Anemia: an independent risk factor of diabetic peripheral neuropathy in type 2 diabetic patients

Comprehensive assessment of ocular parameters for identifying diagnostic indicators of diabetic peripheral neuropathy

PURPOSE

To explore variations in systemic and ocular parameters among patients with diabetes, both with and without diabetic peripheral neuropathy (DPN) and to identify sensitive indicators for DPN diagnosis.

METHODS

Ninty-five patients with type 2 diabetes mellitus (T2DM) were involved in this cross-sectional study, including 49 without DPN and 46 with DPN. Ocular parameters were obtained using optical coherence tomography angiography (OCTA) and corneal confocal microscopy (CCM).

RESULT

Patients with DPN presented with significantly higher HbA1c (p < 0.05) and glycated albumin (GA, p < 0.01) levels, increased prevalence of diabetic retinopathy (DR, p < 0.05), and lower serum albumin (ALB, p < 0.01) and red blood cell (RBC, p < 0.05) levels. Ocular assessments revealed reduced corneal nerve fiber length (CNFL, p < 0.001) and enlarged foveal avascular zone (FAZ) area (p < 0.05) in DPN group. Logistic regression analysis indicated a significant association of presence of DR, RBC, GA, ALB, CNFL and DPN (p < 0.05, respectively). In the binary logistic regression for DPN risk, all three models including the presence of DR and CNFL exhibited the area under the curve (AUC) exceeding 0.8.

CONCLUSION

The study establishes a strong correlation between ocular parameters and DPN, highlighting CCM's role in early diagnosis. Combining systemic and ocular indicators improves DPN risk assessment and early management.

Electrochemical Skin Conductance by Sudoscan in Non-Dialysis Chronic Kidney Disease Patients

BACKGROUND

Peripheral neuropathy is prevalent among patients with chronic kidney disease (CKD). Sudoscan non-invasively detects polyneuropathy by measuring electrochemical skin conductance (ESC). We conducted a study on sudomotor function in CKD patients across various stages based on their estimated glomerular filtration rate (eGFR).

METHODS

In this cross-sectional study of 700 CKD patients, all underwent Sudoscan. Pathological ESC was defined as hands < 40 μS or feet < 50 μS. Clinical neuropathy scores including Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathique en 4 questionnaire (DN4) were obtained.

RESULTS

Among participants, 344 had diabetes and 356 did not. Hands and feet ESC decreased with CKD progression (median (IQR) in stage 1-2, 3, 4-5: 54.0 (39.0-68.0), 45.5 (30.0-63.0), 41.8 (26.5-60.5), p trend < 0.001; 64.5 (53.5-74.0), 60.5 (43.0-72.5), 55.0 (39.0-69.8), p trend < 0.001). Pathological hands and feet ESC increased in later CKD stages (stage 1-2, 3, 4-5: 26.6%, 40.9%, 45.7%, p trend < 0.001; 21.7%, 34.0%, 40.6%, p trend < 0.001). Positive hands and feet ESC-eGFR correlation existed irrespective of diabetes. Diabetic patients had lower hands and feet ESC than non-diabetics as CKD progressed. However, multivariate regression found no significant ESC-eGFR association. Sudoscan correlated with clinical neuropathy scores.

CONCLUSION

Pathological sudomotor function was common in non-dialysis CKD stages 4-5. Diabetic patients had worse function. Sudomotor dysfunction progressed with renal disease but eGFR was not an independent risk factor.

Development of risk prediction scores for diabetic peripheral neuropathy patients

Objectives

Risk prediction scores are important for early diagnosis and treatment of diseases. Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes, but the early diagnosis is challenging. This study developed a risk prediction model for DPN based on modifiable risk factors.

Materials and Methods

The study included 315 type 2 diabetes patients with and without DPN. Demographic, biochemical, and diagnostic data were collected. Multinomial logistic regression analysis was used to identify independent risk factors for DPN.

Results

Hemoglobin% and total red blood cells were identified as independent risk factors for DPN, used to develop a risk prediction score.

Conclusion

The risk prediction score developed in this study can be used by physicians to quickly assess a patient's risk of DPN and select appropriate therapeutic options. Routine monitoring of modifiable risk factors can improve DPN prognosis. Patients stratified by risk scores can better understand their risk and seek appropriate care.

Global Prevalence of Anemia Among Type 2 Diabetic Adult Patients: A Systematic Review and Meta-Analysis

Background

Anemia is a common and often overlooked hematological change observed in patients with diabetes mellitus. However, there is no global survey or health registry that estimates the pooled prevalence of anemia in patients with type 2 diabetes. Therefore, this study aimed to determine the global pooled prevalence of anemia among adult patients with type 2 diabetes.

Methods

This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The study protocol was registered on PROSPERO with the reference number (CRD42022327135), and the link provided (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022327135) display the published methodology. Previously published articles were searched in PubMed/Medline, Cochrane Library, WHO Global Index Medicus, African Journals Online, ScienceDirect, Google Scholar, and Google from October 26 to November 09, 2022. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool. Random-effects model was used to estimate the pooled prevalence of anemia. The degree of heterogeneity among the included studies was assessed using I2 statistics. Publication bias was detected using funnel plot symmetry analysis supplemented by Egger's and Begg's tests.

Results

Twenty-four studies with a total number of 19,118 participants were included in this systematic review and meta-analysis. The overall pooled prevalence of anemia among type 2 diabetic adult patients was 27.0% (95% CI: 24.0, 31.0, I2 = 96.45%; P< 0.001). Geographical and time-based subgroup analysis showed that higher prevalence of anemia was observed in Africa region 28.0% (95% CI: 17.0, 39.0) and from 2015 to 2022, 28.0% (95% CI: 24.0, 33.0), respectively.

Conclusion

Anemia is a moderate public health problem among adult patients with type 2 diabetes. Nearly one in four patients with type 2 diabetes develops anemia. Therefore, considering the negative impact of anemia, it is important to include anemia screening in the routine assessment of diabetes-related complications.

The Prevalence of Anemia in Hospitalized Patients With Diabetic Foot Ulcer (DFU) and the Relationship Between the Severity of Anemia and the Severity of DFU

BACKGROUND AND AIMS

We aim to determine the prevalence of anemia in hospitalized patients with diabetic foot ulcers (DFUs) and estimate the relationship between the severity of anemia and diabetic foot ulcer.

MATERIALS AND METHODS

We retrospectively collected and evaluated the data of 323 patients hospitalized with diabetic foot ulcer (DFU). We included 299 type 2 diabetic patients with foot ulcers of neuropathic or neuroischemic nature with infection. Anemia was defined based on World Health Organization (WHO) criteria, and the severity of DFU was classified in University of Texas (UT) grades.

RESULTS

Anemia was detected in 94.3% of DFU, and the prevalence of mild, moderate, and severe anemia was 16.7%, 55.7%, and 27.6%, respectively. There was a significant difference in the mean hemoglobin (Hb) levels among the patients with varying grades of severity of DFU (1B: Hb=10.17±2.08 gm/dL, 2B: Hb=9.27±2.04 gm/dL, 3B: Hb=8.03±1.829 gm/dL; p value=<0.0001). The iron study was available in 141 (47.15%) patients and was suggestive of anemia of chronic disorder (mean serum iron=40.22±23.81 mcg/dL, mean total iron-binding capacity (TIBC)=239.34±67.24 mcg/dL, mean ferritin=378.05±141.337 ng/mL). TIBC significantly decreased (1B=262.13±61.05, 2B=233.65±71.26, 3B=222.43±74.18; p=0.04), and ferritin significantly increased (1B=309.9±70.76, 2B=351.73±94.22, 3B=488.58±170.4; p<0.0001) with increasing DFU severity. Hemoglobin was significantly decreased at the time of discharge in comparison to that at admission (9.3±2.1 gm/dL versus 8.8±1.5 gm/dL; p value=0.01). Red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), lymphocyte counts, albumin, calcium, and high-density lipoprotein (HDL) significantly decreased with the increase of DFU severity. The duration of hospitalization, total leucocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR) increased with the severity of DFU.

CONCLUSIONS

The prevalence of anemia was very high in DFU and more than three-fourths of the patients had moderate to severe anemia. The severity of anemia was associated with the severity of DFU. The most common cause of anemia was anemia of chronic disorder secondary to diabetic foot infection. During the period of hospitalization, hemoglobin decreased despite improvement in DFU infection.

Prevalence of anemia in diabetes mellitus in South Asia: A systematic review and meta-analysis

OBJECTIVE

Anemia and Diabetes Mellitus (DM) are amongst major clinical and public health challenges in South Asia that influence the progression of chronic health problems in this population. Despite a growing body of research on these problems, there is a lack synthesized evidence on the burden of anemia among people with DM in this region. This meta-analytic review was conducted to estimate the prevalence of anemia among people with DM in South Asia.

METHODS

A systematic search of the literature was conducted in five primary databases and additional sources up to July 29, 2022, that reported the prevalence of anemia among DM patients in any of the eight South Asian countries. Observational studies that met pre-determined eligibility criteria according to the protocol registered in PROSPERO (CRD42022348433) were included in this meta-analysis. Random effect models were used to estimate pooled prevalence.

RESULTS

Of the 40 eligible studies, 38 underwent meta-analysis representing 14,194 participants with DM. The pooled prevalence of anemia was 45% (95% CI: 37.0-54.0, I2 = 99.28%, p = 0.00) among diabetic people in South Asia. In sub-group analysis, the pooled prevalence of anemia was higher in females (48%, 95% CI: 37.0-60.0, I2 = 98.86%, p = 0.00) compared to males (39%, 95% CI: 29.0-48.0, I2 = 98.18%, p = 0.00). Diabetic patients with older age (≥ 50 years) reported higher pooled estimates of anemia (48%, 95% CI: 38.0-58.0, I2 = 99.07%) than younger age group (< 50 years) (34%, 95% CI: 21.0-47.0, I2 = 98.83%). In addition, we found variation in pooled prevalence estimates of anemia considering the type of DM, such as type 1 reported 2% (95% CI: 0.00-4.00), type-2 reported 48% (95% CI: 40.0-56.0, I2 = 98.94%), and Gestational diabetes mellitus (GDM) reported 6% (95% CI: 3.00-12.0).

CONCLUSION

High pooled estimates of anemia among diabetic patients in South Asia, including publication bias, warrants further clinical and public health research following standard research methods to understand the more context-specific epidemiological insights and evidence.

Glycemic profile variability: An independent risk factor for diabetic neuropathy in patients with type 2 diabetes

BACKGROUND

Impaired glycemic control is a potential predictor for macro- and microvascular complications of diabetes, which could be recognized by glycemic variability. The aim of this 10-year prospective cohort study presented here is to gain a better understanding of the correlation between GV and diabetic peripheral neuropathy (DPN) as one of the most common complications of T2DM.

METHODS

Since February 2010, 1152 adult patients with T2DM have been followed-up. Baseline features, anthropometric measurements, and laboratory findings were collected and documented during ten years. The association between DPN incidence and glycemic profile variability was evaluated using cox regression analysis. The coefficient of variation of glycemic indices within subjects was calculated and compared using an independent sample t-test.

RESULTS

Individuals who developed neuropathy had significantly higher mean levels of glycemic indices (HbA1c, FBS, and 2hpp), urinary albumin excretion, mean creatinine levels, and a longer duration of diabetes. A significant positive correlation between incidence of DPN and glycemic profile variability (cv-FBS10 %, cv-FBS20 %, cv-2hpp20 %, cv-HbA1c5 % and cv-HbA1c10 %) was revealed. Results also showed that higher variability of FBS was associated with the higher risk of neuropathy incidence (HR: 12.29, p-value: 0.045), which indicates that glycemic profile variability is an independent risk factor for DPN in patients with T2DM.

CONCLUSION

Variability of glycemic profiles from a visit to visit, regardless of sustained hyperglycemia, was indeed a significant risk factor for DPN in diabetic type 2 patients. CV-FBS was the most critical glycemic variability indices for DPN development.

Time to diabetic neuropathy and its predictors among adult type 2 diabetes mellitus patients in Amhara regional state Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022: A retrospective follow up study

BACKGROUND

Diabetic neuropathy is the primary cause of foot ulcers and amputations in both industrialized and poor countries. In spite of this, most epidemiological research on diabetic neuropathy in Ethiopia have only made an effort to estimate prevalence, and the information underlying the condition's beginning is not well-established. Therefore, determining the time to diabetic neuropathy and its variables among adult patients with type 2 diabetes mellitus at the Compressive Specialized Hospitals of the Amhara region was the aim of this study.

METHODS

An institutional-based retrospective follow-up study was undertaken among 669 newly recruited adult patients with type 2 diabetes mellitus who were diagnosed between the first of March 2007 and the last day of February 2012. Patients with diabetic neuropathy at the time of the diagnosis for type 2 diabetes mellitus (T2DM), patients without a medical chart, patients with an unknown date of DM diagnosis, and patients with an unknown date of diabetic neuropathy diagnosis were excluded from the study. All newly diagnosed type 2 diabetes mellitus (T2DM) patients aged 18 years and older who were enrolled from 1st March 2007 to 28th February 2012 in selected hospitals were included in this study. Cox proportional hazard model was fitted to determine predictors of time to diabetic neuropathy, and the Kaplan Meier survival curve was used to assess the cumulative survival time. Variables with a p-value < 0.05 were considered to be statistically significance at 95% confidence interval.

RESULTS

The restricted mean survival time of this study was 179.45 (95% CI: 173.77-185.14) months. The overall incidence rate of diabetic neuropathy was 2.14 cases per 100 persons-years. Being aged > 60 years [AHR = 2.93(95% CI: 1.29-6.66)], having diabetic retinopathy [AHR = 2.76(95% CI: 1.84-4.16)], having anemia [AHR = 3.62 (95% CI: 2.46-5.33)], having hypertension [AHR = 3.22(95% CI: 2.10-4.93)], and baseline fasting blood sugar > 200 mg/dl [AHR = 2.56(95% CI: 1.68-3.92)] were the predictors of diabetic neuropathy.

CONCLUSION

The risk of occurrence of diabetic neuropathy among type two diabetes mellitus patients was high in the early period. Age > 60 years, diabetic retinopathy, anemia, baseline fasting blood sugar level > 200 mg/dl, and hypertension were the main predictors of incidence of diabetic neuropathy. Therefore, early detection and appropriate interventions are important for patients with old age, diabetic retinopathy, anemia, hypertension, and FBS > 200mg/dl.

Time to diabetic neuropathy and its predictors among newly diagnosed type 2 diabetes mellitus patients in Northwest Ethiopia

Introduction

Despite the high number of patients suffering from the negative impact of diabetic neuropathy (DN) in Ethiopia, evidence regarding the time to DN and its predictors are not well document in Ethiopia. Therefore, the current study aimed to determine time to DN and its predictors among newly diagnosed type 2 diabetes patients (T2DM) in North West Ethiopia.

Methods

Institutional based retrospective cohort study was conducted among 463 T2DM. Cox proportional hazard model was fitted to identify predictors of time to DN. The adjusted hazard ratio (AHR) with its 95% confidence interval was used to declare the presence and strength of association.

Results

From a total 463 study participants, 77 (16.63%), (95% CI 13.23%, 20.03%) had developed diabetic neuropathy. The median time to develop DN was 233.77 months. About 40 (51.95%) diabetic neuropathy cases occurred within 6 years of diagnosis of diabetic mellitus. The incidence density was 2.01/100 PY with 95% CI of [1.60, 2.53]. In the multivariable Cox proportional hazard analysis; being aged 65–69 [AHR = 2.78; 95% CI 1.20, 6.46], living with diabetes for less than 4 years [AHR = 3.77; 95% CI 1.82, 7.76], having anaemia [AHR = 3.82; 95% CI 1.66, 8.82] and having other complications [AHR = 1.68; 95% CI 1.03, 2.76 were significant predictors of DN.

Conclusion

More than half of diabetic neuropathy cases occurred within a short period of diagnosed with T2DM. Significant predictors for the time to DN were age, duration, having anaemia and other DM complication. Therefore, we recommend that early screening for DM and its complication for risky groups. While doing that due consideration should be assumed for old and anemic patients.

Association Between Early Markers of Renal Injury and Type 2 Diabetic Peripheral Neuropathy

OBJECTIVE

Diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN) are both common chronic complications of type 2 diabetes mellitus (T2DM). The aim of this study was to examine whether some markers of early renal injury were associated with DPN.

METHODS

Retrospective hospitalization data from 471 patients with T2DM were analyzed. Subjects were divided into DPN group and non-DPN group according to clinical history, symptoms, signs and nerve conduction study. Markers of glomerular injury [urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR)] and tubular injury [urinary N-acetyl-β-D-glucosaminidase/creatinine ratio (NAG/Cr) and urinary β2 microglobulin (β2-MG)] were innovatively combined to assess the association with DPN. Staging of chronic kidney disease (CKD) was classified as G1, G2, G3a, G3b, G4 based on eGFR categories of ≥90, 60-89, 45-59, 30-44, 15-29 mL/min/1.73m2.

RESULTS

DPN was detected in 71.1% of our population. Subjects in DPN group suffered from older age, longer duration of diabetes and worse blood glucose control compared with non-DPN group. The levels of UACR, NAG/Cr and β2-MG were significantly increased in DPN group than those in non-DPN group, while eGFR was decreased. The prevalence of DPN increased gradually in G1, G2 and G3-4 of CKD, which were 66.3%, 73.2% and 82.7% (P = 0.014). After adjusting for confounding factors, NAG/Cr >1.41 U/mmol (the highest tertile) was a consistently independent risk factor for DPN [odds ratio, OR (95% confidence interval, CI) = 1.86 (1.04-3.33)]. However, UACR, eGFR and β2-MG did not significantly affect the risk of DPN.

CONCLUSION

When T2DM patients suffer from CKD, DPN will be more likely to appear, accelerate or deteriorate. Some easily available urinary markers of glomerular and tubular damage can be used for early prediction of DPN, in which increased NAG/Cr is an independent risk factor for DPN.

Serum albumin was negatively associated with diabetic peripheral neuropathy in Chinese population: a cross-sectional study

BACKGROUND

Previous studies that explored the relationship of serum albumin with diabetic peripheral neuropathy (DPN) have indicated inconsistent results. Thus, the present study aimed to evaluated the association between serum albumin and DPN, defined as vibration perception threshold (VPT) values ≥ 25 V and/or inability to feel the monofilament, in Chinese patients with type 2 diabetes mellitus (T2DM).

METHODS

1465 T2DM patients aged ≥ 16 years, who completed the measurement of serum albumin and DPN screening between 2012 and 2015, were included in the cross-sectional study. Correlation and multivariate logistic regression analysis models were used to evaluate the possible relationship between serum albumin and DPN.

RESULTS

Patients with higher quartiles of serum albumin had significantly lower VPT values and prevalence of DPN compared with those with lower quartiles (P for trend < 0.01), and there was an inverse relationship between serum albumin and VPT values and prevalence of DPN (all P < 0.01). Multivariate logistic regression analysis demonstrated that the risk of DPN was progressively decreased across serum albumin quartiles (P for trend < 0.01), and participants in the highest quartile of serum albumin were at a significantly decreased risk of DPN compared to those in the lowest quartile (odds rate: 0.311, 95% confidence intervals 0.134-0.724, P < 0.01). ROC analysis revealed that the optimal cutoff point of serum albumin for the prevalence of DPN was 39.95 g/L in patients with T2DM, with a sensitivity of 65.88% and a specificity of 66.7%.

CONCLUSIONS

Decreased levels of serum albumin might be correlated with increased risk of DPN in Chinese patients with T2DM. Future longitudinal studies with large samples are warranted to confirm our findings, and elucidate putative mechanisms for the association.

Hemoglobin, Body Mass Index, and Age as Risk Factors for Paclitaxel- and Oxaliplatin-Induced Peripheral Neuropathy

IMPORTANCE

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating adverse effect of neurotoxic cancer treatments including taxanes and platinum agents. Limited knowledge exists of potential prechemotherapy factors associated with CIPN development.

OBJECTIVE

To identify the association of pretreatment blood-based and clinical factors with CIPN persistence in patients who received paclitaxel or oxaliplatin.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study assessed pretreatment blood-based clinical factors and demographic characteristics of 333 patients treated with paclitaxel and oxaliplatin chemotherapy at urban multicenter cancer clinics and academic institutions in Australia between September 2015 and February 2020. Comprehensive neuropathy assessments were undertaken 3 to 12 months posttreatment. Posttreatment CIPN severity was compared with blood-based factors within 30 days prior to commencing chemotherapy. Data were analyzed between March and December 2020.

EXPOSURES

Paclitaxel or oxaliplatin chemotherapy.

MAIN OUTCOMES AND MEASURES

CIPN was measured using composite neurological grading scales, nerve conduction studies, and assessments of fine motor skills (grooved pegboard test), sensory function (grating orientation test and 2-point discrimination), and patient-reported outcomes. Independent samples t tests and Mann-Whitney U tests with post hoc Bonferroni correction were used to compare CIPN between patients according to blood-based factor normative ranges. Linear regression was used to identify blood-based and clinical associations with CIPN development.

RESULTS

The study included 333 participants (266 [79.9%] women; median [interquartile range] age, 58 [18] years) who were consecutively recruited and referred (228 treated with paclitaxel, 105 treated with oxaliplatin; 138 [41.4%] with breast cancer, 83 [24.9%] with colorectal cancer). Most participants had grade 1 CIPN or higher (238 [71.5%] participants). Participants with low hemoglobin pretreatment had worse CIPN posttreatment (median [IQR] composite neurological grading scale score, 5 [2-8] vs 4 [1-6]; P = .002; grooved pegboard mean [SD] time, 84.2 [28.7] vs 72.9 [21.1] seconds; P = .002; grating orientation task, 4.8 [2.8] vs 3.9 [1.8] mm; P = .03; 2-point discrimination, 45% vs 28%; P = .01), with no other impairments outside normative ranges associated with CIPN. In the multivariable model, several factors were associated with worse CIPN (F4,315 = 18.6; P < .001; r2 = .19) including for lower hemoglobin (β = -0.47; 95% CI, -0.73 to -0.21; P < .001), higher body mass index (β = 0.08; 95% CI, 0.02 to 0.12; P = .007), older age (β = 0.08; 95% CI, 0.06 to 0.11; P < .001), and female sex (β = -1.08; 95% CI, -1.76 to -0.16; P = .01).

CONCLUSIONS AND RELEVANCE

The results of this cohort study suggest that participants with low pretreatment hemoglobin, higher body mass index, older age, and female sex were more likely to develop paclitaxel- or oxaliplatin-induced CIPN posttreatment. Future research should investigate prospectively whether these risk factors are associated with a higher incidence of CIPN development.

Association Between Early Markers of Renal Injury and Type 2 Diabetic Peripheral Neuropathy

OBJECTIVE

Diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN) are both common chronic complications of type 2 diabetes mellitus (T2DM). The aim of this study was to examine whether some markers of early renal injury were associated with DPN.

METHODS

Retrospective hospitalization data from 471 patients with T2DM were analyzed. Subjects were divided into DPN group and non-DPN group according to clinical history, symptoms, signs and nerve conduction study. Markers of glomerular injury [urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR)] and tubular injury [urinary N-acetyl-β-D-glucosaminidase/creatinine ratio (NAG/Cr) and urinary β2 microglobulin (β2-MG)] were innovatively combined to assess the association with DPN. Staging of chronic kidney disease (CKD) was classified as G1, G2, G3a, G3b, G4 based on eGFR categories of ≥90, 60-89, 45-59, 30-44, 15-29 mL/min/1.73m².

RESULTS

DPN was detected in 71.1% of our population. Subjects in DPN group suffered from older age, longer duration of diabetes and worse blood glucose control compared with non-DPN group. The levels of UACR, NAG/Cr and β2-MG were significantly increased in DPN group than those in non-DPN group, while eGFR was decreased. The prevalence of DPN increased gradually in G1, G2 and G3-4 of CKD, which were 66.3%, 73.2% and 82.7% (P = 0.014). After adjusting for confounding factors, NAG/Cr >1.41 U/mmol (the highest tertile) was a consistently independent risk factor for DPN [odds ratio, OR (95% confidence interval, CI) = 1.86 (1.04-3.33)]. However, UACR, eGFR and β2-MG did not significantly affect the risk of DPN.

CONCLUSION

When T2DM patients suffer from CKD, DPN will be more likely to appear, accelerate or deteriorate. Some easily available urinary markers of glomerular and tubular damage can be used for early prediction of DPN, in which increased NAG/Cr is an independent risk factor for DPN.

Associations of serum low-density lipoprotein and systolic blood pressure levels with type 2 diabetic patients with and without peripheral neuropathy: systemic review, meta-analysis and meta-regression analysis of observational studies

BACKGROUND

Compositional abnormalities in lipoproteins and cardiovascular risk factors play an important role in the progression of diabetic peripheral neuropathy (DPN). This systematic review aimed to estimate the predicting value of low-density lipoprotein (LDL) and systolic blood pressure (SBP) level in type-2 diabetes mellitus (T2DM) patients with and without peripheral neuropathy. We also tried to determine whether LDL and SBP are associated with an increased collision risk of DPN.

METHODS

A systematic search was conducted for eligible publications which explored the LDL and SBP level in T2DM patients with and without peripheral neuropathy. The quality of the included studies was assessed by the QUADAS-2 tool. The standardized mean difference (SMD) with 95% CI of LDL and SBP level were pooled to assess the correlation between LDL and SBP level with DPN. We performed random effects meta-regression analyses to investigate factors associated with an increased collision risk of DPN.

RESULTS

There was a significant association between LDL and SBP with poor prognosis of DPN in those included studies (I₂ = 88.1% and I₂ = 84.9%, respectively, Both P < 0.001). European T2DM patients have higher serum level of LDL in compare with the European DPN patients (SMD = 0.16, 95% CI: - 0.06 - 0.38; P < 0.001). SBP level was associated with a 2.6-fold decrease in non-DPN patients of T2DM (SMD = - 2.63, 95% CI: - 4.00 - -1.27, P < 0.001). Old age European T2DM patients have significantly high risk for diabetes drivers. Furthermore, the results of the case-control study design model are more precise to show the accuracy of SBP in Asian T2DM patients.

CONCLUSION

Our finding supports the LDL and SBP status could be associated with increased risk of peripheral neuropathy in T2DM patients.

Prevalence of vitamin B12 deficiency in South Indians with different grades of glucose tolerance

AIMS

To determine the prevalence of vitamin B₁₂ deficiency in an urban south Indian population in individuals with different grades of glucose tolerance.

METHODS

A total of 1500 individuals [900 normal glucose tolerance (NGT), 300 prediabetes and 300 type 2 diabetes (T2DM)] who were not on vitamin B₁₂ supplementation were randomly selected from the Chennai Urban Rural Epidemiological Study (CURES) follow-up study. Anthropometric, clinical and biochemical investigations, which included vitamin B₁₂, insulin, homocysteine, HbA1c and serum lipids, were measured. Vitamin B₁₂ ≤ 191 pg/ml was defined as absolute vitamin B₁₂ deficiency and vitamin B₁₂ > 191 pg/ml and ≤ 350 pg/ml as borderline deficiency.

RESULTS

The mean levels of vitamin B₁₂ significantly decreased with increasing degrees of glucose tolerance (NGT 444 ± 368; prediabetes 409 ± 246; T2DM 389 ± 211 pg/ml, p = 0.021). The prevalence of absolute vitamin B₁₂ deficiency was 14.9% while 37.6% had borderline deficiency. The prevalence of absolute vitamin B₁₂ deficiency was significantly higher among individuals with T2DM (18.7%) followed by prediabetes (15%) and NGT(13.7%) [p for trend = 0.05]. The prevalence of vitamin B₁₂ significantly increased with age (p < 0.05) and in those with abdominal obesity (p < 0.001). Men and vegetarians had twice the risk of vitamin B₁₂ deficiency compared to women and non-vegetarians, respectively. Among individuals with NGT, prediabetes and T2DM, vitamin B₁₂ negatively correlated with homocysteine.

CONCLUSION

This study reports that the levels of vitamin B₁₂ decreased with increasing severity of glucose tolerance.

HbA1c variability and diabetic peripheral neuropathy in type 2 diabetic patients

BACKGROUND

Diabetic complications may be associated with impaired time-dependent glycemic control. Therefore, long-term glycemic variability, assessed by variations in haemoglobin A1c (HbA1c), may be a potential risk factor for microvascular complications, such as diabetic peripheral neuropathy (DPN). We investigated the association of HbA1c variability with DPN in patients with type 2 diabetes.

METHODS

In this cross-sectional study, 563 type 2 diabetic patients who had been screened for DPN and undergone quarterly HbA1c measurements during the year preceding enrolment were recruited. DPN was confirmed in patients displaying both clinical manifestations of neuropathy and abnormalities in a nerve conduction evaluation. HbA1c variability was assessed by the coefficient of variation of HbA1c (CV-HbA1c), and the mean of HbA1c (M-HbA1c) was calculated. In addition, medical history and clinical data were collected.

RESULTS

Among the recruited patients, 18.1% (n = 102) were found to have DPN, and these patients also presented with a higher CV-HbA1c than the patients without DPN (p < 0.001). The proportion of patients with DPN increased significantly from 6.9% in the first to 19.1% in the second and 28.5% in the third tertile of CV-HbA1c (p for trend < 0.001). After adjusting for initial HbA1c, M-HbA1c and other clinical factors via multiple logistic regression analysis, the odds ratios (ORs) for DPN in the second and third versus those in the first CV-HbA1c tertile were 3.61 (95% CI 1.62-8.04) and 6.48 (2.86-14.72), respectively. The area under the receiver operating characteristic (ROC) curve of CV-HbA1c was larger than that of M-HbA1c, at 0.711 (95% CI 0.659-0.763) and 0.662 (0.604-0.721), respectively. ROC analysis also revealed that the optimal cutoff value of CV-HbA1c to indicate DPN was 15.15%, and its corresponding sensitivity and specificity were 66.67% and 65.73%, respectively.

CONCLUSIONS

Increased HbA1c variability is closely associated with DPN in type 2 diabetic patients and could be considered as a potent indicator for DPN in these patients.

Prevalence of and Risk Factors for Peripheral Neuropathy in Chinese Patients With Diabetes: A Multicenter Cross-Sectional Study

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, and its progression significantly worsens the patient's quality of life. This study investigated the prevalence and risk factors associated with DPN in a large sample of Beijing individuals with type 1 and 2 diabetes, as well as compared the diagnostic methods for DPN. A total of 2,048 diabetic patients from 13 centers in Beijing were assessed for DPN through questionnaires and examination. Patients were divided into DPN group and suspected DPN/non-DPN group. The demographic, clinical and biological characteristics between the two groups were compared. Binary logistic regression analysis was performed to identify potential variables associated with DPN in diabetic patients. The diagnostic methods for DPN were also compared. Among the 2,048 diabetic patients, 73 cases of type 1 diabetes mellitus, 1,975 cases of type 2 diabetes were included in this study. Among them, 714 (34.86%) were identified with DPN, 537 (26.22%) were suspected of having DPN, and 797 (38.92%) were identified without DPN. Patient's age, duration of diabetes, and diabetic retinopathy were the significant independent risk factor for DPN among patients with type 2 diabetes. The odds ratio (OR) was 1.439 (95% confidence interval (CI): 1.282-1.616, P < 0.001), 1.297 (95% CI: 1.151-1.462, P < 0.001), and 0.637 (95% CI: 0.506-0.802, P < 0.001), respectively. Ankle reflex, temperature sensation plus vibration sensation are the best screening test for patients with type 1 and 2 diabetes. The Youden indexes were 62.2 and 69.8%, respectively. The prevalence rates of DPN in the Chinese patients with type 1 and type 2 diabetes in Beijing were 21.92 and 35.34%, respectively. Patient's age, duration of diabetes, and diabetic retinopathy are the independent risk factors for DPN.