Obesity, older age associated with higher polyneuropathy risk
medwireNews: Older patients with type 2 diabetes and those with markers of obesity have an increased risk for diabetic polyneuropathy, results of a longitudinal study suggest.
Using the Danish arm of the ADDITION trial, the researchers analyzed data from 1256 type 2 diabetes patients with a median age of 60.8 years who were free from polyneuropathy at baseline, 6.2% of whom went on to develop the condition over a median follow-up of 10.7 years.
Diabetic polyneuropathy was detected using the Michigan Neuropathy Screening Instrument questionnaire, which was completed by participants at baseline and at 6- and 13-year follow-up visits.
Patients who experienced neuropathy had a significantly higher bodyweight, waist circumference, and BMI at baseline than those who did not, at 90.5 versus 87.4 kg, 106.3 versus 103.5 cm, and 32.0 versus 30.0 kg/m2, respectively.
In a multivariable model, each additional 5 kg of bodyweight was associated with a 9% increased risk for neuropathy, while each additional 5 cm of waist circumference and 2 kg/m2 of BMI were both associated with a 14% increased risk after adjustment for factors including age and sex.
These findings provide “further epidemiological evidence for obesity as a risk factor for [diabetic polyneuropathy],” Signe Andersen (Aarhus University, Denmark) and colleagues write in Diabetes Care.
The team also found that each year of older age was associated with a 3% increased risk for polyneuropathy, but there was no significant association with sex. Higher levels of the glucose-derived metabolite methylglyoxal and lower levels of both high- and low- density lipoprotein (LDL) cholesterol were associated with a higher risk for polyneuropathy.
This inverse association between LDL cholesterol levels and neuropathy risk contradicts “the prevailing view of hyperlipidemia as a risk factor for [diabetic polyneuropathy],” say the researchers, noting that “[t]he reason for this unexpected finding is unknown.” They hypothesize that an increase in treatment with statins following diabetes diagnosis may explain the association, but caution that data on statin dosage and date of onset were not available.
Andersen and team say that although their study had a large sample size and long duration of follow-up, their results “might not apply to cohorts of younger people or cohorts where diabetes and other risk factors for [diabetic polyneuropathy] are poorly controlled.”
They explain that the incidence of polyneuropathy in the ADDITION cohort was “low” compared with previous studies, possibly due to earlier detection by screening, and that progression of the condition “might be different in younger people, although the age of onset of type 2 diabetes has previously been shown to have no clear impact on the development of microvascular complications.”
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