Predictors of vibration perception threshold in type 2 diabetic patients with proliferative retinopathy

• Published in: Postgraduate medical journal Vol. 87; no. 1032; pp. 658 - 663
• Main Authors: Magri, Caroline Jane, Calleja, Neville, Buhagiar, Gerald, Fava, Stephen, Vassallo, Josanne
• Format: Journal Article
• Language: English
• Published: London The Fellowship of Postgraduate Medicine 01.10.2011; BMJ Publishing Group; Oxford University Press
• Subjects: Age Factors; Aged; Amputation; Biological and medical sciences; Blood pressure; Cholesterol; Creatinine; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - diagnosis; Diabetic Neuropathies - physiopathology; Diabetic neuropathy; Diabetic retinopathy; Diabetic Retinopathy - complications; Diabetic Retinopathy - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Glucose; haemoglobin; Hemoglobins - metabolism; Humans; Hyperglycemia; Insulin resistance; Ischemia; Male; Medical sciences; Metabolism; Middle Aged; Mortality; Multivariate Analysis; Neurologic Examination; Ophthalmology; Patients; Perception - physiology; Peripheral neuropathy; peripheral vascular disease; Psychomotor Performance - physiology; Regression analysis; Retinopathies; Risk Factors; Sensory Thresholds - physiology; Sex Factors; Surveys and Questionnaires; Urine; Variables; Vibration; Endocrinopathy; Type 2 diabetes; Human; Retinopathy; Vibration; Perception threshold; Prediction; Metabolic diseases; Patient; Proliferative vitreoretinopathy; Vitreous body disease; Medicine; Eye disease; Predictive factor
• ISSN: 0032-5473; 1469-0756; 1469-0756
• DOI: 10.1136/pgmj.2010.104216

Purpose of the studyDistal peripheral neuropathy (DPN) is a troublesome complication of diabetes mellitus (DM). The factors associated with the disease are still incompletely understood. The purpose of this study was to investigate factors associated with vibration perception threshold (VPT) as a marker of DPN in a type 2 diabetic population with advanced microvascular disease.MethodsThe study included 203 diabetic patients (117 male, 86 female) with proliferative diabetic retinopathy. Subjects were investigated by questionnaires, clinical examinations, blood and urine sampling, and review of medical records in the period from November 2008 through April 2009. Presence of DPN was defined as VPT ≥25 V.ResultsThe mean (±SD) age was 65.2 (±9.9) years and median (IQR) diabetes duration was 18 (10–25) years. Forty-six per cent of subjects were found to have DPN, defined as a VPT ≥25 V by neurothesiometer testing. Prevalence of DPN was found to be associated with age (p=0.038), male gender (p=0.046), low haemoglobin (p<0.001), high erythrocyte sedimentation rate (p=0.03), uric acid values (p=0.034), and peripheral vascular disease (PVD) (p=0.003) in univariate analysis. Multivariate logistic regression analysis revealed male gender (OR 5.52; p<0.001) and low haemoglobin values (B=−0.58; p<0.001) to be independent predictors of VPT ≥25 V in subjects with proliferative retinopathy, while linear regression analysis revealed male gender (p<0.001), haemoglobin (p=0.001), age (p=0.04), and PVD (p=0.001) to be significant predictors of VPT.ConclusionsThis study reports a novel independent association of DPN with low haemoglobin values. In the study population with type 2 DM and proliferative retinopathy, DPN was also independently associated with male gender, age, and PVD. Further studies are needed to confirm the association with low haemoglobin and identify the underlying mechanism.