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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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posted on 15.04.2020 by Diana H. Christensen, Søren T. Knudsen, Sandra S. Gylfadottir, Lotte B. Christensen, Jens S. Nielsen, Henning Beck-Nielsen, Henrik T. Sørensen, Henning Andersen, Brian C. Callaghan, Eva L. Feldman, Nanna B. Finnerup, Troels S. Jensen, Reimar W. Thomsen
OBJECTIVE:To investigate the association of metabolic and lifestyle factors with possible diabetic polyneuropathy (DPN) and neuropathic pain in patients with early type 2 diabetes.


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.

Funding

The Danish Centre for Strategic Research in Type 2 Diabetes Project (DD2) is supported by the Danish Agency for Science [grant number 09-067009, 09-075724], the Danish Health and Medicines Authority, the Danish Diabetes Association, and an unrestricted donation from Novo Nordisk A/S. Project partners are listed on the website www.DD2.nu. Research reported in this publication is part of the International Diabetic Neuropathy Consortium (IDNC) research programme, which is supported by a Novo Nordisk Foundation Challenge Programme grant (Grant number NNF14OC0011633). The Department of Clinical Epidemiology, Aarhus University Hospital, receives funding for other studies from companies in the form of research grants to (and administered by) Aarhus University. None of these studies has any relation to the present study.

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