Potential risk factors for diabetic neuropathy: a case control study

Fargol Booya, Fatemeh Bandarian, Bagher Larijani, Mohammad Pajouhi, Mahdi Nooraei, Jamshid Lotfi, Fargol Booya, Fatemeh Bandarian, Bagher Larijani, Mohammad Pajouhi, Mahdi Nooraei, Jamshid Lotfi

Abstract

Background: Diabetes mellitus type II afflicts at least 2 million people in Iran. Neuropathy is one of the most common complications of diabetes and lowers the patient's quality of life. Since neuropathy often leads to ulceration and amputation, we have tried to elucidate the factors that can affect its progression.

Methods: In this case-control study, 110 diabetic patients were selected from the Shariati Hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to differentiate cases from controls. The diagnosis of neuropathy was confirmed by nerve conduction studies (nerve conduction velocity and electromyography). The multiple factors compared between the two groups included consumption of angiotensin converting enzyme inhibitors (ACEI), blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality.

Results: Statistically significant relationships were found between neuropathy and age, gender, quality of diabetes control and duration of disease (P values in the order: 0.04, 0.04, < 0.001 and 0.005). No correlation was found with any atherosclerosis risk factor (high BP, hyperlipidemia, cigarette smoking).

Conclusion: In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control reduces the incidence of neuropathy, slows its progression and improves the diabetic patient's quality of life. More attention must be paid to elderly male diabetic patients with poor diabetes control with regard to regular foot examinations and more practical education.

Figures

Figure 1
Figure 1
Box plot demonstrating relationship between MNDS score and sex (0 = male, 1 = female). The dark line in the plot is equivalent to mean MNDS score. Average score is higher in males.
Figure 2
Figure 2
Box plot demonstrating relationship between MNDS score and quality of diabetes control (0 = poor, 1 = fair, 2 = good). The dark line in the plot is equivalent to mean MNDS score. Average score is higher in poor control of diabetes.

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