Callaghan Brian C, Anjana Ranjit Mohan, Muthukumar Lavanya, Reynolds Evan L, Saravanan Jebarani, Vignesh Mani Arun, Mukundan Aswin, Feldman Eva L, Mohan Viswanathan
Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
J Diabetes Investig. 2025 Jun;16(6):1045-1049. doi: 10.1111/jdi.70033. Epub 2025 Mar 27.
The effect of diabetes subtypes on neuropathy prevalence and metabolic drivers of this relationship are unknown. Using electronic medical records from 50 diabetes care centers in eight states of India with biothesiometer and complete phenotyping data on 22,348 patients, we determined neuropathy prevalence stratified by India-specific diabetes subtypes and evaluated associations with neuropathy (biothesiometer). Neuropathy prevalence was highest in severe insulin-deficient diabetes (SIDD; 25.5%), followed by insulin-resistant obese diabetes (IROD; 21.8%), mild age-related diabetes (MARD; 18.9%), and combined insulin-resistant and deficient diabetes (CIRDD; 17.3%, P = <0.001). HbA1c (odds ratio [OR]: 1.19, 1.16-1.21), diabetes duration (OR: 1.04, 1.04-1.05), and waist circumference (OR: 1.01, 1.01-1.02) were associated with neuropathy. SIDD (OR: 2.23, 2.01-2.47), CIRDD (OR: 1.89, 1.69-2.11), and IROD (OR: 1.84, 1.66-2.04) had increased neuropathy compared to MARD. In India, SIDD patients are more likely to have neuropathy compared to MARD patients likely from longer diabetes duration and higher HbA1c; therefore, interventions should focus on hyperglycemia. Interventions in CIRDD and IROD patients should likely address obesity as well.
糖尿病亚型对神经病变患病率的影响以及这种关系的代谢驱动因素尚不清楚。我们利用印度八个邦50个糖尿病护理中心的电子病历，这些病历包含生物感觉阈值测量仪数据以及22348例患者的完整表型数据，确定了按印度特定糖尿病亚型分层的神经病变患病率，并评估了与神经病变（生物感觉阈值测量仪）的关联。严重胰岛素缺乏型糖尿病（SIDD；25.5%）患者的神经病变患病率最高，其次是胰岛素抵抗型肥胖糖尿病（IROD；21.8%）、轻度年龄相关性糖尿病（MARD；18.9%）以及胰岛素抵抗合并缺乏型糖尿病（CIRDD；17.3%，P <0.001）。糖化血红蛋白（比值比[OR]：1.19，1.16 - 1.21）、糖尿病病程（OR：1.04，1.04 - 1.05）和腰围（OR：1.01，1.01 - 1.02）与神经病变相关。与MARD相比，SIDD（OR：2.23，2.01 - 2.47）、CIRDD（OR：1.89，1.69 - 2.11）和IROD（OR：1.84，1.66 - 2.04）的神经病变发生率更高。在印度，与MARD患者相比，SIDD患者更易发生神经病变，这可能是由于糖尿病病程更长和糖化血红蛋白水平更高；因此，干预措施应侧重于控制高血糖。对于CIRDD和IROD患者的干预可能还应针对肥胖问题。
