Gao Li, Qin Jiexing, Chen Ying, Jiang Wenqun, Zhu Desheng, Zhou Xiajun, Ding Jie, Qiu Huiying, Zhou Yan, Dong Qing, Guan Yangtai
Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Jan 25;17:417-426. doi: 10.2147/DMSO.S433024. eCollection 2024.
To investigate the risk factors associated with subclinical diabetic peripheral neuropathy (sDPN) in patients with type 2 diabetes mellitus (T2DM).
This cross-sectional, retrospective study involved 311 patients with T2DM who were successively admitted from January 2018 to December 2021 without any neurological symptoms. All participants underwent a nerve conduction study (NCS), and those asymptomatic patients with abnormal nerve conduction were diagnosed with sDPN. Differences between groups were evaluated by the chi-squared, Wilcoxon, or Fisher's exact test. Binary logistic regression analysis was performed to determine the independent risk factors for sDPN. Receiver operating characteristic (ROC) curves were constructed, and the areas under curves (AUCs) were detected.
Among 311 asymptomatic patients with T2DM, 142 (45.7%) with abnormal nerve conduction were diagnosed with sDPN. Patients with sDPN significantly differed from those without diabetic peripheral neuropathy (DPN) in age, history of hypertension, duration of diabetes, anemia, neutrophil-to-lymphocyte ratio, fasting C-peptide level, serum creatinine level, and albuminuria (all <0.05). Furthermore, the duration of diabetes (odds ratio [OR]: 1.062, 95% confidence interval [CI]: 1.016-1.110), fasting C-peptide level (OR: 2.427, 95% CI: 1.126-5.231), and presence of albuminuria (OR: 2.481, 95% CI: 1.406-4.380) were independently associated with the development of sDPN (all <0.05). The AUCs for fasting C-peptide level, duration of diabetes, and the two factors combined were 0.6229 (95% CI: 0.5603-0.6855, =0.0002), 0.6738 (95% CI: 0.6142-0.7333, <0.0001), and 0.6808 (95% CI: 0.6212-0.7404, <0.0001), respectively.
For patients with T2DM and longer duration of diabetes, lower fasting C-peptide levels, and presence with albuminuria, the risk for developing DPN is higher even if they have no clinical signs or symptoms. Identifying potential risk factors for the development of sDPN and effectively controlling them early are critical for the successful management of DPN.
探讨2型糖尿病（T2DM）患者亚临床糖尿病周围神经病变（sDPN）的相关危险因素。
本横断面回顾性研究纳入了2018年1月至2021年12月期间连续入院的311例无任何神经症状的T2DM患者。所有参与者均接受了神经传导研究（NCS），那些神经传导异常的无症状患者被诊断为sDPN。通过卡方检验、Wilcoxon检验或Fisher精确检验评估组间差异。进行二元逻辑回归分析以确定sDPN的独立危险因素。构建受试者工作特征（ROC）曲线，并检测曲线下面积（AUC）。
在311例无症状的T2DM患者中，142例（45.7%）神经传导异常被诊断为sDPN。sDPN患者与无糖尿病周围神经病变（DPN）的患者在年龄、高血压病史、糖尿病病程、贫血、中性粒细胞与淋巴细胞比值、空腹C肽水平、血清肌酐水平和蛋白尿方面存在显著差异（均P<0.05）。此外，糖尿病病程（比值比[OR]：1.062，95%置信区间[CI]：1.016 - 1.110）、空腹C肽水平（OR：2.427，95%CI：1.126 - 5.2,31）和蛋白尿的存在（OR：2.481，95%CI：1.406 - 4.380）与sDPN的发生独立相关（均P<0.05）。空腹C肽水平、糖尿病病程以及两者联合的AUC分别为0.6229（95%CI：0.5603 - 0.6855，P = 0.0002）、0.6738（95%CI：0.6142 - 0.7333，P<0.0001）和0.6808（95%CI：0.6212 - 0.7404，P<0.0001）。
对于糖尿病病程较长、空腹C肽水平较低且存在蛋白尿的T2DM患者，即使没有临床体征或症状，发生DPN的风险也更高。识别sDPN发生的潜在危险因素并尽早有效控制它们对于DPN的成功管理至关重要。
