Practice Update: Diabetes

16 / 24

High Prevalence of Diabetic
Peripheral Neuropathy
Found in Young People
with Diabetes
Diabetes Care
Take-home message
• The authors of this study aimed to characterize risk factors and measure the
prevalence of diabetic peripheral neuropathy (DPN) in young people with type 1
diabetes (T1D) and type 2 diabetes (T2D). Researchers assessed 1734 individuals
with T1D (age, 18 ± 4 years; diabetes duration, 7.2 ± 1.2 years; HbA1c, 9.1 ± 1.9%)
and 258 individuals with T2D (age, 22.0 ± 3.5 years; diabetes duration, 7.9 ± 2
years; HbA1c, 9.4 ± 2.3%) using the Michigan Neuropathy Screening Instrument.
High rates of DPN were identified in both groups: 7% in participants with T1D and
22% in participants with T2D. In both groups, older age, longer diabetes duration,
smoking, and lower HDL cholesterol levels were associated with risk of DPN. Poor
glycemic control, obesity, increased LDL levels, and higher triglyceride levels were
also associated with DPN, but only in T1D.
• DPN occurs frequently in youth with T1D and T2D. The authors suggest that better
screening procedures and strategies to manage risk factors are needed to curb
the rate of neuropathic complications in young people with diabetes.
Abstract
OBJECTIVE We assessed the prevalence of and
risk factors for diabetic peripheral neuropathy
(DPN) in youth with type 1 diabetes (T1D) and
type 2 diabetes (T2D) enrolled in the SEARCH
for Diabetes in Youth study.
RESEARCH DESIGN AND METHODS The Michigan
Neuropathy Screening Instrument (MNSI) was
used to assess DPN in 1,734 youth with T1D (age
18 ± 4 years, T1D duration 7.2 ± 1.2 years, and
HbA1c 9.1 ± 1.9%) and 258 youth with T2D (age
22.0 ± 3.5 years, T2D duration 7.9 ± 2 years,
and HbA1c 9.4 ± 2.3%) who were enrolled in
the SEARCH study and had ≥5 years of diabe-
tes duration. DPN was defined as an MNSI exam
score of >2. Glycemic control over time was esti-
mated as area under the curve for HbA1c.
RESULTS The prevalence of DPN was 7% in youth
with T1D and 22% in youth with T2D. Risk fac-
tors for DPN in youth with T1D were older age,
longer diabetes duration, smoking, increased
diastolic blood pressure, obesity, increased LDL
cholesterol and triglycerides, and lower HDL
cholesterol (HDL-c). In youth with T2D, risk fac-
tors were older age, male sex, longer diabetes
duration, smoking, and lower HDL-c. Glycemic
control over time was worse among those with
DPN compared with those without for youth with
T1D (odds ratio 1.53 [95% CI 1.24; 1.88]) but not
for youth with T2D (1.05 [0.7; 1.56]).
CONCLUSIONS The high rates of DPN among
youth with diabetes are a cause of concern
and suggest a need for early screening and
better risk factor management. Interventions in
youth that address poor glycemic control and
dyslipidemia may prevent or delay debilitating
neuropathic complications.
Prevalence of and risk factors for diabetic
peripheral neuropathy in youth with type 1 and
type 2 diabetes: SEARCH for Diabetes in Youth
Study. Diabetes Care 2017 Jul 03;[EPub Ahead
of Print], M Jaiswal, J Divers, D Dabelea, et al.
COMMENT
By Jencia Wong MD, PhD
T he study from the SEARCH
investigators is one of few cohort
studies examining the prevalence
of diabetic peripheral neuropathy in
type 1 diabetes and specifically in youth-
onset type 2 diabetes. This study, using
a robust and validated neuropathy
assessment tool (the MNSI) adds a
further perspective to the recently
published SEARCH study results on
the development of microvascular
complications in youth with diabetes.1
These are important and practical
results that should concern clinicians for
several reasons. First, these data show
the high prevalence of neuropathy
already evident at a young age, a
diabetic peripheral neuropathy (DPN)
prevalence of 13%and 36%after 10 years
duration for type 1 and young-onset
type 2 diabetes, respectively. Given
the early age of onset and the noted
increase in prevalence over 5 years,
extrapolated further this could predict a
high lifetime risk of clinically significant
sequelae including ulceration, Charcot’s
arthropathy, and amputation for such
youth. Second, the almost threefold
higher prevalence of DPN in youth with
type 2 diabetes compared with type 1
diabetes is concerning, and the results
suggest that factors other than glycemia
are at play. Third, it is also notable
that there are several modifiable risk
factors associated with prevalent DPN
in youth; in particular, glycemic control
and dyslipidemia. Taken together,
these data add to the growing body
of evidence that screening for DPN
and attention to modifiable risk factors
should take place early for youth with
either type of diabetes. Youth-specific
intervention trials are needed in this
area.
Reference
1. Dabelea D, Stafford JM, Mayer-Davis EJ, et
al. Association of type 1 diabetes vs type 2
diabetes diagnosed during childhood and
adolescence with complications during
teenage years and young adulthood. JAMA
2017; 317 (8):825-835.
Dr Wong is Senior Staff Specialist
Endocrinologist at Royal Prince Alfred
Hospital, Sydney; Clinical Associate
Professor, Central Clinical School, Sydney
Medical School, University of Sydney;
and Director of Research at Royal Prince
Alfred Hospital Diabetes Centre.
DIABETES 16
PRACTICEUPDATE DIABETES