Peripheral sensory neuropathy associates with micro- or macroangiopathy: results from a population-based study of type 2 diabetic patients in Sweden

Lars Kärvestedt, Eva Mårtensson, Valdemar Grill, Stig Elofsson, Gunvor von Wendt, Anders Hamsten, Kerstin Brismar, Lars Kärvestedt, Eva Mårtensson, Valdemar Grill, Stig Elofsson, Gunvor von Wendt, Anders Hamsten, Kerstin Brismar

Abstract

Objective: To assess associations between peripheral sensory neuropathy (PSN) and other diabetes-related complications.

Research design and method: In an area-based cohort of type 2 diabetic subjects, we investigated 156 subjects (age 61.7 +/- 7.2 years and diabetes duration 7.0 +/- 5.7 years) by questionnaires, clinical examinations, blood and urine sampling, and review of medical records.

Results: Prevalence of PSN, assessed by monofilament and neurothesiometer testing, increased with severity of retinopathy (50% frequency in moderate and 100% in severe or proliferative retinopathy; P = 0.02). Vibration perception threshold was higher in subjects with retinopathy (25.6 +/- 8.9 vs. 20.5 +/- 8.9 V; P = 0.007). PSN was more common in subjects with overt nephropathy, with higher vibration perception thresholds, than in subjects without overt nephropathy. Subjects with PSN but no retinopathy had twice the prevalence of peripheral vascular disease (PVD) (52%) as subjects with both PSN and retinopathy (19%; P = 0.05). In subjects with PSN alone, PVD was three times more likely (52%) than in subjects without PSN (16%; P = 0.001). In multivariate analysis, PSN was independently associated with PVD (odds ratio 2.31; P = 0.007), age (1.12; P = 0.008), male sex (2.01; P = 0.02), and HDL cholesterol (0.21; P < 0.05) and tended to be independently associated with IGF-1 binding protein (1.03; P = 0.05) but not with diabetes duration or A1C.

Conclusions: In a representative population of type 2 diabetes, PSN is related to microvascular and macrovascular pathology. PSN is possibly affected by the IGF axis.

References

    1. Bloomgarden ZT: Diabetic retinopathy and neuropathy. Diabetes Care 28:963–970, 2005
    1. Boulton AJ, Malik RA, Arezzo JC, Sosenko JM: Diabetic somatic neuropathies. Diabetes Care 27:1458–1486, 2004
    1. Wiles PG, Pearce SM, Rice PJ, Mitchell JM: Vibration perception threshold: influence of age, height, sex, and smoking, and calculation of accurate centile values. Diabet Med 8:157–161, 1991
    1. Chiarelli F, Santilli F, Mohn A: Role of growth factors in the development of diabetic complications. Horm Res 53:53–67, 2000
    1. Brismar K, Lewitt MS: The IGF and IGFBP system in insulin resistance and diabetes mellitus. In IGF and nutrition in health and disease. Houston S, Holly J, Feldman E, Eds., New York, Humana Press Inc., 2004, p. 251–270
    1. Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT: Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682, 2003
    1. Borg H, Gottsäter A, Fernlund P, Sundkvist G: A 12-year prospective study of the relationship between islet antibodies and β-cell function at and after the diagnosis in patients with adult-onset diabetes. Diabetes 51:1754–1762, 2002
    1. Pozzilli P, Di Mario U: Autoimmune diabetes not requiring insulin at diagnosis (latent autoimmune diabetes of the adult): definition, characterization, and potential prevention. Diabetes Care 24:1460–1467, 2001
    1. Póvoa G, Roovete A, Hall K: Cross-reaction of serum somatomedin-binding protein in a radioimmunoassay developed for somatomedin-binding protein isolated from human amniotic fluid. Acta Endocrinol (Copenh )107:563–570, 1984
    1. Pirart J: Diabetic neuropathy: a metabolic or a vascular disease? Diabetes 14:1–9, 1965
    1. Maser RE, Laudadio C, DeCherney GS: The effects of age and diabetes mellitus on nerve function. J Am Geriatr Soc 41:1202–1204, 1993
    1. Maser RE, Steenkiste AR, Dorman JS, Nielsen VK, Bass EB, Manjoo Q, Drash AL, Becker DJ, Kuller LH, Greene DA, Orchad TJ: Epidemiological correlates of diabetic neuropathy: report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes 38:1456–1461, 1989
    1. Dyck PJ, Davies JL, Wilson DM, Service FJ, Melton LJ 3rd, O'Brien PC: Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care 22:1479–1486, 1999
    1. El-Asrar AM, Al-Rubeaan KA, Al-Amro SA, Moharram OA, Kangave D: Retinopathy as a predictor of other diabetic complications. Int Ophthalmol 24:1–11, 2001
    1. Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG: Risk factors for diabetic peripheral sensory neuropathy: results of the Seattle Prospective Diabetic Foot Study. Diabetes Care 20:1162–1167, 1997
    1. Adler AI, Stevens RJ, Neil A, Stratton IM, Boulton AJ, Holman RR: UKPDS 59: hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes. Diabetes Care 25:894–899, 2002
    1. Pittenger GL, Mehrabyan A, Simmons K, Amandarice, Dublin C, Barlow P, Vinik AI: Small fiber neuropathy is associated with the metabolic syndrome. Metab Syndr Relat Disord 3:113–121, 2005
    1. Cameron NE, Eaton SE, Cotter MA, Tesfaye S: Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia 44:1973–1988, 2001
    1. Crosby SR, Tsigos C, Anderton CD, Gordon C, Young RJ, White A: Elevated plasma insulin-like growth factor binding protein-1 levels in type 1 (insulin-dependent) diabetic patients with peripheral neuropathy. Diabetologia 35:868–872, 1992
    1. Ishii DN: Implication of insulin-like growth factors in the pathogenesis of diabetic neuropathy. Brain Res Brain Res Rev 20:47–67, 1995
    1. Brismar K, Fernqvist-Forbes E, Wahren J, Hall K: Effect of insulin on the hepatic production of insulin-like growth factor-binding protein-1 (IGFBP-1), IGFBP-3, and IGF-I in insulin-dependent diabetes. J Clin Endocrinol Metab 79:872–878, 1994
    1. Schmechel H, Heinrich U: Retinopathy and nephropathy in 772 insulin-treated diabetic patients in relation to the type of diabetes. Diabete Metab 19:138–142, 1993
    1. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, Matthews DR: UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis. Diabetologia 44:156–163, 2001
    1. Coppini DV, Wellmer A, Weng C, Young PJ, Anand P, Sonksen PH: The natural history of diabetic peripheral neuropathy determined by a 12 year prospective study using vibration perception thresholds. J Clin Neurosci 8:520–524, 2001
    1. Maguire AM, Craig ME, Craighead A, Chan AK, Cusumano JM, Hing SJ, Silink M, Howard NJ, Donaghue KC: Autonomic nerve testing predicts the development of complications: a 12-year follow-up study. Diabetes Care 30:77–82, 2007

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