Metabolic factors, lifestyle habits, and possible polyneuropathy in early type 2 diabetes: A nationwide study of 5,249 patients in the Danish DD2 cohort
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RESEARCH DESIGN AND METHODS: We thoroughly characterized 6,726 patients with recently diagnosed diabetes. After a median of 2.8 years, we sent a detailed questionnaire on neuropathy, including the Michigan Neuropathy Screening Instrument questionnaire (MNSIq) to identify possible DPN (score ≥4) and the Douleur Neuropathique en 4 Questions (DN4) questionnaire for possible associated neuropathic pain (MNSIq ≥4 + pain in both feet + DN4-score ≥3).
RESULTS: Among 5,249 patients with data on both DPN and pain, 17.9% (n=938) had possible DPN, including 7.4% (n=386) with possible neuropathic pain. In regression analyses, central obesity (waist circumference, waist-hip ratio, and waist-height ratio) was markedly associated with DPN. Other important metabolic factors associated with DPN included hypertriglyceridemia ≥1.7 mmol/L: adjusted prevalence ratio (aPR) 1.36 (1.17; 1.59), decreased HDL cholesterol <1.0/1.2 mmol/L (male/female): aPR 1.35 (1.12; 1.62), high-sensitive CRP ≥3.0 mg/L: aPR 1.66 (1.42; 1.94), C-peptide ≥1,550 pmol/L: aPR 1.72 (1.43; 2.07), HbA1c ≥78 mmol/mol: aPR 1.42 (1.06; 1.88), and antihypertensive drug use: aPR 1.34 (1.16; 1.55). Smoking: aPR 1.50 (1.24; 1.81) and lack of physical activity (0 vs ≥3 days/week): aPR 1.61 (1.39; 1.85) were also associated with DPN. Smoking, high alcohol intake, and failure to increase activity after diabetes diagnosis associated with neuropathic pain.
CONCLUSIONS:Possible DPN was associated with metabolic syndrome factors, insulin resistance, inflammation, and modifiable lifestyle habits in early type 2 diabetes.