Large-Fiber Dysfunction in Diabetic Peripheral Neuropathy Is Predicted by Cardiovascular Risk Factors

• Published in: Diabetes care Vol. 32; no. 10; pp. 1896 - 1900
• Main Authors: Elliott, Jackie, Tesfaye, Solomon, Chaturvedi, Nish, Gandhi, Rajiv A, Stevens, Lynda K, Emery, Celia, Fuller, John H
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.10.2009
• Subjects: Adult; Biological and medical sciences; Cardiovascular diseases; Cardiovascular Diseases - metabolism; Cholesterol; Cholesterol - metabolism; Cholesterol, LDL - metabolism; Clinics; Diabetes; Diabetes Complications; Diabetes Mellitus, Type 1 - complications; Diabetes. Impaired glucose tolerance; Diabetic foot; Diabetic Nephropathies - complications; Diabetic Neuropathies - etiology; Diabetic Neuropathies - metabolism; Diabetic retinopathy; Diabetics; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Health aspects; Heart attacks; Humans; Hypertension - complications; Male; Medical research; Medical sciences; Medicine, Experimental; Metabolic diseases; Miscellaneous; Mortality; Original Research; Perception - physiology; Peripheral Nervous System Diseases - etiology; Peripheral Nervous System Diseases - metabolism; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Sensory Thresholds - physiology; Sex Factors; Smoking; Young Adult; Endocrinopathy; Human; Nervous system diseases; Nutrition; Diabetes mellitus; Fiber; Prediction; Metabolic diseases; Cardiovascular disease; Epidemiology; Feeding; Diet; Dysfunction; Risk factor; Cardiovascular risk; Peripheral nerve disease; Predictive factor; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc09-0554

OBJECTIVE: Diabetic large-nerve fiber dysfunction, as measured by vibration perception threshold (VPT), predicts foot ulceration, amputation, and mortality. Thus, determination of modifiable risk factors is of great clinical importance. RESEARCH DESIGN AND METHODS: We assessed 1,407 patients with type 1 diabetes and a normal VPT participating in the EURODIAB Prospective Complications Study, at baseline mean ± SD age of 32.7 ± 10.2 years with diabetes duration of 14.7 ± 9.3 years and follow-up of 7.3 ± 0.6 years. VPT was measured using biothesiometry on the right big toe and medial malleolus. An abnormal result was defined as >2 SD from the predicted mean for the patient s age. RESULTS: An abnormal VPT was associated with an increased incidence of gangrene, amputation, foot ulceration, leg bypass or angioplasty, and mortality (P [less-than or equal to] 0.02). The incidence of abnormal VPT was 24% over the 7.3-year follow-up. Duration of diabetes and A1C significantly influenced the incidence of abnormal VPT (P < 0.0001). After correction for these, established risk factors for cardiovascular disease (CVD), including male sex (P = 0.0004), hypertension (P < 0.0001), total cholesterol (P = 0.002), LDL cholesterol (P = 0.01), smoking (P < 0.0001), weight (P < 0.0001), and diabetes complications (retinopathy [P = 0.0001], nephropathy [P = 0.01], and autonomic neuropathy [P = 0.001]), were all found to be significant risk factors. A previous history of CVD doubled the incidence of abnormal VPT. CONCLUSIONS: This prospective study indicates that cardiovascular risk factors predict development of large-fiber dysfunction, which may account for the high mortality rate in patients with an abnormal VPT, and emphasizes the importance of early determination of VPT to detect subclinical neuropathy and to address cardiovascular risk factors.