Type 2 diabetes: albuminuria is a strong predictor of diabetic peripheral neuropathy

  • Pai YW & al.
  • PLoS ONE
  • 1 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes (T2D), the presence of moderately and severely increased albuminuria is a strong predictor of diabetic peripheral neuropathy (DPN) and greater long-term glycaemic variability is associated with increased risk for DPN.

Why this matters

  • Findings suggest that in addition to achieving average blood glucose control, albuminuria screening and reduction of blood glucose fluctuations might be useful for improving diabetic microvascular complications.

Study design

  • This retrospective case-control study screened 2837 patients with T2D for DPN using the Michigan Neuropathy Screening Instrument.
  • Of 2837 patients, 604 (21.3%) patients were found to have DPN and among those 275 patients with DPN were selected because of longer follow-up and paired with 351 age-, sex- and duration of diabetes-matched controls.
  • Funding: Medical Research Project of Taichung Veterans General Hospital.

Key results

  • After univariate analysis, insulin use (P=.001), prior severe hypoglycaemic episodes (P=.008), greater fasting plasma glucose-coefficient of variation (P<.001 higher creatinine levels lower glomerular filtration rate the presence of albuminuria and larger amounts were significantly associated with dpn.>
  • According to the results of the stepwise selection, the presence of moderately and severely increased albuminuria showed the lowest Akaike Information Criterion (682.186) and Schwarz Criterion (690.643) scores, which indicated the best predictive performance.
  • After adjustment for confounders, moderately and severely increased albuminuria (OR, 1.85; 95% CI, 1.25-2.73) and greater long-term glycaemic variability (OR, 1.61; 95% CI, 1.02-2.55) significantly associated with increased risk for DPN.

Limitations

  • Causality cannot be inferred because of the cross-sectional design.
  • DPN diagnosis was not confirmed by electrophysiological tests.