity, BMI, and other type 2 diabetes-associated factors with the development of diabetic peripheral neuropathy (DPN) in youth with type 2 diabetes enrolled in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.
The Michigan Neuropathy Screening Instrument (MNSI) and a 10-g monofilament exam were performed annually. DPN was defined as a score (>2) on the MNSI-exam or combined MNSI-exam and MNSI-survey scores (exam >2 and/or survey ≥4), or monofilament exam (<8 of 10 correct responses) at two or more consecutive visits. Multivariable time-to-event models assessed the association of risk factors evaluated longitudinally with DPN events.
A total of 674 participants (35% male), with a mean age of 14 years and diabetes duration <2 years at study entry, were evaluated annually over an average of 10.2 years. Male subjects had a significantly higher cumulative incidence of DPN than female subjects (38.5% vs. 27.2% via MNSI-exam, = 0.002; 14.0% vs. 5.1% via monofilament exam, = 0.01). Rates did not differ by race/ethnicity. Higher HbA and BMI were associated with higher DPN, by both MNSI and the monofilament test. In multivariable models, male sex, older age, and higher BMI were associated with MNSI-exam DPN risk.
DPN was evident early in the course of youth-onset type 2 diabetes and increased over time. It was higher in male subjects and related to glycemic control. These findings raise concern for long-term development of neuropathy-related morbidity in youth with type 2 diabetes and the need to achieve improved glycemic control.
2型糖尿病青年患者中与糖尿病神经病变相关的数据有限。我们在青少年和青年2型糖尿病治疗选择（TODAY）研究中，研究了血糖控制、性别、种族/民族、体重指数（BMI）以及其他2型糖尿病相关因素与2型糖尿病青年患者糖尿病周围神经病变（DPN）发生之间的关系。
每年进行密歇根神经病变筛查工具（MNSI）检查和10克单丝检查。DPN定义为MNSI检查得分（>2）或MNSI检查与MNSI调查得分相结合（检查>2和/或调查≥4），或在连续两次或更多次就诊时单丝检查（10次正确反应中<8次）。多变量事件发生时间模型评估纵向评估的危险因素与DPN事件的关联。
共有674名参与者（35%为男性），研究开始时平均年龄为14岁，糖尿病病程<2年，平均随访10.2年。男性受试者DPN的累积发病率显著高于女性受试者（通过MNSI检查为38.5%对27.2%，P=0.002；通过单丝检查为14.0%对5.1%，P=0.01）。发病率在种族/民族方面没有差异。通过MNSI和单丝试验，较高的糖化血红蛋白（HbA）和BMI与较高的DPN相关。在多变量模型中，男性、年龄较大和BMI较高与MNSI检查的DPN风险相关。
DPN在青年起病的2型糖尿病病程早期就很明显，且随时间增加。男性受试者中更高，并且与血糖控制有关。这些发现引发了对2型糖尿病青年患者神经病变相关发病率长期发展的担忧，以及改善血糖控制的必要性。
