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Risk Factors for Diabetic Peripheral Neuropathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study

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posted on 29.10.2021, 16:09 by Lorraine E. Levitt Katz, Neil H. White, Laure El ghormli, Christine L. Chan, Kenneth C. Copeland, Terri H. Lipman, Marsha D. Marcus, Philip Zeitler, the TODAY Study Group
Objective: Data related to diabetic neuropathy in youth with type 2 diabetes are limited. We examined the relationship of glycemic control, sex, race-ethnicity, BMI, and other type 2 diabetes-associated factors with the development of diabetic peripheral neuropathy (DPN) in type 2 diabetes youth enrolled in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.

Research Design and Methods: The Michigan Neuropathy Screening Instrument (MNSI) and a 10-gram monofilament exam were performed annually. DPN was defined as a score (>2) on the MNSI-exam or combined MNSI-exam and MNSI-survey scores (exam >2 and/or survey ≥4), or monofilament (<8/10 correct responses) at 2 or more consecutive visits. Multivariable time-to-event models assessed the association of risk factors evaluated longitudinally with DPN events.

Results: 674 participants (35% male), with mean age 14 years and diabetes duration <2 years at study entry were evaluated annually over an average of 10.2 years. Males had a significantly higher cumulative incidence of DPN than females (38.5% vs. 27.2% via MNSI-exam, p=0.002; 14.0% vs. 5.1% via monofilament, p=0.01). Rates did not differ by race-ethnicity. Higher HbA1c and BMI were associated with higher DPN, by both MNSI and monofilament. In multivariable models, male sex, older age, and higher BMI were associated with MNSI-exam DPN risk.

Conclusions: DPN was evident early in the course of youth-onset type 2 diabetes and increased over time. It was higher in males and related to glycemic control. These findings raise concern for long-term development of neuropathy-related morbidity in youth with type 2 diabetes and the need to achieve improved glycemic control.

Funding

This work was completed with funding from NIDDK and the NIH Office of the Director through grants U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The NIDDK project office was involved in all aspects of the study, including: design and conduct; collection, management, analysis, and interpretation of the data; review and approval of the manuscript; and decision to submit the manuscript for publication.

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