medwireNews: Two population-based studies published in Diabetes Care suggest that more than one in 10 people with long-term type 1 diabetes have diabetic peripheral neuropathy (DPN), with socioeconomic factors playing an important role in the risk for its development.
The authors of the first study, Nicole Foster (Jaeb Center for Health Research, Tampa, Florida, USA) et al, say: “The impact of the social determinants on diabetes self-management and glycemic control in diabetes is emerging as an important theme, particularly in the U.S., due to the rising costs of insulin and the resulting deliberate underuse of insulin.”
They believe their findings highlight “the importance of ongoing research for more disadvantaged populations with type 1 diabetes.”
Foster and team report that DPN prevalence, defined as a Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) score of 4 or more, was 11% among 5936 T1D Exchange participants who had a mean age of 39 years, a median type 1 diabetes duration of 18 years, and a mean glycated hemoglobin (HbA1c) of 8.1% (65.3 mmol/mol).
They found that, after adjustment for potentially confounding variables, both traditional and non-traditional risk factors were associated with DPN.
Among the traditional risk factors, the likelihood for DPN increased significantly with increasing HbA1c (odds ratio [OR]=1.27 per 1% increase), and was significantly higher in people with Charcot neuroarthropathy (OR=4.75), cardiovascular disease (OR=1.73), and retinopathy (OR=1.46), as well as in Black people (OR=1.95 vs White) and smokers (HR=1.83).
However, the team also observed that socioeconomic factors and acute diabetes complications impacted risk, with people with non-private versus private insurance and a lower versus higher education level having ORs of 1.89 and 1.15 for DPN, respectively, and those with diabetic ketoacidosis and severe hypoglycemia having ORs of 2.41 and 1.46, respectively.
The second study, by Anita Jeyam (University of Edinburgh, UK) and colleagues, found that 13% of 5558 Scottish adults with type 1 diabetes had DPN according to the MNSIQ criteria. This group, who were representative of the Scottish population with diabetes, had a median age of 44.7 years and a median diabetes duration of 20.5 years.
Like Foster and team, Jeyam and co-investigators report that poor glycemic control was a risk factor for DPN, with an HbA1c of 9.0% (75.0 mmol/mol) carrying a significant 1.51-fold higher likelihood for the condition than an HbA1c of 7.0% (53.0 mmol/mol).
Other significant risk traditional factors in the Scottish cohort included diabetes duration, waist-to-hip ratio, total cholesterol, triglycerides, estimated glomerular filtration rate at or below 60 mL/min per 1.73 m2, albuminuria, aspirin use, and antihypertensive use.
In addition, Jeyam and team found that people who lived in more deprived areas were 2.17 times more likely to have DPN than those in less deprived areas. People with DPN were 2.62 times more likely to have at least one other diabetes complication and 10.53 times more likely to have two or more complications than those without DPN.
They conclude: “Patients need to have a comprehensive support, which is holistic in terms of diabetes care, as they are likely to present several concurrent complications.”
Furthermore, “the significant association of socioeconomic status in the likelihood of having DPN indicates an urgent need to tackle inequalities in health within patients with [type 1 diabetes],” the authors write.
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