Risk Factors for Developing Diabetic Polyneuropathy in Type 2 Diabetes

Risk factors for developing diabetic polyneuropathy (DPN) in individuals with type 2 diabetes may include obesity, low high-density lipoprotein cholesterol levels, and higher levels of methylglyoxal, according to a study published in Diabetes Care.

Researchers conducted an observational prospective cohort analysis study of 1256 individuals not yet diagnosed with DPN with 13 years of prospectively acquired data, after screening-based diagnosis of type 2 diabetes obtained from the Danish arm of the Anglo-Danish Dutch study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION), to identify potential risk factors associated with the development of DPN.

Study results found the median age of participants to be 60.8 years (interquartile range, 55.6-65.5 years), with 59% of participants being men. During the 13 years after screening-based diagnosis of diabetes, the cumulative incidence of DPN was found to be 10% (n=78), with a corresponding annual incidence of 0.7% (7 cases per 1000 person-years).

In addition, researchers determined that individuals diagnosed with DPN were also found at baseline to have higher measures of obesity, such as weight (hazard ratio [HR], 1.09; 95% CI, 1.03-1.16), waist circumference (HR, 1.14; 95% CI, 1.05-1.24), and body mass index (HR, 1.14; 95% CI, 1.06-1.23), compared with individuals without DPN. Other factors also associated with a higher risk for DPN included increased age (HR, 1.03; 95% CI, 1.00-1.07), lower levels of high-density lipoprotein (HR, 0.82; 95% CI, 0.69-0.99), and low-density lipoprotein (HR, 0.92; 95% CI, 0.86-0.98), and higher levels of log₂ methylglyoxal (HR, 1.45; 95% CI, 1.12-1.89).

There was an absence of data to support the listing of an individual’s smoking status or alcohol consumption as begin risk factors for DPN. There were no associations between DPN and HbA1c, and a nonstatistically significant lower HR for men compared with women for developing DPN (HR, 0.68; 95% CI, 0.47-1.01).

The researchers concluded that obesity was strongly supported by epidemiological evidence as being a risk factor for developing DPN, whereas study results also suggest that increased methylglyoxal levels also serve as an additional risk factor. Therefore, clinicians should strongly encourage individuals to implement interventions aimed at reducing measures of obesity such as weight, weight circumference, and body mass index in an effort to reduce their risk of developing DPN. Further, clinicians should consider monitoring levels of methylglyoxal, as it could potentially identify an individual at higher risk of developing DPN.

Reference

Andersen ST, Witte DR, Dalsgaard EM, et al. Risk factors for incident diabetic polyneuropathy in a cohort with screen-detected type 2 diabetes followed for 13 Years: ADDITION-Denmark [published online February 27, 2018]. Diabetes Care. doi: 10.2337/dc17-2062